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Noronha V, Budukh A, Chaturvedi P, Anne S, Punjabi A, Bhaskar M, Sahoo TP, Menon N, Shah M, Batra U, Nathany S, Kumar R, Shetty O, Ghodke TP, Mahajan A, Chakrabarty N, Hait S, Tripathi SC, Chougule A, Chandrani P, Tripathi VK, Jiwnani S, Tibdewal A, Maheshwari G, Kothari R, Patil VM, Bhat RS, Khanderia M, Mahajan V, Prakash R, Sharma S, Jabbar AA, Yadav BK, Uddin AK, Dutt A, Prabhash K. Uniqueness of lung cancer in Southeast Asia. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 27:100430. [PMID: 39157507 PMCID: PMC11328770 DOI: 10.1016/j.lansea.2024.100430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 05/07/2024] [Accepted: 05/17/2024] [Indexed: 08/20/2024]
Abstract
Lung cancer varies between Caucasians and Asians. There have been differences recorded in the epidemiology, genomics, standard therapies and outcomes, with variations according to the geography and ethnicity which affect the decision for optimal treatment of the patients. To better understand the profile of lung cancer in Southeast Asia, with a focus on India, we have comprehensively reviewed the available data, and discuss the challenges and the way forward. A substantial proportion of patients with lung cancer in Southeast Asia are neversmokers, and adenocarcinoma is the common histopathologic subtype, found in approximately a third of the patients. EGFR mutations are noted in 23-30% of patients, and ALK rearrangements are noted in 5-7%. Therapies are similar to global standards, although access to newer modalities and molecules is a challenge. Collaborative research, political will with various policy changes and patient advocacy are urgently needed.
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Affiliation(s)
- Vanita Noronha
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Atul Budukh
- Centre for Cancer Epidemiology, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Pankaj Chaturvedi
- Department of Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Srikanth Anne
- Department of Medical Oncology, GSL Medical College, Rajahmundry, Andhra Pradesh, India
| | - Anshu Punjabi
- Department of Pulmonary Medicine, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Maheema Bhaskar
- Department of Pulmonary Medicine, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Tarini P. Sahoo
- Consultant Medical Oncologist, Silverline Hospital, Bhopal, Madhya Pradesh, India
| | - Nandini Menon
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Minit Shah
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Shrinidhi Nathany
- Molecular Diagnostics Section, Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, Delhi, India
| | - Rajiv Kumar
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Omshree Shetty
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Trupti Pai Ghodke
- Department of Pathology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Abhishek Mahajan
- Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
- Honorary Senior Lecturer, University of Liverpool, UK
| | - Nivedita Chakrabarty
- Department of Radiodiagnosis, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Supriya Hait
- Integrated Cancer Genomics Laboratory, Advanced Centre for Treatment Research Education in Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, Maharashtra, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | | | - Anuradha Chougule
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Pratik Chandrani
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Virendra Kumar Tripathi
- Department of Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Sabita Jiwnani
- Department of Surgical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Anil Tibdewal
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Guncha Maheshwari
- Department of Radiation Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Rushabh Kothari
- Consultant Medical Oncologist, Oncowin Cancer Centre, Ahmedabad, India
| | - Vijay M. Patil
- Consultant Medical Oncologist, PD Hinduja Hospital & Medical Research Centre, Khar and Mahim, Mumbai, India
| | - Rajani Surendar Bhat
- Interventional Pulmonology and Palliative Medicine, Sparsh Hospitals, Bangalore, India
| | - Mansi Khanderia
- Department of Medical Oncology, Mazumdar Shaw Cancer Centre, Narayana Health City, Bommasandra, Bangalore, Karnataka, India
| | - Vandana Mahajan
- PG Integrated Counselling, Cancer Counsellor and Palliative Care Coach and Cancer Survivor, India
| | - Ravi Prakash
- British Broadcasting Corporation (BBC), Based in Ranchi, Jharkhand, India
| | - Sanjeev Sharma
- NGO Excellence Program, Patient Advocate, Lung Connect, Mumbai, India
| | | | - Birendra Kumar Yadav
- Department of Clinical Oncology, Purbanchal Cancer Hospital, Birtamode Jhapa State, Koshi, Nepal
| | - A.F.M. Kamal Uddin
- Department of Radiation Oncology, National Institute of Ear Nose and Throat, Dhaka, Bangladesh
| | - Amit Dutt
- Integrated Cancer Genomics Laboratory, Advanced Centre for Treatment Research Education in Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, Maharashtra, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Kumar Prabhash
- Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
- Homi Bhabha National Institute (HBNI), Mumbai, India
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Xie W, Jiang R, Xie J, Vince R, More SS. Geometric Isomer of Guanabenz Confers Hepatoprotection to a Murine Model of Acetaminophen Toxicity. Chem Res Toxicol 2023; 36:1071-1080. [PMID: 37348131 PMCID: PMC10355191 DOI: 10.1021/acs.chemrestox.3c00047] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Indexed: 06/24/2023]
