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Thomsen FB, Garmo H, Brasso K, Egevad L, Stattin P. Temporal changes in cause-specific death in men with localised prostate cancer treated with radical prostatectomy: a population-based, nationwide study. J Surg Oncol 2021; 124:867-875. [PMID: 34145588 PMCID: PMC8518635 DOI: 10.1002/jso.26579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 11/07/2022]
Abstract
Background and Objective Changes in diagnostic work‐up, histopathological assessment, and treatment of men with prostate cancer during the last 20 years have affected the prognosis. The objective was to investigate the risk of prostate cancer death in men with clinically localised prostate cancer treated with radical prostatectomy in Sweden in 2000–2010. Methods Population‐based, nationwide, study on men with clinically localised prostate cancer treated with radical prostatectomy in the period 2000–2010. Cox regression analyses were used to assess differences in risk of prostate cancer death according to calendar period for diagnosis and stratified on risk category. Results The study included 19 330 men with a median follow‐up of 12.4 years. Men diagnosed in 2007–2008 and 2009–2010 had a significantly lower risk of prostate cancer death compared to men diagnosed in 2000–2002. The reduced risk of prostate cancer death was restricted to men with intermediate‐risk prostate cancer with no differences observed in men with low‐ or high‐risk prostate cancer. Conclusion During the study period, the risk of prostate cancer death decreased in the total population of men with localised prostate cancer treated with radical prostatectomy. The decrease was restricted to men with intermediate‐risk prostate cancer.
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Affiliation(s)
- Frederik B Thomsen
- Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen Prostate Cancer Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hans Garmo
- Regional Cancer Centre Uppsala Örebro, Uppsala University Hospital, Uppsala, Sweden.,Division of Cancer Studies, King's College London, School of Medicine, Cancer Epidemiology Group, London, UK
| | - Klaus Brasso
- Department of Urology, Copenhagen University Hospital - Rigshospitalet, Copenhagen Prostate Cancer Center, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden.,Department of Surgical and Perioperative Sciences, Urology, and Andrology, Umeå University Hospital, Umeå, Sweden
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2
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Thomsen FB, Pedersen TB, Berg KD, Clark PE, Lund L. Comparison of venous thromboembolic complications following urological surgery between patients with or without cancer. Turk J Urol 2020; 46:tud.2020.20030. [PMID: 32412407 PMCID: PMC7360159 DOI: 10.5152/tud.2020.20030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/20/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Guidelines recommend 4 weeks of thromboembolic prophylaxis in patients who undergo major surgery for solid malignancies. However, there are limited head-to-head comparisons of risk of venous thromboembolic complications in patients with and without cancer undergoing similar surgical procedures. The purpose of this study was to compare risk of venous thromboembolic complications following major renal surgery and cystectomy between patients with and without cancer at the time of surgery. MATERIAL AND METHODS In the nationwide Danish National Patient Registry, which captures all hospital contacts, including surgical procedures, we identified 8,645 patients who underwent major renal surgery (4,273 without cancer and 4,372 with cancer) and 2,164 patients who underwent cystectomy (359 without cancer and 1,805 with cancer) in 2000-2009. The rate of venous thromboembolic events within 6 months from surgery was compared for patients with and without cancer after stratification on organ using Chi-squared test. RESULTS There was no difference in the rate of venous thromboembolic complications within the first 6 months after major renal surgery (0.4% and 0.3% [p=0.91]) or cystectomy (1.3% and 0.8% [p=0.44]) for patients with and without cancer. The cost for 28 days of Tinzaparin 4.500 IE administered by the patient was €112, whereas the cost if administered by a community nurse was €1.988. CONCLUSIONS Our study questions the different recommendations in thromboembolic prophylaxis between patients with and without cancer after major renal surgery and cystectomy.
