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Taroeno-Hariadi KW, Herdini C, Briliant AS, Husodoputro HK, Dhamiyati W, Indrasari SR, Lestari SP, Widyastuti Y, Puspitaningtyas H, Rahmasari R, Rachmawati IN, Purwanto I, Setyawan NH, Ekaputra E, Hutajulu SH, Dwidanarti SR, Kurniawan T, Meidania L, Yanuarta SE, Hardianti MS, Kurnianda J. Multidisciplinary Team Meeting in the Core of Nasopharyngeal Cancer Management Improved Quality of Care and Survival of Patients. Health Serv Insights 2023; 16:11786329231204757. [PMID: 37850152 PMCID: PMC10578065 DOI: 10.1177/11786329231204757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 09/14/2023] [Indexed: 10/19/2023] Open
Abstract
Nasopharyngeal cancer (NPC) cases are often diagnosed in advanced stages. The complexity of clinical management for advanced-stage NPC requires thorough communication and shared decisions between medical professionals and allied teams. Incorporating a multidisciplinary team meeting (MDTM) for newly diagnosed NPC patients was chosen to facilitate collaboration and communication between physicians. This retrospective study aimed to compare the quality of care, clinical responses and survival between NPC patients treated with and without MDTM. Data on clinical responses, assessment visits, date of progression and death with progression-free survival (PFS), overall survival (OS), and hazard ratio (HR) were collected and analyzed with 95% confidence interval (CI) and significance set as P < .05. There were 87 of 178 NPC patients treated with MDTM. Revisions of diagnosis and stage occurred in 5.7% and 52.9% of cases during the MDTM. More clinical responses were achieved by patients treated with MDTM (69.0%vs 32.0%, P < .00). NPC patients who received MDTM treatment recommendation had a lower risk for progression (median PFS 59.89 months vs 12.68 months; HR 0.267, 95% CI: 0.17-0.40, P < .00) and mortality (median OS was not reached vs 13.44 months; HR 0.134, 95% CI: 0.08-0.24, P < .00) compared to patients without MDTM. Incorporating the MDTM approach into NPC management improves patients' clinical responses and survival.
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Affiliation(s)
- Kartika W Taroeno-Hariadi
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Camelia Herdini
- Department of Ear, Nose and Throat, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Aulia S Briliant
- Department of Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Henry K Husodoputro
- Division of Radiodiagnosis, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Wigati Dhamiyati
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Sagung Rai Indrasari
- Department of Ear, Nose and Throat, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Setiyani P Lestari
- Department of Pathology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | | | - Risa Rahmasari
- Tulip Cancer Clinic, Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | | | - Ibnu Purwanto
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Nurhuda H Setyawan
- Division of Radiodiagnosis, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Ericko Ekaputra
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Susanna H Hutajulu
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Sri R Dwidanarti
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Torana Kurniawan
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Lidya Meidania
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Seize E Yanuarta
- Division of Radiotherapy, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Mardiah S Hardianti
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
| | - Johan Kurnianda
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Yogyakarta, Indonesia
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Rizky D, Yunarvika V, Putra YR, Pangarsa EA, Kartiyani I, Panunggal DG, Hutajulu SH, Setiawan B, Hariadi KW, Santosa D, Herdini C, Yoshuantari N, Dhamiyati W, Purwanto I. Impact of independent multidisciplinary work on the survival rate of stage 3 and 4 nasopharyngeal cancer in Indonesia: a retrospective cohort study. Ann Med Surg (Lond) 2023; 85:4248-4255. [PMID: 37663678 PMCID: PMC10473326 DOI: 10.1097/ms9.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/02/2023] [Indexed: 09/05/2023] Open
Abstract
Background The utilization of a multidisciplinary team (MDT) strategy is a beneficial approach in integrating the knowledge and proficiencies of various fields to produce thorough and advantageous cancer treatment plans for patients. Nevertheless, MDT has yet to be widely adopted in Indonesia. In this study, the authors examined an early form of MDT in Indonesia that does not involve dedicated meetings, referred as independent multidisciplinary work (IMW). The objective is to investigate the differences in survival rates of nasopharyngeal cancer (NPC) patients who underwent treatment with and without IMW. Materials and methods This study has a retrospective cohort design. Data were collected from the medical records of newly diagnosed stage 3 and 4 NPC patients between 2016 and 2018. The subjects were divided into two groups: the IMW group and the non-IMW group. The primary end point of the study is overall survival rate between the two groups. Kaplan-Meier survival analysis, log-rank test, and cox proportional hazard analysis were used for statistical analysis. Results This study included a total of 124 patients with NPC, 81 patients in the IMW group and 43 patients in the non-IMW group. At the end of the 36-month follow-up period, the median survival of the IMW group was not reached, while in the non-IMW, it was 12 months [95% confidence intervals (95% CI), 8.78-15.22], hazard ratio (HR): 0.47 (95% CI, 0.28-0.78; P<0.01). The 1-year survival rate was 66.7% in the IMW group versus 46.5% in the non-IMW group (HR=0.7, 95% CI 0.49-0.99; P=0.03); the 2-year survival rate was 40.7% in the IMW group versus 16.3% in the non-IMW group (HR=0.4, 95% CI 0.19-0.83; P<0.01). Daniel Rizky, Vina Yunarvika, and Yasjudan Rastrama Putra, these authors contributed equally to this work. In the multivariate analysis, the IMW approach, ECOG (The Eastern Cooperative Oncology Group) status, distant metastasis, and treatment approach were significantly associated with survival outcome. Conclusion The use of IMW approach in the treatment of NPC was associated with a better survival outcome compared to non-IMW treatment.
