Priority of Fibular Reconstruction in Patients with Oral Cavity Cancer Undergoing Segmental Mandibulectomy
Identifieur interne : 000C04 ( Ncbi/Merge ); précédent : 000C03; suivant : 000C05Priority of Fibular Reconstruction in Patients with Oral Cavity Cancer Undergoing Segmental Mandibulectomy
Auteurs : Chih-Hung Lin [République populaire de Chine] ; Chung-Jan Kang [République populaire de Chine] ; Chung-Kan Tsao [République populaire de Chine] ; Christopher Glenn Wallace [République populaire de Chine] ; Li-Yu Lee [République populaire de Chine] ; Chien-Yu Lin [République populaire de Chine] ; Hung-Ming Wang [République populaire de Chine] ; Shu-Hang Ng [République populaire de Chine] ; Tzu-Chen Yen [République populaire de Chine] ; Chun-Ta Liao [République populaire de Chine]Source :
- PLoS ONE [ 1932-6203 ] ; 2014.
Abstract
The fibula osteoseptocutaneous free flap is generally used for segmental mandibular reconstructions following resection of oral cavity squamous cell carcinoma (OSCC). However, less complex reconstructions may be feasible for patients with predicted poor survival. Herein, we sought to identify the main risk factors (RFs) associated with poor prognosis in OSCC patients undergoing segmental mandibulectomy to help decide between fibular and non-fibular reconstructions.
Between 1996 and 2011, we examined the 5-year control, distant metastases, and survival rates in 310 consecutive, previously untreated patients with primary OSCC who underwent segmental mandibulectomy.
Margin status was the only independent RF for 5-year local control. Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent RFs for poor 5-year survival. In the entire study cohort, 23% of the patients had 2 or 3 adverse RFs; such a high-risk group was characterized by a poor prognosis and may be suitable for non-fibular reconstructions. Overall, 70% of the study patients were cT1-4N0, cT1N2, cT2N1, or had tumor depth <15 mm; less than 5% of patients in this subgroup had 2 or 3 adverse RFs and were thus candidates for fibular reconstructions. Among the remaining 30% of patients who showed both advanced clinical stage (cT2N2, cT3-4N1-2) and tumor depth ≥15 mm, 70% exhibited 2 or 3 adverse RFs.
Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent predictors of poor prognosis in OSCC patients undergoing segmental mandibulectomy. The preoperative or intraoperative identification of adverse RFs may help decide between fibular and non-fibular mandibular reconstruction. High-risk patients bearing 2 or 3 adverse RFs have poor prognosis and should not be considered as candidates for fibular reconstructions.
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DOI: 10.1371/journal.pone.0094315
PubMed: 24722353
PubMed Central: 3983152
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Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Wallace, Christopher Glenn" sort="Wallace, Christopher Glenn" uniqKey="Wallace C" first="Christopher Glenn" last="Wallace">Christopher Glenn Wallace</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Lee, Li Yu" sort="Lee, Li Yu" uniqKey="Lee L" first="Li-Yu" last="Lee">Li-Yu Lee</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Lin, Chien Yu" sort="Lin, Chien Yu" uniqKey="Lin C" first="Chien-Yu" last="Lin">Chien-Yu Lin</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Wang, Hung Ming" sort="Wang, Hung Ming" uniqKey="Wang H" first="Hung-Ming" last="Wang">Hung-Ming Wang</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Ng, Shu Hang" sort="Ng, Shu Hang" uniqKey="Ng S" first="Shu-Hang" last="Ng">Shu-Hang Ng</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Yen, Tzu Chen" sort="Yen, Tzu Chen" uniqKey="Yen T" first="Tzu-Chen" last="Yen">Tzu-Chen Yen</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Liao, Chun Ta" sort="Liao, Chun Ta" uniqKey="Liao C" first="Chun-Ta" last="Liao">Chun-Ta Liao</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">24722353</idno><idno type="pmc">3983152</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3983152</idno><idno type="RBID">PMC:3983152</idno><idno 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Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Kang, Chung Jan" sort="Kang, Chung Jan" uniqKey="Kang