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Affiliation(s)
- Frederik B. Thomsen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Copenhagen, Denmark
| | | | - Kasper D. Berg
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, Copenhagen, Denmark
- Department of Urology, Holstebro Hospital, Holstebro, Denmark
| | - Peter E. Clark
- Department of Urology, Carolinas HealthCare System, Levine Cancer Institute, North Carolina, NC, USA
- Department of Clinical Research Urology, University of Southern Denmark, Odense, Denmark
| | - Lars Lund
- Department of Urology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research Urology, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient data Explorative Network, University of Southern Denmark, Odense, Denmark
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Caffo O, Wissing M, Bianchini D, Bergman A, Thomsen FB, Schmid S, Yu EY, Bournakis E, Sella A, Zagonel V, De Giorgi U, Tucci M, Gelderblom H, Galli L, Pappagallo G, Bria E, Sperduti I, Oudard S. Survival Outcomes From a Cumulative Analysis of Worldwide Observational Studies on Sequential Use of New Agents in Metastatic Castration-Resistant Prostate Cancer. Clin Genitourin Cancer 2019; 18:69-76.e4. [PMID: 31767448 DOI: 10.1016/j.clgc.2019.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 08/12/2019] [Accepted: 09/10/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The sequential use of a number of new agents (NAs) have improved the overall survival (OS) of patients with metastatic castration-resistant prostate cancer whose disease progresses after docetaxel (DOC) treatment. The aim of this study was to assess the cumulative survival outcomes of different sequencing strategies by evaluating the individual data from published studies of patients treated with a post-DOC treatment sequence of 2 NAs. PATIENTS AND METHODS The patients' individual data were analyzed to investigate whether different sequencing strategies lead to differences in OS. RESULTS We analyzed the data of 1099 evaluable patients. Among the patients treated with a second-line new hormone agent (NHA), median OS from the start of third-line treatment was significantly longer in the patients treated with cabazitaxel (CABA) than in those treated with abiraterone acetate or enzalutamide. Median cumulative OS (cumOS) from the start of second-line treatment was 21.1 months in the patients who received NHA then NHA, 22.1 months in those who received NHA then CABA, and 21.0 months in those who received CABA then NHA. Among the patients with a second-line progression-free survival of ≥6 months, median cumOS was significantly longer in patients who received CABA-including sequences than in those treated with NHA then NHA sequences (29.5 vs. 24.8 months; P = .03). CONCLUSION Our findings suggest that the sequential use of NAs with different mechanisms of action improves cumOS regardless of the order in which they are administered, thus supporting the hypothesis of cross-resistance between the 2 NHAs.
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Affiliation(s)
- Orazio Caffo
- Medical Oncology Department, Santa Chiara Hospital, Trento, Italy.
| | - Michel Wissing
- Medical Oncology Department, University Medical Centre, Leiden, the Netherlands
| | - Diletta Bianchini
- Division of Clinical Studies, Prostate Cancer Targeted Therapies Group, Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Andries Bergman
- Division of Internal Medicine (MOD) and Oncogenomics, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | | | - Sebastian Schmid
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Evan Y Yu
- Department of Medicine, University of Washington School of Medicine, Seattle, WA
| | - Evangelos Bournakis
- Oncology Department, ARETAIEIO University Hospital of Athens, IASO General Clinic of Athens, Athens, Greece
| | - Avishay Sella
- Department of Oncology, Yitzhak Shamir Medical Center, Assaf Harofe Campus Harofeh Medical Center, Sackler School of Medicine, Tel-Aviv, Israel
| | - Vittorina Zagonel
- Medical Oncology Department, Istituto Oncologico Veneto, Padua, Italy
| | - Ugo De Giorgi
- Medical Oncology Department, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy
| | - Marcello Tucci
- Medical Oncology Department, Azienda Ospedaliera Universitaria S. Luigi Gonzaga, Orbassano, Italy
| | - Hans Gelderblom
- Medical Oncology Department, University Medical Centre, Leiden, the Netherlands
| | - Luca Galli
- Medical Oncology Department, Azienda Ospedaliera Universitaria, Pisa, Italy
| | | | - Emilio Bria
- Oncology Unit, Università Cattolica del Sacro Cuore, Fondazione Policlinico "A. Gemelli", Rome, Italy
| | - Isabella Sperduti
- Biostatistical Unit, Regina Elena National Cancer Institute, Rome, Italy
