Loading…

Prognostic value of preoperative weight loss-adjusted body mass index on survival after esophagectomy for esophageal squamous cell carcinoma

The impact of body mass index (BMI) on survival in patients with esophageal squamous cell carcinoma (ESCC) undergoing surgery remains unclear. Therefore, a definition of clinically significant BMI in patients with ESCC is needed. To explore the impact of preoperative weight loss (PWL)-adjusted BMI o...

Full description

Saved in:
Bibliographic Details
Published in:World journal of gastroenterology : WJG 2020-02, Vol.26 (8), p.839-849
Main Authors: Zhang, Han-Lu, Yang, Yu-Shang, Duan, Jia-Nan, Shang, Qi-Xin, He, Song-Lin, Gu, Yi-Min, Hu, Wei-Peng, Wang, Wen-Ping, Hu, Yang, Wang, Yun, Yuan, Yong, Chen, Long-Qi
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c390t-1be9974313e8c3c9521839ea01a4c50642de95d699a3f83ac28a773a077948913
cites cdi_FETCH-LOGICAL-c390t-1be9974313e8c3c9521839ea01a4c50642de95d699a3f83ac28a773a077948913
container_end_page 849
container_issue 8
container_start_page 839
container_title World journal of gastroenterology : WJG
container_volume 26
creator Zhang, Han-Lu
Yang, Yu-Shang
Duan, Jia-Nan
Shang, Qi-Xin
He, Song-Lin
Gu, Yi-Min
Hu, Wei-Peng
Wang, Wen-Ping
Hu, Yang
Wang, Yun
Yuan, Yong
Chen, Long-Qi
description The impact of body mass index (BMI) on survival in patients with esophageal squamous cell carcinoma (ESCC) undergoing surgery remains unclear. Therefore, a definition of clinically significant BMI in patients with ESCC is needed. To explore the impact of preoperative weight loss (PWL)-adjusted BMI on overall survival (OS) in patients undergoing surgery for ESCC. This retrospective study consisted of 1545 patients who underwent curative resection for ESCC at West China Hospital of Sichuan University between August 2005 and December 2011. The relationship between PWL-adjusted BMI and OS was examined, and a multivariate analysis was performed and adjusted for age, sex, TNM stage and adjuvant therapy. Trends of poor survival were observed for patients with increasing PWL and decreasing BMI. Patients with BMI ≥ 20.0 kg/m and PWL < 8.8% were classified into Group 1 with the longest median OS (45.3 mo). Patients with BMI < 20.0 kg/m and PWL < 8.8% were classified into Group 2 with a median OS of 29.5 mo. Patients with BMI ≥ 20.0 kg/m and PWL ≥ 8.8% (HR = 1.9, 95%CI: 1.5-2.5), and patients with BMI < 20.0 kg/m and PWL ≥ 8.8% (HR = 2.0, 95%CI: 1.6-2.6), were combined into Group 3 with a median OS of 20.1 mo. Patients in the three groups were associated with significantly different OS ( < 0.05). In multivariate analysis, PWL-adjusted BMI, TNM stage and adjuvant therapy were identified as independent prognostic factors. PWL-adjusted BMI has an independent prognostic impact on OS in patients with ESCC undergoing surgery. BMI might be an indicator for patients with PWL < 8.8% rather than ≥ 8.8%.