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Affiliation(s)
- Daniel Rizky
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital
| | - Vina Yunarvika
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital
| | - Yasjudan R. Putra
- Division of Hematology-Medical Oncology, Department of Internal Medicine
| | - Eko A. Pangarsa
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital
| | - Ika Kartiyani
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital
| | | | | | - Budi Setiawan
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital
| | | | - Damai Santosa
- Division of Hematology-Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Diponegoro University/Dr. Kariadi General Hospital
| | | | | | - Wigati Dhamiyati
- Department of Radiology, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Ibnu Purwanto
- Division of Hematology-Medical Oncology, Department of Internal Medicine
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Wardana T, Chasanah SN, Oktriani R, Herawati C, Anwar SL, Astuti I, Mubarika Haryana S. Circulation microRNA expression profiles in patients with complete responses to chemoradiotherapy in nasopharyngeal carcinoma. Noncoding RNA Res 2022; 7:233-241. [PMID: 36203524 PMCID: PMC9519485 DOI: 10.1016/j.ncrna.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/28/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022] Open
Abstract
Background Aims Methods Results Conclusion
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Affiliation(s)
- Tirta Wardana
- Department of Biomedicine, Faculty of Medicine, Jenderal Soedirman University, Purwokerto, Central Java, Indonesia
- Corresponding author.
| | - Siti Nur Chasanah
- Graduate Student, Biomedical Science, Faculty of Medicine, Nursing, and Public Health, Gadjah Mada University, Yogyakarta, Indonesia
| | - Risky Oktriani
- Department of Biochemistry, Faculty of Medicine, Nursing, and Public Health, Gadjah Mada University, Yogyakarta, Indonesia
| | - Cita Herawati
- Department of THT, Dharmais Hospital National Cancer Center, West Jakarta, Indonesia
| | - Sumadi Lukman Anwar
- Department of Surgery, Faculty of Medicine, Nursing, and Public Health, Gadjah Mada University, Yogyakarta, Indonesia
| | - Indwiani Astuti
- Department of Pharmacology and Therapy, Faculty of Medicine, Nursing, and Public Health, Gadjah Mada University, Yogyakarta, Indonesia
| | - Sofia Mubarika Haryana
- Department of Histology and Cell Biology, Faculty of Medicine, Nursing, and Public Health, Gadjah Mada University, Yogyakarta, Indonesia
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Jin X, Hu R, Guo H, Ding C, Pi G, Tian M. Pretreatment Body Mass Index (BMI) as an Independent Prognostic Factor in Nasopharyngeal Carcinoma Survival: A Systematic Review and Meta-Analysis. Nutr Cancer 2022; 74:3457-3467. [PMID: 35658769 DOI: 10.1080/01635581.2022.2084557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We performed a meta-analysis to investigate the association between pretreatment body mass index (BMI) and prognosis of nasopharyngeal carcinoma (NPC). Case-control and cohort studies were searched from PubMed, Web of Science, EMBASE, and CNKI databases. Pooled hazard ratios (HR) with 95% confidence intervals (CI) for overall survival (OS) or distant metastasis-free survival (DMSF) were used to estimate the prognostic value. Bias in the included studies was evaluated using funnel plots. The results showed that compared with normal weight patients, the estimated HR of OS was 1.54 (95% CI: 1.25-1.90; P < 0.05) for underweight, 0.63 (95% CI: 0.48-0.83; P < 0.05) for overweight, and 0.67 (95% CI: 0.41-1.08; P = 0.102) obese patients. We also found that compared with normal-weight patients, the estimated HR of DMFS was 1.63 (95% CI: 1.38-1.92; P < 0.05) for underweight, 0.83 (95% CI: 0.61-1.13; P = 0.244) for overweight, and 0.60 (95% CI: 0.39-0.92; P < 0.05) for patients with obesity. BMI is an independent prognostic factor for NPC survival. Being underweight before treatment was associated with poorer OS and DMFS in patients with NPC. Neither overweight nor obesity before treatment has an unfavorable effect on NPC survival.