C" first="Chung-Jan" last="Kang">Chung-Jan Kang</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Tsao, Chung Kan" sort="Tsao, Chung Kan" uniqKey="Tsao C" first="Chung-Kan" last="Tsao">Chung-Kan Tsao</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Wallace, Christopher Glenn" sort="Wallace, Christopher Glenn" uniqKey="Wallace C" first="Christopher Glenn" last="Wallace">Christopher Glenn Wallace</name><affiliation wicri:level="1"><nlm:aff id="aff1"><addr-line>Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Lee, Li Yu" sort="Lee, Li Yu" uniqKey="Lee L" first="Li-Yu" last="Lee">Li-Yu Lee</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff4"><addr-line>Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Lin, Chien Yu" sort="Lin, Chien Yu" uniqKey="Lin C" first="Chien-Yu" last="Lin">Chien-Yu Lin</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff5"><addr-line>Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Wang, Hung Ming" sort="Wang, Hung Ming" uniqKey="Wang H" first="Hung-Ming" last="Wang">Hung-Ming Wang</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff6"><addr-line>Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Ng, Shu Hang" sort="Ng, Shu Hang" uniqKey="Ng S" first="Shu-Hang" last="Ng">Shu-Hang Ng</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff7"><addr-line>Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Yen, Tzu Chen" sort="Yen, Tzu Chen" uniqKey="Yen T" first="Tzu-Chen" last="Yen">Tzu-Chen Yen</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff8"><addr-line>Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author><author><name sortKey="Liao, Chun Ta" sort="Liao, Chun Ta" uniqKey="Liao C" first="Chun-Ta" last="Liao">Chun-Ta Liao</name><affiliation wicri:level="1"><nlm:aff id="aff2"><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff3"><addr-line>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></nlm:aff><country xml:lang="fr">République populaire de Chine</country><wicri:regionArea>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan</wicri:regionArea><wicri:noRegion>Taiwan</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS ONE</title><idno type="eISSN">1932-6203</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>The fibula osteoseptocutaneous free flap is generally used for segmental mandibular reconstructions following resection of oral cavity squamous cell carcinoma (OSCC). However, less complex reconstructions may be feasible for patients with predicted poor survival. Herein, we sought to identify the main risk factors (RFs) associated with poor prognosis in OSCC patients undergoing segmental mandibulectomy to help decide between fibular and non-fibular reconstructions.</p></sec><sec><title>Methods</title><p>Between 1996 and 2011, we examined the 5-year control, distant metastases, and survival rates in 310 consecutive, previously untreated patients with primary OSCC who underwent segmental mandibulectomy.</p></sec><sec><title>Results</title><p>Margin status was the only independent RF for 5-year local control. Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent RFs for poor 5-year survival. In the entire study cohort, 23% of the patients had 2 or 3 adverse RFs; such a high-risk group was characterized by a poor prognosis and may be suitable for non-fibular reconstructions. Overall, 70% of the study patients were cT1-4N0, cT1N2, cT2N1, or had tumor depth <15 mm; less than 5% of patients in this subgroup had 2 or 3 adverse RFs and were thus candidates for fibular reconstructions. Among the remaining 30% of patients who showed both advanced clinical stage (cT2N2, cT3-4N1-2) and tumor depth ≥15 mm, 70% exhibited 2 or 3 adverse RFs.</p></sec><sec><title>Conclusions</title><p>Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent predictors of poor prognosis in OSCC patients undergoing segmental mandibulectomy. The preoperative or intraoperative identification of adverse RFs may help decide between fibular and non-fibular mandibular reconstruction. High-risk patients bearing 2 or 3 adverse RFs have poor prognosis and should not be considered as candidates for fibular reconstructions.