| | - Stephane Oudard
- Service de cancérologie médicale, Hôpital Européen Georges Pompidou, René Descartes University, Paris, France
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Thomsen FB, Røder MA, Jakobsen H, Langkilde NC, Borre M, Jakobsen EB, Frey A, Lund L, Lunden D, Dahl C, Brasso K. Active Surveillance Versus Radical Prostatectomy in Favorable-risk Localized Prostate Cancer. Clin Genitourin Cancer 2019; 17:e814-e821. [DOI: 10.1016/j.clgc.2019.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/01/2019] [Accepted: 05/12/2019] [Indexed: 11/26/2022]
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Winther CF, Thomsen K, Sørensen LP, Jenstrup M, Thomsen FB. Venous thromboembolic complications following surgical treatment for degenerative spinal disease. Dan Med J 2019; 66:A5541. [PMID: 31066352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION A venous thromboembolism (VTE), i.e. deep vein thrombosis (DVT) or pulmonary embolism (PE), is a potentially lethal complication to surgical procedures. The aim of this study was to evaluate the incidence of symptomatic VTEs in a large consecutive Danish cohort treated surgically for degenerative spinal disease. METHODS This was a retrospective, consecutive, one-centre cohort study of patients treated surgically for either cervical or lumbar degenerative disease. According to the local treatment protocol, patients with an increased risk of VTE received rivaroxaban as thrombosis prophylaxis. VTE events within six months from the surgical procedure were identified via the Danish National Patient Register and confirmed by patient chart review. RESULTS A total of 6,145 surgical procedures were included - 808 cervical and 5,337 lumbar procedures. Twelve patients (0.2%) were examined on suspicion of symptomatic VTE, ten for DVT and two for PE. VTE was confirmed in eight patients (0.1%), seven DVT and one PE. One patient died within six months, producing a mortality rate of 0.01%. CONCLUSIONS VTEs are an uncommon but potentially lethal complication in patients who undergo surgery for a degenerative spinal disease. Incidence and mortality were low in a consecutive cohort where rivaroxaban was used as thrombosis prophylaxis in patients with an increased preoperative risk of VTE. FUNDING none. TRIAL REGISTRATION not relevant.
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Boesen L, Thomsen FB, Nørgaard N, Løgager V, Balslev I, Bisbjerg R, Thomsen HS, Jakobsen H. A predictive model based on biparametric magnetic resonance imaging and clinical parameters for improved risk assessment and selection of biopsy-naïve men for prostate biopsies. Prostate Cancer Prostatic Dis 2019; 22:609-616. [DOI: 10.1038/s41391-019-0149-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/13/2019] [Accepted: 03/21/2019] [Indexed: 01/30/2023]
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Thomsen FB, Jakobsen H, Langkilde NC, Borre M, Jakobsen EB, Frey A, Lund L, Lunden D, Dahl C, Helgstrand JT, Brasso K. Active Surveillance for Localized Prostate Cancer: Nationwide Observational Study. J Urol 2019; 201:520-527. [PMID: 30240689 DOI: 10.1016/j.juro.2018.09.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The objective of this study was to investigate nationwide survival outcomes in men with localized prostate cancer managed on active surveillance. MATERIALS AND METHODS A total of 936 men with localized prostate cancer were initiated on active surveillance in Denmark in 2002 to 2012. Kaplan-Meier estimated curative treatment-free, hormonal therapy-free, castration resistant prostate cancer-free and cause specific survival was calculated. RESULTS Prostate cancer was classified as very low risk in 223 men, low risk in 436, intermediate risk in 259 (87% were at favorable intermediate risk) and high risk in 18. Median followup was 7.5 years (IQR 6.1-9.1). Kaplan-Meier estimated 10-year curative treatment-free survival was 62.8% (95% CI 59.1-66.3), 10-year hormonal therapy-free survival was 92.2% (95% CI 89.2-94.4), 10-year castration resistant prostate cancer-free survival was 97.2% (95% CI 95.3-98.4) and 10-year cause specific survival was 99.6% (95% CI 98.6-99.9). Compared to men with low risk prostate cancer, those with intermediate risk prostate cancer had higher curative treatment-free survival (69% vs 56%, p = 0.008), lower hormonal therapy-free survival (88% vs 95%, p = 0.005) and similar castration resistant prostate cancer-free survival (95% vs 99%, p = 0.17). CONCLUSIONS In this nationwide cohort 10-year cause specific survival was similar to that in prospective active surveillance cohorts. Our study supports the use of active surveillance in men with localized prostate cancer, including men with favorable intermediate risk characteristics.