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Affiliation(s)
- Xin Jin
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Renchong Hu
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Huan Guo
- Department of Cancer Prevention Center, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Chenchen Ding
- Department of Cancer Prevention Center, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Guoliang Pi
- Department of Radiation Oncology, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Mengxing Tian
- Department of Clinical Nutrition, Hubei Cancer Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Diaz A, Bujnowski D, Chen H, Pendergrast K, Horowitz P, Das P, Roxbury C. Health Insurance Coverage and Survival Outcomes among Nasopharyngeal Carcinoma Patients: A SEER Retrospective Analysis. J Neurol Surg B Skull Base 2022; 84:240-247. [PMID: 37180866 PMCID: PMC10171937 DOI: 10.1055/s-0042-1747962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/07/2022] [Indexed: 10/18/2022] Open
Abstract
Abstract
Objectives Insurance coverage plays a critical role in head and neck cancer care. This retrospective study examines how insurance coverage affects nasopharyngeal carcinoma (NPC) survival in the United States using the Surveillance, Epidemiology, and End Results (SEER) program database.
Design, Setting, and Participants A total of 2,278 patients aged 20 to 64 years according to the International Classification of Diseases for Oncology (ICD-O) codes C11.0–C11.9 and ICD-O histology codes 8070–8078 and 8080–8083 between 2007 and 2016 were included and grouped into privately insured, Medicaid, and uninsured groups. Log-rank test and multivariable Cox's proportional hazard model were performed.
Main Outcome Measures Tumor stage, age, sex, race, marital status, disease stage, year of diagnosis, median household county income, and disease-specific survival outcomes including cause of death were analyzed.
Results Across all tumor stages, privately insured patients had a 59.0% lower mortality risk than uninsured patients (hazard ratio [HR]: 0.410, 95% confidence interval [CI]: [0.320, 0.526], p < 0.01). Medicaid patients were also estimated to have 19.0% lower mortality than uninsured patients (HR: 0.810, 95% CI: [0.626, 1.048], p = 0.108). Privately insured patients with regional and distant NPC had significantly better survival outcomes compared with uninsured individuals. Localized tumors did not show any association between survival and type of insurance coverage.
Conclusion Privately insured individuals had significantly better survival outcomes than uninsured or Medicaid patients, a trend that was preserved after accounting for tumor grade, demographic and clinicopathologic factors. These results underscore the difference in survival outcomes when comparing privately insured to Medicaid/uninsured populations and warrant further investigation in efforts for health care reform.
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Affiliation(s)
- Ashley Diaz
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, United States
| | - Daniel Bujnowski
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois, United States
| | - Haobin Chen
- Program in Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, United States
| | - Keaton Pendergrast
- University of Minnesota Medical School – Twin Cities, Minneapolis, Minnesota, United States
| | - Peleg Horowitz
- Section of Neurosurgery, Department of Surgery, The University of Chicago, Chicago, Illinois, United States
| | - Paramita Das
- Section of Neurosurgery, Department of Surgery, The University of Chicago, Chicago, Illinois, United States
| | - Christopher Roxbury
- Section of Otolaryngology, Department of Surgery, The University of Chicago, Chicago, Illinois, United States
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Efficacy of the Nourishing Yin and Clearing Heat Therapy Based on Traditional Chinese Medicine in the Prevention and Treatment of Radiotherapy-Induced Oral Mucositis in Nasopharyngeal Carcinomas: A Systematic Review and Meta-Analysis of Thirty Randomized Controlled Trials. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4436361. [PMID: 35529930 PMCID: PMC9068295 DOI: 10.1155/2022/4436361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/25/2022] [Accepted: 04/03/2022] [Indexed: 11/21/2022]
Abstract
This study aimed to evaluate the efficacy of nourishing Yin and clearing heat therapy (NYCH therapy) based on traditional Chinese medicine (TCM) in the treatment of radiotherapy-induced oral mucositis (RTOM) in nasopharyngeal carcinomas (NPCs). A total of eight online databases were searched from inception to September 2021 for randomized controlled trials (RCTs). The control group was treated with Western medicine (WM) alone, whereas the experimental group was treated with a combined NYCH and WM therapy. A total of 30 RCTs involving 2562 participants were ultimately included. NYCH therapy combined with conventional WM delayed the onset time (days) of RTOM (MD = 10.80, p < 0.001), and at that time, a higher cumulative radiotherapy dose (Gy) (MD = 5.72, p < 0.001) was completed in the experimental group. The combination regimen also reduced the incidence of severe oral mucositis (Grade III–IV) (RR = 0.25, p < 0.001). In addition, the treatment efficacy of the experimental group was significantly better than that of the control group (RR = 1.31, p < 0.001). Compared with the patients in the control group, the experimental group had lower xerostomia scores (MD = -1.07, p < 0.001) and more saliva (MD = 0.36, p < 0.001). NYCH combined with WM improved the efficacy of treating RTOM in NPC. This study provides a sufficient basis for conducting further large RCTs to prove the efficacy of NYCH.