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Wei, Fc" uniqKey="Wei F">FC Wei</name></author><author><name sortKey="Demirkan, F" uniqKey="Demirkan F">F Demirkan</name></author><author><name sortKey="Chen, Hc" uniqKey="Chen H">HC Chen</name></author><author><name sortKey="Chen, Ih" uniqKey="Chen I">IH Chen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wei, Fc" uniqKey="Wei F">FC Wei</name></author><author><name sortKey="Celik, N" uniqKey="Celik N">N Celik</name></author><author><name sortKey="Chen, Hc" uniqKey="Chen H">HC Chen</name></author><author><name sortKey="Cheng, Mh" uniqKey="Cheng M">MH Cheng</name></author><author><name sortKey="Huang, Wc" uniqKey="Huang W">WC Huang</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Liao, Ct" uniqKey="Liao C">CT Liao</name></author><author><name sortKey="Lee, Ly" uniqKey="Lee L">LY Lee</name></author><author><name sortKey="Hsueh, C" uniqKey="Hsueh C">C Hsueh</name></author><author><name sortKey="Lin, Cy" uniqKey="Lin C">CY Lin</name></author><author><name sortKey="Fan, Kh" uniqKey="Fan K">KH Fan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liao, Ct" uniqKey="Liao C">CT Liao</name></author><author><name sortKey="Chang, Jt" uniqKey="Chang J">JT Chang</name></author><author><name sortKey="Wang, Hm" uniqKey="Wang H">HM Wang</name></author><author><name sortKey="Ng, Sh" uniqKey="Ng S">SH Ng</name></author><author><name sortKey="Hsueh, C" uniqKey="Hsueh C">C Hsueh</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liao, Ct" uniqKey="Liao C">CT Liao</name></author><author><name sortKey="Lee, Ly" uniqKey="Lee L">LY Lee</name></author><author><name sortKey="Huang, Sf" uniqKey="Huang S">SF Huang</name></author><author><name sortKey="Chen, Ih" uniqKey="Chen I">IH Chen</name></author><author><name sortKey="Kang, Cj" uniqKey="Kang C">CJ Kang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="O Brien, Cj" uniqKey="O Brien C">CJ O'Brien</name></author><author><name sortKey="Adams, Jr" uniqKey="Adams J">JR Adams</name></author><author><name sortKey="Mcneil, Eb" uniqKey="Mcneil E">EB McNeil</name></author><author><name sortKey="Taylor, P" uniqKey="Taylor P">P Taylor</name></author><author><name sortKey="Laniewski, P" uniqKey="Laniewski P">P Laniewski</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Saber, Tk" uniqKey="Saber T">TK Saber</name></author><author><name sortKey="Hussein, Ha" uniqKey="Hussein H">HA Hussein</name></author><author><name sortKey="Mebeed, Ah" uniqKey="Mebeed A">AH Mebeed</name></author><author><name sortKey="El Sebai, Hi" uniqKey="El Sebai H">HI El Sebai</name></author><author><name sortKey="Sami, I" uniqKey="Sami I">I Sami</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Munoz Guerra, Mf" uniqKey="Munoz Guerra M">MF Munoz Guerra</name></author><author><name sortKey="Naval Gias, L" uniqKey="Naval Gias L">L Naval Gias</name></author><author><name sortKey="Campo, Fr" uniqKey="Campo F">FR Campo</name></author><author><name sortKey="Perez, Js" uniqKey="Perez J">JS Perez</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Patel, Rs" uniqKey="Patel R">RS Patel</name></author><author><name sortKey="Dirven, R" uniqKey="Dirven R">R Dirven</name></author><author><name sortKey="Clark, Jr" uniqKey="Clark J">JR Clark</name></author><author><name sortKey="Swinson, Bd" uniqKey="Swinson B">BD Swinson</name></author><author><name sortKey="Gao, K" uniqKey="Gao K">K Gao</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liao, Ct" uniqKey="Liao C">CT Liao</name></author><author><name sortKey="Chang, Jt" uniqKey="Chang J">JT Chang</name></author><author><name sortKey="Wang, Hm" uniqKey="Wang H">HM Wang</name></author><author><name sortKey="Ng, Sh" uniqKey="Ng S">SH Ng</name></author><author><name sortKey="Huang, Sf" uniqKey="Huang S">SF Huang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Liao, Ct" uniqKey="Liao C">CT Liao</name></author><author><name sortKey="Wang, Hm" uniqKey="Wang H">HM Wang</name></author><author><name sortKey="Huang, Sf" uniqKey="Huang S">SF Huang</name></author><author><name sortKey="Chen, Ih" uniqKey="Chen I">IH Chen</name></author><author><name sortKey="Kang, Cj" uniqKey="Kang C">CJ Kang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Johnson, Re" uniqKey="Johnson R">RE Johnson</name></author><author><name sortKey="Sigman, Jd" uniqKey="Sigman J">JD Sigman</name></author><author><name