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Affiliation(s)
| | - Henrik Jakobsen
- Departments of Urology, Herlev and Gentofte Hospital, Herlev, Denmark
| | | | | | | | | | - Lars Lund
- Department of Clinical Research Urology, University of Southern Denmark and Department of Urology, Odense University Hospital, Odense, Denmark
| | | | - Claus Dahl
- Zealand University Hospital, Roskilde, Denmark
| | | | - Klaus Brasso
- Department of Urology, Rigshospitalet, Copenhagen, Denmark
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Jacobsen MG, Thomsen FB, Fode M, Bisbjerg R, Østergren PB. Results of 14 years of brachytherapy for localized prostate cancer in Denmark: the Herlev cohort. Scand J Urol 2018; 52:164-168. [PMID: 29463165 DOI: 10.1080/21681805.2018.1438510] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Brachytherapy is one of several curative treatments for localized prostate cancer (PCa). The objective of this study was to report biochemical recurrence-free survival (BRFS), metastatic-free survival (MFS) and PCa-specific mortality after low-dose brachytherapy, stratified according to the D'Amico risk classification in a large Danish cohort. MATERIALS AND METHODS The study population comprised 502 men treated with brachytherapy in 1998-2012. BRFS was defined by the Phoenix criteria. Kaplan-Meier survival analysis was used to estimate BRFS and MFS. The cumulative PCa mortality was analysed using competing risk analyses. Multivariable Cox regression analysis was used to estimate risk of biochemical recurrence. RESULTS In total, 206 men were classified with low-risk PCa, 265 men with intermediate-risk PCa and 33 men with high-risk PCa. Median follow-up was 6.6 years [95% confidence interval (CI) 6.2-7.0]. The 10 year BRFS was 90% (95% CI 83-97), 75% (95% CI 65-87) and 75% (95% CI 59-92) in men with low-, intermediate- and high-risk PCa, respectively. The 10 year MFS was 95% (95% CI 89-100), 93% (95% CI 88-98) and 78% (95% CI 57-99) in men with low-, intermediate- and high-risk PCa, respectively. The 10 year cumulative incidence of PCa mortality was 1% (95% CI 0-3), 5% (95% CI 0-12) and 11% (95% CI 0-25) for men with low-, intermediate- and high-risk PCa, respectively. CONCLUSIONS Low-dose brachytherapy offers good short- to intermediate-term cancer control in selected men with localized PCa. Further studies are needed for safety analyses and for comparison with other treatment modalities.
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Affiliation(s)
- Mikael G Jacobsen
- a Department of Urology , Gentofte and Herlev University Hospital , Herlev , Denmark
| | - Frederik B Thomsen
- a Department of Urology , Gentofte and Herlev University Hospital , Herlev , Denmark
| | - Mikkel Fode
- a Department of Urology , Gentofte and Herlev University Hospital , Herlev , Denmark.,b Department of Urology , Zealand University Hospital , Roskilde , Denmark
| | - Rasmus Bisbjerg
- a Department of Urology , Gentofte and Herlev University Hospital , Herlev , Denmark
| | - Peter B Østergren
- a Department of Urology , Gentofte and Herlev University Hospital , Herlev , Denmark
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Thostrup M, Thomsen FB, Iversen P, Brasso K. Active surveillance for localized prostate cancer: update of a prospective single-center cohort. Scand J Urol 2017; 52:14-19. [DOI: 10.1080/21681805.2017.1380697] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mathias Thostrup
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frederik B. Thomsen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Iversen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Thomsen FB, Mikkelsen MK, Hansen RB, Krug AH, Glenthøj A, Stattin P, Brasso K. Clinical characteristics and primary management of patients diagnosed with prostate cancer between 2007 and 2013: status from a Danish primary referral center. Acta Oncol 2016; 55:1456-1460. [PMID: 27333339 DOI: 10.1080/0284186x.2016.1191667] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The Danish Cancer Registry holds information on all prostate cancers (PCa) cases, including diagnostic TNM. However, stratification according to contemporary risk classification is not possible because histopathological grading and prostate-specific antigen (PSA) level are not registered. The objective of the study was to report clinical characteristics and primary management of men diagnosed with PCa from a primary referral center in Denmark. MATERIAL AND METHODS Records on all men diagnosed with PCa at the Department of Urology, Frederiksberg Hospital, 1 January 2007 - 31 December 2013, were reviewed. Clinical characteristics and primary treatment were recorded. The National Comprehensive Cancer Network risk group classification was used. RESULTS A total of 1934 men with a median age of 69 years (interquartile range 65-75) were diagnosed with PCa in the study period resulting in an incidence rate (World Standard Population) of 84/100 000. Overall, 18% were classified as low-risk, 34% as intermediate-risk, 23% as high-risk, 8% as very high-risk and 17% had metastatic disease at diagnosis. Among men age <65 years 70% had low- or intermediate-risk disease, while this was the case for 58% of men aged 65-75 and 22% of men aged >75. Metastatic disease was found in 11% of men <65 years, 17% of men 65-75 years and 23% of men >75 years. In total 73% of men with low-risk PCa were managed on watchful waiting or active surveillance. Curatively intended treatment was performed in 56% of men with intermediate-risk and 61% of men with high-risk PCa, while hormonal therapy was used in 90% of men with very high-risk and 98% of men with metastatic PCa. CONCLUSION In a population without systematic PSA testing we found a large proportion of patients presenting with advanced PCa at diagnosis. Elderly patients presented with more advanced disease. Curative treatment was primarily used in younger men with clinically localized PCa.