Abstract
Overdose of acetaminophen, a widely used antipyretic and analgesic drug, is one of the leading causes of drug-induced acute liver injury in the United States and worldwide. Phase-I metabolism of acetaminophen generates the toxic N-acetyl-p-benzoquinone imine (NAPQI) intermediate. Reactions of NAPQI with a wide range of biomolecules cause increased oxidative stress, endoplasmic reticulum (ER) stress, inflammation, and mitochondrial dysfunction, some of the cellular events contributing toward liver toxicity. Previously, we evaluated the potential of an FDA-approved, ER stress-modulating antihypertensive drug, Wytensin (trans-guanabenz, E-GA), as an antidote for acetaminophen hepatotoxicity. E-GA prevented elevation of the liver enzyme alanine aminotransferase (ALT), even when administered up to 6 h after acetaminophen overdose, and exhibited synergistic analgesic interactions. However, the commercially available guanabenz exists solely as a trans-isomer and suffers from sedative side effects resulting from the inhibition of central α2A-adrenergic receptors in locus coeruleus. Here, we studied the utility of the relatively unexplored cis-isomer of guanabenz as a treatment option for acetaminophen-induced liver toxicity. cis(Z)-Guanabenz acetate (Z-GA) lacks interaction with α2A-adrenoreceptors and is thus devoid of sedative, blood-pressure-lowering side effects of E-GA. Treatment of mice with Z-GA (10 mg/kg) before acetaminophen overdose and up to 6 h post APAP administration prevented liver injury and suppressed the elevation of serum ALT levels. Mechanistically, hepatoprotective effects of both isomers are similar and partly attributed to attenuation of the ER stress and oxidative stress in the liver. The results of this study suggest that Z-GA may be a safer, effective antidote for the clinical management of acute liver injury resulting from acetaminophen overdose. It also raises a tantalizing possibility of a prophylactic combination of the geometric isomer of the approved drug guanabenz with acetaminophen in a clinical setting.
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Affiliation(s)
- Wei Xie
- Center for Drug Design, College
of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | | | - Jiashu Xie
- Center for Drug Design, College
of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Robert Vince
- Center for Drug Design, College
of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, United States
| | - Swati S. More
- Center for Drug Design, College
of Pharmacy, University of Minnesota, Minneapolis, Minnesota 55455, United States
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Hu X, Huang W, Sun Z, Ye H, Man K, Wang Q, Sun Y, Yan W. Predictive factors, preventive implications, and personalized surgical strategies for bone metastasis from lung cancer: population-based approach with a comprehensive cancer center-based study. EPMA J 2022; 13:57-75. [PMID: 35273659 PMCID: PMC8897531 DOI: 10.1007/s13167-022-00270-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
Background Bone metastasis (BM) and skeletal-related events (SREs) happen to advanced lung cancer (LC) patients without warning. LC-BM patients are often passive to BM diagnosis and surgical treatment. It is necessary to guide the diagnosis and treatment paradigm for LC-BM patients from reactive medicine toward predictive, preventive, and personalized medicine (PPPM) step by step. Methods Two independent study cohorts including LC-BM patients were analyzed, including the Surveillance, Epidemiology, and End Results (SEER) cohort (n = 203942) and the prospective Fudan University Shanghai Cancer Center (FUSCC) cohort (n = 59). The epidemiological trends of BM in LC patients were depicted. Risk factors for BM were identified using a multivariable logistic regression model. An individualized nomogram was developed for BM risk stratification. Personalized surgical strategies and perioperative care were described for FUSCC cohort. Results The BM incidence rate in LC patients grew (from 17.53% in 2010 to 19.05% in 2016). Liver metastasis was a significant risk factor for BM (OR = 4.53, 95% CI = 4.38-4.69) and poor prognosis (HR = 1.29, 95% CI = 1.25-1.32). The individualized nomogram exhibited good predictive performance for BM risk stratification (AUC = 0.784, 95%CI = 0.781-0.786). Younger patients, males, patients with high invasive LC, and patients with other distant site metastases should be prioritized for BM prevention. Spine is the most common site of BM, causing back pain (91.5%), pathological vertebral fracture (27.1%), and difficult walking (25.4%). Spinal surgery with personalized spinal reconstruction significantly relieved pain and improved daily activities. Perioperative inflammation, immune, and nutrition abnormities warrant personalized managements. Radiotherapy needs to be recommended for specific postoperative individuals. Conclusions The presence of liver metastasis is a strong predictor of LC-BM. It is recommended to take proactive measures to prevent BM and its SREs, particularly in young patients, males, high invasive LC, and LC with liver metastasis. BM surgery and perioperative management are personalized and required. In addition, adjuvant radiation following separation surgery must also be included in PPPM-guided management. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1007/s13167-022-00270-9.