sortKey="Funk, Gf" uniqKey="Funk G">GF Funk</name></author><author><name sortKey="Robinson, Ra" uniqKey="Robinson R">RA Robinson</name></author><author><name sortKey="Hoffman, Ht" uniqKey="Hoffman H">HT Hoffman</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS One</journal-id><journal-id journal-id-type="iso-abbrev">PLoS ONE</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosone</journal-id><journal-title-group><journal-title>PLoS ONE</journal-title></journal-title-group><issn pub-type="epub">1932-6203</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">24722353</article-id><article-id pub-id-type="pmc">3983152</article-id><article-id pub-id-type="publisher-id">PONE-D-13-46067</article-id><article-id pub-id-type="doi">10.1371/journal.pone.0094315</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Biology and Life Sciences</subject><subj-group><subject>Anatomy</subject><subj-group><subject>Biological Tissue</subject><subj-group><subject>Connective Tissue</subject><subj-group><subject>Bone</subject></subj-group></subj-group></subj-group><subj-group><subject>Musculoskeletal System</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Medicine and Health Sciences</subject><subj-group><subject>Oncology</subject><subj-group><subject>Cancers and Neoplasms</subject><subj-group><subject>Carcinomas</subject><subj-group><subject>Squamous Cell Carcinomas</subject><subj-group><subject>Head and Neck Squamous Cell Carcinoma</subject></subj-group></subj-group></subj-group><subj-group><subject>Head and Neck Tumors</subject></subj-group></subj-group><subj-group><subject>Cancer Treatment</subject></subj-group></subj-group><subj-group><subject>Oral Medicine</subject><subj-group><subject>Oral Diseases</subject></subj-group></subj-group><subj-group><subject>Otorhinolaryngology</subject><subj-group><subject>Head and Neck Cancers</subject></subj-group></subj-group><subj-group><subject>Surgical and Invasive Medical Procedures</subject><subj-group><subject>Plastic Surgery and Reconstructive Techniques</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Research and Analysis Methods</subject><subj-group><subject>Research Design</subject><subj-group><subject>Clinical Research Design</subject><subject>Retrospective Studies</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Priority of Fibular Reconstruction in Patients with Oral Cavity Cancer Undergoing Segmental Mandibulectomy</article-title><alt-title alt-title-type="running-head">Segmental Mandibulectomy and Outcomes in OSCC</alt-title></title-group><contrib-group><contrib contrib-type="author" equal-contrib="yes"><name><surname>Lin</surname><given-names>Chih-Hung</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" equal-contrib="yes"><name><surname>Kang</surname><given-names>Chung-Jan</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Tsao</surname><given-names>Chung-Kan</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Wallace</surname><given-names>Christopher Glenn</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lee</surname><given-names>Li-Yu</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib><contrib contrib-type="author"><name><surname>Lin</surname><given-names>Chien-Yu</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff5"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Wang</surname><given-names>Hung-Ming</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff6"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Ng</surname><given-names>Shu-Hang</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff7"><sup>7</sup></xref></contrib><contrib contrib-type="author"><name><surname>Yen</surname><given-names>Tzu-Chen</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff8"><sup>8</sup></xref></contrib><contrib contrib-type="author"><name><surname>Liao</surname><given-names>Chun-Ta</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref><xref ref-type="aff" rid="aff3"><sup>3</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib></contrib-group><aff id="aff1"><label>1</label><addr-line>Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></aff><aff id="aff2"><label>2</label><addr-line>Department of Head and Neck Oncology Group, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></aff><aff