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Affiliation(s)
- Frederik B. Thomsen
- Department of Urology, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Marta K. Mikkelsen
- Department of Urology, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Rikke B. Hansen
- Department of Urology, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Andrea H. Krug
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anders Glenthøj
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Pär Stattin
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden
- Department of Urology, Uppsala University Hospital, Uppsala, Sweden
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Thomsen FB, Folkvaljon Y, Brasso K, Loeb S, Robinson D, Egevad L, Stattin P. Prognostic implications of 2005 Gleason grade modification. Population-based study of biochemical recurrence following radical prostatectomy. J Surg Oncol 2016; 114:664-670. [PMID: 27511833 DOI: 10.1002/jso.24408] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 07/25/2016] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess the impact of the 2005 modification of the Gleason classification on risk of biochemical recurrence (BCR) after radical prostatectomy (RP). PATIENTS AND METHODS In the Prostate Cancer data Base Sweden (PCBaSe), 2,574 men assessed with the original Gleason classification and 1,890 men assessed with the modified Gleason classification, diagnosed between 2003 and 2007, underwent primary RP. Histopathology was reported according to the Gleason Grading Groups (GGG): GGG1 = Gleason score (GS) 6, GGG2 = GS 7(3 + 4), GGG3 = GS 7(4 + 3), GGG4 = GS 8 and GGG5 = GS 9-10. Cumulative incidence and multivariable Cox proportional hazards regression models were used to assess difference in BCR. RESULTS The cumulative incidence of BCR was lower using the modified compared to the original classification: GGG2 (16% vs. 23%), GGG3 (21% vs. 35%) and GGG4 (18% vs. 34%), respectively. Risk of BCR was lower for modified versus original classification, GGG2 Hazard ratio (HR) 0.66, (95%CI 0.49-0.88), GGG3 HR 0.57 (95%CI 0.38-0.88) and GGG4 HR 0.53 (95%CI 0.29-0.94). CONCLUSION Due to grade migration following the 2005 Gleason modification, outcome after RP are more favourable. Consequently, outcomes from historical studies cannot directly be applied to a contemporary setting. J. Surg. Oncol. 2016;114:664-670. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Frederik B Thomsen
- Copenhagen Prostate Cancer Center and Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Yasin Folkvaljon
- Regional Cancer Centre, Uppsala/Örebro, Uppsala University Hospital, Uppsala, Sweden
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center and Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Stacy Loeb
- Department of Urology, Population Health and the Laura and Isaac Perlmutter Cancer Institute, New York University and Manhattan Veterans Affairs Medical Center, New York, New York
| | - David Robinson
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Urology, Ryhov Hospital, Jönköping, Sweden
| | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.,Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University Hospital, Umeå, Sweden
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Berg KD, Thomsen FB, Nerstrøm C, Røder MA, Iversen P, Toft BG, Vainer B, Brasso K. The impact of the 2005 International Society of Urological Pathology consensus guidelines on Gleason grading - a matched-pair analysis. BJU Int 2016; 117:883-9. [DOI: 10.1111/bju.13439] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Kasper D. Berg
- Department of Urology; Copenhagen Prostate Cancer Center; University of Copenhagen; Copenhagen Denmark
| | - Frederik B. Thomsen
- Department of Urology; Copenhagen Prostate Cancer Center; University of Copenhagen; Copenhagen Denmark
| | - Camilla Nerstrøm
- Department of Urology; Copenhagen Prostate Cancer Center; University of Copenhagen; Copenhagen Denmark
| | - Martin A. Røder
- Department of Urology; Copenhagen Prostate Cancer Center; University of Copenhagen; Copenhagen Denmark