doi_str_mv 10.3748/wjg.v26.i8.839
format article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7052531</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2375502244</sourcerecordid><originalsourceid>FETCH-LOGICAL-c390t-1be9974313e8c3c9521839ea01a4c50642de95d699a3f83ac28a773a077948913</originalsourceid><addsrcrecordid>eNpVkU1v1DAQhi1ERZfClSPykUuCP5K1fUFCFV9SJXpoz9asM8l6lcSpnaTd_8CPxquWAidL43femWdeQt5xVkpV6Y_3h65cxbb0utTSvCAbIbgphK7YS7LhjKnCSKHOyeuUDowJKWvxipxLwSstNd-QX9cxdGNIs3d0hX5BGlo6RQwTRpj9ivQefbefaR9SKqA5LGnGhu5Cc6QDpET92OADDSNNS1x9tqDQzhgppjDtoUM3h-FI2_C3kiXpboEhLIk67HvqIDo_hgHekLMW-oRvn94Lcvv1y83l9-Lq57cfl5-vCicNmwu-Q2NUJblE7aQzteCZHYFxqFzNtpVo0NTN1hiQrZbghAalJDClTKUNlxfk06PvtOwGbByOc4TeTtEPEI82gLf__4x-b7uwWsVqUcuTwYcngxjuFkyzHXw6scCIGcsKqeqaCVFVWVo-Sl3MF4zYPo_hzJ4itDlCmyO0XtuMkRve_7vcs_xPZvI3NYydDQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2375502244</pqid></control><display><type>article</type><title>Prognostic value of preoperative weight loss-adjusted body mass index on survival after esophagectomy for esophageal squamous cell carcinoma</title><source>PubMed Central</source><creator>Zhang, Han-Lu ; Yang, Yu-Shang ; Duan, Jia-Nan ; Shang, Qi-Xin ; He, Song-Lin ; Gu, Yi-Min ; Hu, Wei-Peng ; Wang, Wen-Ping ; Hu, Yang ; Wang, Yun ; Yuan, Yong ; Chen, Long-Qi</creator><creatorcontrib>Zhang, Han-Lu ; Yang, Yu-Shang ; Duan, Jia-Nan ; Shang, Qi-Xin ; He, Song-Lin ; Gu, Yi-Min ; Hu, Wei-Peng ; Wang, Wen-Ping ; Hu, Yang ; Wang, Yun ; Yuan, Yong ; Chen, Long-Qi</creatorcontrib><description><![CDATA[The impact of body mass index (BMI) on survival in patients with esophageal squamous cell carcinoma (ESCC) undergoing surgery remains unclear. Therefore, a definition of clinically significant BMI in patients with ESCC is needed. To explore the impact of preoperative weight loss (PWL)-adjusted BMI on overall survival (OS) in patients undergoing surgery for ESCC. This retrospective study consisted of 1545 patients who underwent curative resection for ESCC at West China Hospital of Sichuan University between August 2005 and December 2011. The relationship between PWL-adjusted BMI and OS was examined, and a multivariate analysis was performed and adjusted for age, sex, TNM stage and adjuvant therapy. Trends of poor survival were observed for patients with increasing PWL and decreasing BMI. Patients with BMI ≥ 20.0 kg/m and PWL < 8.8% were classified into Group 1 with the longest median OS (45.3 mo). Patients with BMI < 20.0 kg/m and PWL < 8.8% were classified into Group 2 with a median OS of 29.5 mo. Patients with BMI ≥ 20.0 kg/m and PWL ≥ 8.8% (HR = 1.9, 95%CI: 1.5-2.5), and patients with BMI < 20.0 kg/m and PWL ≥ 8.8% (HR = 2.0, 95%CI: 1.6-2.6), were combined into Group 3 with a median OS of 20.1 mo. Patients in the three groups were associated with significantly different OS ( < 0.05). In multivariate analysis, PWL-adjusted BMI, TNM stage and adjuvant therapy were identified as independent prognostic factors. PWL-adjusted BMI has an independent prognostic impact on OS in patients with ESCC undergoing surgery. BMI might be an indicator for patients with PWL < 8.8% rather than ≥ 8.8%.]]></description><identifier>ISSN: 1007-9327</identifier><identifier>EISSN: 2219-2840</identifier><identifier>DOI: 10.3748/wjg.v26.i8.839</identifier><identifier>PMID: 32148381</identifier><language>eng</language><publisher>United States: Baishideng Publishing Group Inc</publisher><subject>Aged ; Body Mass Index ; Chemotherapy, Adjuvant - mortality ; China ; Esophageal Neoplasms - mortality ; Esophageal Neoplasms - physiopathology ; Esophageal Neoplasms - surgery ; Esophageal Squamous Cell Carcinoma - mortality ; Esophageal Squamous Cell Carcinoma - physiopathology ; Esophageal Squamous Cell Carcinoma - surgery ; Esophagectomy - mortality ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Nutritional Status ; Predictive Value of Tests ; Preoperative Period ; Prognosis ; Retrospective Studies ; Retrospective Study ; Treatment Outcome ; Weight Loss</subject><ispartof>World journal of gastroenterology : WJG, 2020-02, Vol.26 (8), p.839-849</ispartof><rights>The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.