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Affiliation(s)
- Xianglin Hu
- grid.452404.30000 0004 1808 0942Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032 China ,grid.11841.3d0000 0004 0619 8943Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Wending Huang
- grid.452404.30000 0004 1808 0942Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032 China ,grid.11841.3d0000 0004 0619 8943Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Zhengwang Sun
- grid.452404.30000 0004 1808 0942Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032 China ,grid.11841.3d0000 0004 0619 8943Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Hui Ye
- grid.267313.20000 0000 9482 7121Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX 75390 USA
| | - Kwong Man
- grid.259384.10000 0000 8945 4455Department of General Surgery, University Hospital of Macau University of Science and Technology, Macau, 999078 China
| | - Qifeng Wang
- grid.452404.30000 0004 1808 0942Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032 China
| | - Yangbai Sun
- grid.452404.30000 0004 1808 0942Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032 China ,grid.11841.3d0000 0004 0619 8943Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
| | - Wangjun Yan
- grid.452404.30000 0004 1808 0942Department of Musculoskeletal Surgery, Fudan University Shanghai Cancer Center, Shanghai, 200032 China ,grid.11841.3d0000 0004 0619 8943Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 China
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Optimized Dosing: The Next Step in Precision Medicine in Non-Small-Cell Lung Cancer. Drugs 2021; 82:15-32. [PMID: 34894338 DOI: 10.1007/s40265-021-01654-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 12/20/2022]
Abstract
In oncology, and especially in the treatment of non-small-cell lung cancer (NSCLC), dose optimization is often a neglected part of precision medicine. Many drugs are still being administered in "one dose fits all" regimens or based on parameters that are often only minor determinants for systemic exposure. These dosing approaches often introduce additional pharmacokinetic variability and do not add to treatment outcomes. Fortunately, pharmacological knowledge is increasing, providing valuable information regarding the potential of, for example, therapeutic drug monitoring. This article focuses on the evidence for the most promising and easily implemented optimized dosing approaches for the small-molecule inhibitors, chemotherapeutic agents, and monoclonal antibodies as treatment options currently approved for NSCLC. Despite limitations such as investigations having been conducted in oncological diseases other than NSCLC or the retrospective origin of many analyses, an alternative dosing regimen could be beneficial for treatment outcomes, prescriber convenience, or financial burden on healthcare systems. This review of the literature provides recommendations on the implementation of dose optimization and advice regarding promising strategies that deserve further research in NSCLC.