| | - Peter Iversen
- Department of Urology; Copenhagen Prostate Cancer Center; University of Copenhagen; Copenhagen Denmark
| | - Birgitte G. Toft
- Department of Pathology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Ben Vainer
- Department of Pathology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Klaus Brasso
- Department of Urology; Copenhagen Prostate Cancer Center; University of Copenhagen; Copenhagen Denmark
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Thomsen FB, Folkvaljon Y, Garmo H, Robinson D, Loeb S, Ingvar C, Lambe M, Stattin P. Risk of malignant melanoma in men with prostate cancer: Nationwide, population-based cohort study. Int J Cancer 2016; 138:2154-60. [DOI: 10.1002/ijc.29961] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 11/18/2015] [Indexed: 01/07/2023]
Affiliation(s)
- Frederik B. Thomsen
- Department of Urology; Bispebjerg and Frederiksberg Hospital; Frederiksberg Denmark
| | - Yasin Folkvaljon
- Regional Cancer Centre, Uppsala/Örebro, Uppsala University Hospital; Uppsala Sweden
| | - Hans Garmo
- King's College London, School of Medicine, Division of Cancer Studies, Cancer Epidemiology Group; London United Kingdom
| | - David Robinson
- Department of Surgical and Perioperative Sciences; Urology and Andrology, Umeå University; Umeå Sweden
- Department of Urology; Ryhov Hospital; Jönköping Sweden
| | - Stacy Loeb
- Department of Urology; Population Health and the Laura and Isaac Perlmutter Cancer Institute, New York University and Manhattan Veterans Affairs Medical Center; New York NY
| | - Christian Ingvar
- Department of Surgery; Clinical Sciences, Lund University, Skåne University Hospital; Lund Sweden
| | - Mats Lambe
- Regional Cancer Centre, Uppsala/Örebro, Uppsala University Hospital; Uppsala Sweden
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm Sweden
| | - Pär Stattin
- Department of Surgical and Perioperative Sciences; Urology and Andrology, Umeå University; Umeå Sweden
- Department of Urology; Uppsala University Hospital; Uppsala Sweden
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Thomsen FB, Mikkelsen MK, Hansen RB, Brasso K. The Movember campaign: Impact on referral patterns and diagnosis of prostate cancer. Scand J Public Health 2015; 44:228-32. [DOI: 10.1177/1403494815613184] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2015] [Indexed: 11/17/2022]
Abstract
Aims: The aims of the present study were to investigate referral patterns and the diagnosis of prostate cancer (PCa) before and after the Movember campaign was initiated in Denmark. Methods: All men ( n=2817) referred to the Department of Urology at Frederiksberg Hospital with suspicion of having PCa in the period 1 January 2007–31 January 2014 were identified. Based on the referral date, patients were categorised as pre-Movember (1 January 2007–31 January 2011) and Movember (1 February 2011–31 January 2014), respectively. Annual referral-rates/100.000 inhabitants were calculated and compared with rate-ratio (RR) tests. Results: The median prostate-specific antigen (PSA) at referral dropped significantly from 9.8 ng/mL in 2007–2011 to 7.9 ng/mL in 2011–2014, p < 0.001. The incidence rate of men referred with suspicion of PCa increased from 134/100.000 in the pre-Movember period to 168/100.000 in the Movember period (RR 1.25 [95% CI 1.16–1.35]). In contrast to what we anticipated, there was no increase in referral in the months following the campaign. The incidence rates of men diagnosed with PCa and low-risk PCa were similar in the Movember period and the pre-Movember period (PCa: RR 1.08 [0.97–1.21]; low-risk PCa: RR 1.29 [0.98–1.73]). Conclusions: After the initiation of the Movember campaign a significant decline in the PSA level at referral and an increase in the number of patients referred under suspicion of PCa was observed; however, only minor differences in referral patterns and PCa diagnosis were detected. The results indicate that the Movember campaign had a limited immediate effect on referral, however, it may have contributed to an increased awareness of PCa.