</rights><rights>The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved. 2020</rights><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c390t-1be9974313e8c3c9521839ea01a4c50642de95d699a3f83ac28a773a077948913</citedby><cites>FETCH-LOGICAL-c390t-1be9974313e8c3c9521839ea01a4c50642de95d699a3f83ac28a773a077948913</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7052531/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7052531/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32148381$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhang, Han-Lu</creatorcontrib><creatorcontrib>Yang, Yu-Shang</creatorcontrib><creatorcontrib>Duan, Jia-Nan</creatorcontrib><creatorcontrib>Shang, Qi-Xin</creatorcontrib><creatorcontrib>He, Song-Lin</creatorcontrib><creatorcontrib>Gu, Yi-Min</creatorcontrib><creatorcontrib>Hu, Wei-Peng</creatorcontrib><creatorcontrib>Wang, Wen-Ping</creatorcontrib><creatorcontrib>Hu, Yang</creatorcontrib><creatorcontrib>Wang, Yun</creatorcontrib><creatorcontrib>Yuan, Yong</creatorcontrib><creatorcontrib>Chen, Long-Qi</creatorcontrib><title>Prognostic value of preoperative weight loss-adjusted body mass index on survival after esophagectomy for esophageal squamous cell carcinoma</title><title>World journal of gastroenterology : WJG</title><addtitle>World J Gastroenterol</addtitle><description><![CDATA[The impact of body mass index (BMI) on survival in patients with esophageal squamous cell carcinoma (ESCC) undergoing surgery remains unclear. Therefore, a definition of clinically significant BMI in patients with ESCC is needed. To explore the impact of preoperative weight loss (PWL)-adjusted BMI on overall survival (OS) in patients undergoing surgery for ESCC. This retrospective study consisted of 1545 patients who underwent curative resection for ESCC at West China Hospital of Sichuan University between August 2005 and December 2011. The relationship between PWL-adjusted BMI and OS was examined, and a multivariate analysis was performed and adjusted for age, sex, TNM stage and adjuvant therapy. Trends of poor survival were observed for patients with increasing PWL and decreasing BMI. Patients with BMI ≥ 20.0 kg/m and PWL < 8.8% were classified into Group 1 with the longest median OS (45.3 mo). Patients with BMI < 20.0 kg/m and PWL < 8.8% were classified into Group 2 with a median OS of 29.5 mo. Patients with BMI ≥ 20.0 kg/m and PWL ≥ 8.8% (HR = 1.9, 95%CI: 1.5-2.5), and patients with BMI < 20.0 kg/m and PWL ≥ 8.8% (HR = 2.0, 95%CI: 1.6-2.6), were combined into Group 3 with a median OS of 20.1 mo. Patients in the three groups were associated with significantly different OS ( < 0.05). In multivariate analysis, PWL-adjusted BMI, TNM stage and adjuvant therapy were identified as independent prognostic factors. PWL-adjusted BMI has an independent prognostic impact on OS in patients with ESCC undergoing surgery. BMI might be an indicator for patients with PWL < 8.8% rather than ≥ 8.8%.]]