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Zhou C, Wu L, Fan Y, Wang Z, Liu L, Chen G, Zhang L, Huang D, Cang S, Yang Z, Zhou J, Zhou C, Li B, Li J, Fan M, Cui J, Li Y, Zhao H, Fang J, Xue J, Hu C, Sun P, Du Y, Zhou H, Wang S, Zhang W. Sintilimab Plus Platinum and Gemcitabine as First-Line Treatment for Advanced or Metastatic Squamous NSCLC: Results From a Randomized, Double-Blind, Phase 3 Trial (ORIENT-12). J Thorac Oncol 2021; 16:1501-1511. [PMID: 34048947 DOI: 10.1016/j.jtho.2021.04.011] [Citation(s) in RCA: 159] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/31/2021] [Accepted: 04/18/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The standard chemotherapy for squamous NSCLC (sqNSCLC) includes platinum plus gemcitabine. Sintilimab, an anti-programmed cell death protein 1 antibody, plus platinum and gemcitabine (GP) has revealed encouraging efficacy as first-line therapy for sqNSCLC in a phase 1b study. We conducted a randomized, double-blind, phase 3 study to further compare the efficacy and safety of sintilimab with placebo, both in combination with GP. METHODS ORIENT-12, a randomized, double-blind, phase 3 study, was conducted at 42 centers in the People's Republic of China (ClinicalTrials.gov, number NCT03629925). Patients with locally advanced or metastatic sqNSCLC and without EGFR-sensitive mutations or ALK rearrangements were enrolled in the study. The stratification factors included clinical stage, choice of platinum, and programmed death-ligand 1 tumor proportion score. The patients, investigators, research staff, and sponsor team were masked to treatment assignment. Eligible patients were randomized 1:1, using an integrated web-response system, to receive sintilimab 200 mg or placebo plus GP every 3 weeks for four or six cycles, followed by sintilimab or placebo as maintenance therapy until disease progression or 2 years. The primary end point was progression-free survival (PFS), assessed by an independent radiographic review committee. RESULTS Between September 25, 2018 and July 26, 2019, a total of 543 patients were screened, of whom 357 patients were randomized to the sintilimab-GP group (n = 179) and the placebo-GP group (n = 178). After a median follow-up period of 12.9 months, sintilimab-GP continued to reveal a meaningful improvement in PFS than placebo-GP (hazard ratio = 0.536 [95% confidence interval: 0.422-0.681], p < 0.00001). Treatment-emergent adverse events of grade 3 or worse occurred in 86.6% patients in the sintilimab-GP group and in 83.1% in the placebo-GP group. The incidence of treatment-emergent adverse event leading to death was 4.5% and 6.7% in the two treatment groups, respectively. CONCLUSIONS Regarding PFS, sintilimab plus GP reveals clinical benefit than GP alone as first-line therapy in patients with locally advanced or metastatic sqNSCLC. The toxicity was acceptable, and no new unexpected safety signals were observed.
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Affiliation(s)
- Caicun Zhou
- Oncology Department, Shanghai Pulmonary Hospital, Shanghai, People's Republic of China.
| | - Lin Wu
- Thoracic Medicine Department II, Hunan Cancer Hospital, Changsha, People's Republic of China
| | - Yun Fan
- Oncology Department, Cancer Hospital of the University of Chinese Academy of Science, Hangzhou, People's Republic of China
| | - Zhehai Wang
- Respiratory Department, Shandong Cancer Hospital, Jinan, People's Republic of China
| | - Lianke Liu
- Oncology Department, Jiangsu Province Hospital, Nanjing, Country
| | - Gongyan Chen
- Respiratory Department, The Affiliated Tumor Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Li Zhang
- Respiratory Department, Chinese Academy of Medical Sciences & Peking Union Medical College, Guangzhou, People's Republic of China
| | - Dingzhi Huang
- Lung Cancer Department, Tianjin Medical University Cancer Institute & Hospital, Tianjin, People's Republic of China
| | - Shundong Cang
- Oncology Department, Henan Provincial Peoples Hospital, Zhengzhou, People's Republic of China
| | - Zhixiong Yang
- Oncology Department, Affiliated Hospital of Guangdong Medical University, Zhanjiang, People's Republic of China
| | - Jianying Zhou
- Respiratory Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Chengzhi Zhou
- Oncology Department, The First Affiliate Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Baolan Li
- General medicine Department, Beijing Chest Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Juan Li
- Department of Thoracic Medical Oncology, Sichuan Cancer Hospital, Chengdu, People's Republic of China
| | - Min Fan
- The Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Jiuwei Cui
- Oncology Department, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Yuping Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Hui Zhao
- Department of Respiratory Medicine, The Second Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Jian Fang
- Department of Thoracic Oncology, Beijing Cancer Hospital, Beijing, People's Republic of China
| | - Jianxin Xue
- Department of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Chengping Hu
- Respiratory Department, Xiangya Hospital Central South University, Changsha, People's Republic of China
| | - Ping Sun
- Oncology Department, Yantai Yuhuangding Hospital, Yantai, People's Republic of China
| | - Yingying Du
- Oncology Department, The First Affiliated Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Hui Zhou
- Medical Science and Strategy Oncology, Innovent Biologics Inc., Suzhou, People's Republic of China
| | - Shuyan Wang
- Medical Science and Strategy Oncology, Innovent Biologics Inc., Suzhou, People's Republic of China
| | - Wen Zhang
- Medical Science and Strategy Oncology, Innovent Biologics Inc., Suzhou, People's Republic of China
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Patil V, Dessai S. Testing and interpreting assumptions of COX regression analysis. CANCER RESEARCH, STATISTICS, AND TREATMENT 2019. [DOI: 10.4103/crst.crst_40_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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