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Affiliation(s)
| | | | - Rikke B. Hansen
- Department of Urology, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Denmark
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15
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Berg KD, Røder MA, Thomsen FB, Vainer B, Gerds TA, Brasso K, Iversen P. The predictive value of ERG protein expression for development of castration-resistant prostate cancer in hormone-naïve advanced prostate cancer treated with primary androgen deprivation therapy. Prostate 2015; 75:1499-509. [PMID: 26053696 DOI: 10.1002/pros.23026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/30/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Biomarkers predicting response to primary androgen deprivation therapy (ADT) and risk of castration-resistant prostate cancer (CRPC) is lacking. We aimed to analyse the predictive value of ERG expression for development of CRPC. METHODS In total, 194 patients with advanced and/or metastatic prostate cancer (PCa) treated with first-line castration-based ADT were included. ERG protein expression was analysed in diagnostic specimens using immunohistochemistry (anti-ERG, EPR3864). Time to CRPC was compared between ERG subgroups using multiple cause-specific Cox regression stratified on ERG-status. Risk reclassification and time-dependent area under the ROC curves were used to assess the discriminative ability of ERG-status. Time to PSA-nadir, proportion achieving PSA-nadir ≤0.2 ng/ml, and risk of PCa-specific death were secondary endpoints. RESULTS Median follow-up was 6.8 years (IQR: 4.9-7.3). In total, 105 patients (54.1%) were ERG-positive and 89 (45.9%) were ERG-negative. No difference in risk of CRPC was observed between ERG subgroups (P = 0.51). Median time to CRPC was 3.9 years (95%CI: 3.2-5.1) and 4.5 years (95%CI: 2.3-not reached) in the ERG-positive and ERG-negative group, respectively. Compared to a model omitting ERG-status, the ERG-stratified model showed comparable AUC values 1 year (77.6% vs. 78.0%, P = 0.82), 2 years (71.7% vs. 71.8%, P = 0.85), 5 years (68.5% vs. 69.9%, P = 0.32), and 8 years (67.9% vs. 71.4%, P = 0.21) from ADT initiation. No differences in secondary endpoints were observed. CONCLUSIONS ERG expression was not associated with risk of CRPC suggesting that ERG is not a candidate biomarker for predicting response to primary ADT in patients diagnosed with advanced and/or metastatic PCa.
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Affiliation(s)
- Kasper D Berg
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Martin A Røder
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frederik B Thomsen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ben Vainer
- Department of Pathology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas A Gerds
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Iversen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Brasso K, Thomsen FB, Schrader AJ, Schmid SC, Lorente D, Retz M, Merseburger AS, von Klot CA, Boegemann M, de Bono J. Enzalutamide Antitumour Activity Against Metastatic Castration-resistant Prostate Cancer Previously Treated with Docetaxel and Abiraterone: A Multicentre Analysis. Eur Urol 2015; 68:317-24. [DOI: 10.1016/j.eururo.2014.07.028] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 07/21/2014] [Indexed: 12/18/2022]
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17
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Thomsen FB, Berg KD, Røder MA, Iversen P, Brasso K. Active surveillance for localized prostate cancer: an analysis of patient contacts and utilization of healthcare resources. Scand J Urol 2014; 49:43-50. [PMID: 25363612 DOI: 10.3109/21681805.2014.970572] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Evidence supports active surveillance (AS) as a means to reduce overtreatment of low-risk prostate cancer (PCa). The consequences of close and long-standing follow-up with regard to outpatient visits, tests and repeated biopsies are widely unknown. This study investigated the trajectory and costs of AS in patients with localized PCa. MATERIALS AND METHODS In total, 317 PCa patients were followed in a prospective, single-arm AS cohort. The primary outcomes were number of patient contacts, prostate-specific antigen (PSA) tests, biopsies, hospital admissions due to biopsy complications and patients eventually undergoing curative treatment. The secondary outcome was cost. RESULTS The 5 year cumulative incidence of discontinued AS in a competing-risk model was 40%. During the first 5 years of AS patients underwent a median of two biopsy sets, and patients were seen in an outpatient clinic including PSA testing three to four times annually. In total, 38 of the 406 biopsy sessions led to hospital admission and 87 of the 317 patients required treatment for bladder outlet obstruction (BOO). With a median of 3.7 years' follow-up, the total cost of AS was euro (€) 1,240,286. Assuming all patients had otherwise undergone primary radical prostatectomy, the cost difference favoured AS with a net benefit of €662,661 (35% reduction). CONCLUSIONS AS entails a close clinical follow-up with a considerable risk of rebiopsy complication, treatment of BOO and subsequent delayed definitive therapy. This risk should be weighed against a potential economic benefit and reduction in the risk of overtreatment compared to immediate radical treatment.