></description><subject>Aged</subject><subject>Body Mass Index</subject><subject>Chemotherapy, Adjuvant - mortality</subject><subject>China</subject><subject>Esophageal Neoplasms - mortality</subject><subject>Esophageal Neoplasms - physiopathology</subject><subject>Esophageal Neoplasms - surgery</subject><subject>Esophageal Squamous Cell Carcinoma - mortality</subject><subject>Esophageal Squamous Cell Carcinoma - physiopathology</subject><subject>Esophageal Squamous Cell Carcinoma - surgery</subject><subject>Esophagectomy - mortality</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoplasm Staging</subject><subject>Nutritional Status</subject><subject>Predictive Value of Tests</subject><subject>Preoperative Period</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Retrospective Study</subject><subject>Treatment Outcome</subject><subject>Weight Loss</subject><issn>1007-9327</issn><issn>2219-2840</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNpVkU1v1DAQhi1ERZfClSPykUuCP5K1fUFCFV9SJXpoz9asM8l6lcSpnaTd_8CPxquWAidL43femWdeQt5xVkpV6Y_3h65cxbb0utTSvCAbIbgphK7YS7LhjKnCSKHOyeuUDowJKWvxipxLwSstNd-QX9cxdGNIs3d0hX5BGlo6RQwTRpj9ivQefbefaR9SKqA5LGnGhu5Cc6QDpET92OADDSNNS1x9tqDQzhgppjDtoUM3h-FI2_C3kiXpboEhLIk67HvqIDo_hgHekLMW-oRvn94Lcvv1y83l9-Lq57cfl5-vCicNmwu-Q2NUJblE7aQzteCZHYFxqFzNtpVo0NTN1hiQrZbghAalJDClTKUNlxfk06PvtOwGbByOc4TeTtEPEI82gLf__4x-b7uwWsVqUcuTwYcngxjuFkyzHXw6scCIGcsKqeqaCVFVWVo-Sl3MF4zYPo_hzJ4itDlCmyO0XtuMkRve_7vcs_xPZvI3NYydDQ</recordid><startdate>20200228</startdate><enddate>20200228</enddate><creator>Zhang, Han-Lu</creator><creator>Yang, Yu-Shang</creator><creator>Duan, Jia-Nan</creator><creator>Shang, Qi-Xin</creator><creator>He, Song-Lin</creator><creator>Gu, Yi-Min</creator><creator>Hu, Wei-Peng</creator><creator>Wang, Wen-Ping</creator><creator>Hu, Yang</creator><creator>Wang, Yun</creator><creator>Yuan, Yong</creator><creator>Chen, Long-Qi</creator><general>Baishideng Publishing Group Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200228</creationdate><title>Prognostic value of preoperative weight loss-adjusted body mass index on survival after esophagectomy for esophageal squamous cell carcinoma</title><author>Zhang, Han-Lu ; Yang, Yu-Shang ; Duan, Jia-Nan ; Shang, Qi-Xin ; He, Song-Lin ; Gu, Yi-Min ; Hu, Wei-Peng ; Wang, Wen-Ping ; Hu, Yang ; Wang, Yun ; Yuan, Yong ; Chen, Long-Qi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c390t-1be9974313e8c3c9521839ea01a4c50642de95d699a3f83ac28a773a077948913</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Body Mass Index</topic><topic>Chemotherapy, Adjuvant - mortality</topic><topic>China</topic><topic>Esophageal Neoplasms - mortality</topic><topic>Esophageal Neoplasms - physiopathology</topic><topic>Esophageal Neoplasms - surgery</topic><topic>Esophageal Squamous Cell Carcinoma - mortality</topic><topic>Esophageal Squamous Cell Carcinoma - physiopathology</topic><topic>Esophageal Squamous Cell Carcinoma - surgery</topic><topic>Esophagectomy - mortality</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoplasm Staging</topic><topic>Nutritional Status</topic><topic>Predictive Value of Tests</topic><topic>Preoperative Period</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Retrospective Study</topic><topic>Treatment Outcome</topic><topic>Weight Loss</topic><toplevel>online_resources</toplevel><creatorcontrib>Zhang, Han-Lu</creatorcontrib><creatorcontrib>Yang, Yu-Shang</creatorcontrib><creatorcontrib>Duan, Jia-Nan</creatorcontrib><creatorcontrib>Shang, Qi-Xin</creatorcontrib><creatorcontrib>He, Song-Lin</creatorcontrib><creatorcontrib>Gu, Yi-Min</creatorcontrib><creatorcontrib>Hu, Wei-Peng</creatorcontrib><creatorcontrib>Wang, Wen-Ping</creatorcontrib><creatorcontrib>Hu, Yang</creatorcontrib><creatorcontrib>Wang, Yun</creatorcontrib><creatorcontrib>Yuan, Yong</creatorcontrib><creatorcontrib>Chen, Long-Qi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>World journal of gastroenterology : WJG</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhang, Han-Lu</au><au>Yang, Yu-Shang</au><au>Duan, Jia-Nan</au><au>Shang, Qi-Xin</au><au>He, Song-Lin</au><au>Gu, Yi-Min</au><au>Hu, Wei-Peng</au><au>Wang, Wen-Ping</au><au>Hu, Yang</au><au>Wang, Yun</au><au>Yuan, Yong</au><au>Chen, Long-Qi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic value of preoperative weight loss-adjusted body mass index on survival after esophagectomy for