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Reffai A, Mesmoudi M, Derkaoui T, Ghailani Nourouti N, Barakat A, Sellal N, Mallick P, Bennani Mechita M. Epidemiological Profile and Clinicopathological, Therapeutic, and Prognostic Characteristics of Nasopharyngeal Carcinoma in Northern Morocco. Cancer Control 2021; 28:10732748211050587. [PMID: 34664512 PMCID: PMC8529313 DOI: 10.1177/10732748211050587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Nasopharyngeal carcinoma is a multifactorial disease mainly affecting the
Asian and North African populations including Morocco. This study aimed to
determine the epidemiological profile of nasopharyngeal carcinoma in
Northern Morocco as well as its clinicopathological, therapeutic, and
prognostic characteristics. Methods 129 patients with nasopharyngeal carcinoma followed at the regional center of
oncology of Tangier in the period between April 2017 and July 2019, and
diagnosed elsewhere from March 2000 to February 2019, were included in this
study. Statistical analysis of the data was realized using Statistical
Package for the Social Sciences (SPSS) software. Results Nasopharyngeal carcinoma (NPC) represented 5% of all cases with a median age
of 50. The most affected age group was 40–54 years (41.1%). Of all patients,
65.9% were men and 34.1% were women with a sex ratio of 1.93 (Male/Female).
Undifferentiated nasopharyngeal carcinomas were the most common histological
type affecting 96.12% of patients. At diagnosis, the majority of patients
(82.2%) had an advanced stage of NPC (III, VIa, b, c) including 5.4% of
metastatic cases (IVc). Most cases (86%) had lymph node involvement with
cervical mass being the most common clinical presentation. 81.4% of patients
received radiotherapy combined with chemotherapy. Among these patients,
54.3% had concurrent radiochemotherapy preceded by induction chemotherapy.
The 5-year overall survival (OS) was 86.8% for all patients. It represented
91.3% for early stages, 87.9% for locally advanced stages, and 57.1% for the
metastatic stage significantly. The disease-free survival (DFS) at 5 years
was 87.6% knowing that relapse occurred in 16 cases. Conclusions Nasopharyngeal carcinoma is a particular disease with a late declaration. It
is common in Morocco as is the case in other endemic areas with a high
prevalence. Patients’ survival is significantly influenced by disease
staging.
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Affiliation(s)
- Ayman Reffai
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Science and Technology of Tangier (FSTT), 531748Abdelmalek Essaadi University (UAE), Tangier, Morocco
| | - Mohamed Mesmoudi
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Science and Technology of Tangier (FSTT), 531748Abdelmalek Essaadi University (UAE), Tangier, Morocco.,Ahmed Ben Zayed Al Nahyan Center of Cancer Treatment, Tangier, Morocco
| | - Touria Derkaoui
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Science and Technology of Tangier (FSTT), 531748Abdelmalek Essaadi University (UAE), Tangier, Morocco
| | - Naima Ghailani Nourouti
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Science and Technology of Tangier (FSTT), 531748Abdelmalek Essaadi University (UAE), Tangier, Morocco
| | - Amina Barakat
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Science and Technology of Tangier (FSTT), 531748Abdelmalek Essaadi University (UAE), Tangier, Morocco
| | - Nabila Sellal
- Ahmed Ben Zayed Al Nahyan Center of Cancer Treatment, Tangier, Morocco
| | - Parag Mallick
- Canary Center for Cancer Early Detection, School of Medicine, 10624Stanford University, Stanford, CA, USA
| | - Mohcine Bennani Mechita
- Biomedical Genomics and Oncogenetics Research Laboratory, Faculty of Science and Technology of Tangier (FSTT), 531748Abdelmalek Essaadi University (UAE), Tangier, Morocco
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