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Affiliation(s)
- Frederik B Thomsen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen , Copenhagen , Denmark
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18
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Thomsen FB, Marcussen N, Berg KD, Christensen IJ, Vainer B, Iversen P, Brasso K. Repeated biopsies in patients with prostate cancer on active surveillance: clinical implications of interobserver variation in histopathological assessment. BJU Int 2014; 115:599-605. [DOI: 10.1111/bju.12820] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Frederik B. Thomsen
- Copenhagen Prostate Cancer Center; Department of Urology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Niels Marcussen
- Department of Clinical Pathology; Odense Universitets Hospital; University of Southern Denmark; Copenhagen Denmark
| | - Kasper D. Berg
- Copenhagen Prostate Cancer Center; Department of Urology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Ib J. Christensen
- The Finsen Laboratory; Copenhagen Biocenter and Biotech Research and Innovation Centre; Copenhagen Denmark
| | - Ben Vainer
- Department of Pathology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Peter Iversen
- Copenhagen Prostate Cancer Center; Department of Urology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center; Department of Urology; Rigshospitalet; University of Copenhagen; Copenhagen Denmark
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Røder MA, Berg KD, Thomsen FB, Hunde D, Brasso K, Iversen P. MP70-19 KETOCONAZOLE THERAPY IN POST-CHEMO MCRPC - THE CASE FOR A COMPARISON TO ABIRATERONE. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Røder MA, Thomsen FB, Brasso K, Rathenborg P, Borre M, Iversen P. PD27-12 BIOCHEMICAL EFFICACY OF ENZALUTAMIDE IN POST-CHEMO MCRPC PATIENTS PREVIOUSLY TREATED WITH ABIRATERONE. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.2111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Thomsen FB, Brasso K, Klotz LH, Røder MA, Berg KD, Iversen P. Active surveillance for clinically localized prostate cancer--a systematic review. J Surg Oncol 2014; 109:830-5. [PMID: 24610744 DOI: 10.1002/jso.23584] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 02/03/2014] [Indexed: 11/08/2022]
Abstract
Active surveillance (AS) has been introduced as an observational strategy to delay or avoid curative treatment without compromising long-term cancer-specific survival. The 10 studies included in this review, published between 2008 and 2013, generally agreed upon patients selection for the AS strategy and how they should be managed within the program. However, uncertainties persists concerning optimal patient selection and reliable progression criteria, as well as the long-term safety of AS.
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Affiliation(s)
- Frederik B Thomsen
- Copenhagen Prostate Cancer Center, Department of Urology, Rigshospitalet, University of Copenhagen, Denmark
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22
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Thomsen FB, Bandak M, Thomsen MF, Lauritsen J, Christensen IJ, Daugaard G. Survival and toxicity in patients with disseminated germ cell cancer aged 40 years and older. Cancer 2013; 120:43-51. [DOI: 10.1002/cncr.28374] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/16/2013] [Accepted: 08/19/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Frederik B. Thomsen
- Copenhagen Prostate Cancer Center; Department of Urology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Mikkel Bandak
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Maria F. Thomsen
- Department of Internal Medicine; Amager Hospital; Copenhagen Denmark
| | - Jakob Lauritsen
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
| | - Ib J. Christensen
- The Finsen Laboratory; Rigshospitalet and Biotech Research and Innovation Center; University of Copenhagen; Denmark
| | - Gedske Daugaard
- Department of Oncology; Copenhagen University Hospital, Rigshospitalet; Copenhagen Denmark
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Røder MA, Berg KD, Thomsen FB, Gruschy L, Rusch E, Brasso K, Iversen P. 994 STANDARDIZED RELATIVE SURVIVAL AND MORTALITY AFTER RADICAL PROSTATECTOMY FOR CLINICALLY LOCALIZED PROSTATE CANCER. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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