esophageal squamous cell carcinoma</atitle><jtitle>World journal of gastroenterology : WJG</jtitle><addtitle>World J Gastroenterol</addtitle><date>2020-02-28</date><risdate>2020</risdate><volume>26</volume><issue>8</issue><spage>839</spage><epage>849</epage><pages>839-849</pages><issn>1007-9327</issn><eissn>2219-2840</eissn><abstract><![CDATA[The impact of body mass index (BMI) on survival in patients with esophageal squamous cell carcinoma (ESCC) undergoing surgery remains unclear. Therefore, a definition of clinically significant BMI in patients with ESCC is needed. To explore the impact of preoperative weight loss (PWL)-adjusted BMI on overall survival (OS) in patients undergoing surgery for ESCC. This retrospective study consisted of 1545 patients who underwent curative resection for ESCC at West China Hospital of Sichuan University between August 2005 and December 2011. The relationship between PWL-adjusted BMI and OS was examined, and a multivariate analysis was performed and adjusted for age, sex, TNM stage and adjuvant therapy. Trends of poor survival were observed for patients with increasing PWL and decreasing BMI. Patients with BMI ≥ 20.0 kg/m and PWL < 8.8% were classified into Group 1 with the longest median OS (45.3 mo). Patients with BMI < 20.0 kg/m and PWL < 8.8% were classified into Group 2 with a median OS of 29.5 mo. Patients with BMI ≥ 20.0 kg/m and PWL ≥ 8.8% (HR = 1.9, 95%CI: 1.5-2.5), and patients with BMI < 20.0 kg/m and PWL ≥ 8.8% (HR = 2.0, 95%CI: 1.6-2.6), were combined into Group 3 with a median OS of 20.1 mo. Patients in the three groups were associated with significantly different OS ( < 0.05). In multivariate analysis, PWL-adjusted BMI, TNM stage and adjuvant therapy were identified as independent prognostic factors. PWL-adjusted BMI has an independent prognostic impact on OS in patients with ESCC undergoing surgery. BMI might be an indicator for patients with PWL < 8.8% rather than ≥ 8.8%.]]></abstract><cop>United States</cop><pub>Baishideng Publishing Group Inc</pub><pmid>32148381</pmid><doi>10.3748/wjg.v26.i8.839</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 1007-9327
ispartof World journal of gastroenterology : WJG, 2020-02, Vol.26 (8), p.839-849
issn 1007-9327
2219-2840
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7052531
source PubMed Central
subjects Aged
Body Mass Index
Chemotherapy, Adjuvant - mortality
China
Esophageal Neoplasms - mortality
Esophageal Neoplasms - physiopathology
Esophageal Neoplasms - surgery
Esophageal Squamous Cell Carcinoma - mortality
Esophageal Squamous Cell Carcinoma - physiopathology
Esophageal Squamous Cell Carcinoma - surgery
Esophagectomy - mortality
Female
Humans
Male
Middle Aged
Neoplasm Staging
Nutritional Status
Predictive Value of Tests
Preoperative Period
Prognosis
Retrospective Studies
Retrospective Study
Treatment Outcome
Weight Loss
title Prognostic value of preoperative weight loss-adjusted body mass index on survival after esophagectomy for esophageal squamous cell carcinoma
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-01T04%3A21%3A16IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Prognostic%20value%20of%20preoperative%20weight%20loss-adjusted%20body%20mass%20index%20on%20survival%20after%20esophagectomy%20for%20esophageal%20squamous%20cell%20carcinoma&rft.jtitle=World%20journal%20of%20gastroenterology%20:%20WJG&rft.au=Zhang,%20Han-Lu&rft.date=2020-02-28&rft.volume=26&rft.issue=8&rft.spage=839&rft.epage=849&rft.pages=839-849&rft.issn=1007-9327&rft.eissn=2219-2840&rft_id=info:doi/10.3748/wjg.v26.i8.839&rft_dat=%3Cproquest_pubme%3E2375502244%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c390t-1be9974313e8c3c9521839ea01a4c50642de95d699a3f83ac28a773a077948913%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2375502244&rft_id=info:pmid/32148381&rfr_iscdi=true