id="aff3"><label>3</label><addr-line>Department of Otorhinolaryngology, Head and Neck Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></aff><aff id="aff4"><label>4</label><addr-line>Department of Pathology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></aff><aff id="aff5"><label>5</label><addr-line>Department of Radiation Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></aff><aff id="aff6"><label>6</label><addr-line>Department of Medical Oncology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></aff><aff id="aff7"><label>7</label><addr-line>Department of Diagnostic Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></aff><aff id="aff8"><label>8</label><addr-line>Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan, R.O.C.</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Elsalanty</surname><given-names>Mohammed</given-names></name><role>Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Georgia Regents University, College of Dental Medicine, United States of America</addr-line></aff><author-notes><corresp id="cor1">* E-mail: <email>liaoct@adm.cgmh.org.tw</email></corresp><fn fn-type="conflict"><p><bold>Competing Interests: </bold>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con"><p>Conceived and designed the experiments: CTL CJK CHL. Performed the experiments: CTL CJK CHL CKT CGW LYL CYL HMW SHN TCY. Analyzed the data: CTL CJK CHL CKT CGW LYL CYL HMW SHN TCY. Contributed reagents/materials/analysis tools: CTL CJK CHL CKT CGW LYL CYL HMW SHN TCY. Wrote the paper: CTL CJK CHL CKT CGW LYL CYL HMW SHN TCY.</p></fn></author-notes><pub-date pub-type="collection"><year>2014</year></pub-date><pub-date pub-type="epub"><day>10</day><month>4</month><year>2014</year></pub-date><volume>9</volume><issue>4</issue><elocation-id>e94315</elocation-id><history><date date-type="received"><day>4</day><month>11</month><year>2013</year></date><date date-type="accepted"><day>15</day><month>3</month><year>2014</year></date></history><permissions><copyright-year>2014</copyright-year><copyright-holder>Lin et al</copyright-holder><license><license-p>This is an open-access article distributed under the terms of the <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">Creative Commons Attribution License</ext-link>, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.</license-p></license></permissions><abstract><sec><title>Background</title><p>The fibula osteoseptocutaneous free flap is generally used for segmental mandibular reconstructions following resection of oral cavity squamous cell carcinoma (OSCC). However, less complex reconstructions may be feasible for patients with predicted poor survival. Herein, we sought to identify the main risk factors (RFs) associated with poor prognosis in OSCC patients undergoing segmental mandibulectomy to help decide between fibular and non-fibular reconstructions.</p></sec><sec><title>Methods</title><p>Between 1996 and 2011, we examined the 5-year control, distant metastases, and survival rates in 310 consecutive, previously untreated patients with primary OSCC who underwent segmental mandibulectomy.</p></sec><sec><title>Results</title><p>Margin status was the only independent RF for 5-year local control. Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent RFs for poor 5-year survival. In the entire study cohort, 23% of the patients had 2 or 3 adverse RFs; such a high-risk group was characterized by a poor prognosis and may be suitable for non-fibular reconstructions. Overall, 70% of the study patients were cT1-4N0, cT1N2, cT2N1, or had tumor depth <15 mm; less than 5% of patients in this subgroup had 2 or 3 adverse RFs and were thus candidates for fibular reconstructions. Among the remaining 30% of patients who showed both advanced clinical stage (cT2N2, cT3-4N1-2) and tumor depth ≥15 mm, 70% exhibited 2 or 3 adverse RFs.</p></sec><sec><title>Conclusions</title><p>Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent predictors of poor prognosis in OSCC patients undergoing segmental mandibulectomy. The preoperative or intraoperative identification of adverse RFs may help decide between fibular and non-fibular mandibular reconstruction. High-risk patients bearing 2 or 3 adverse RFs have poor prognosis and should not be considered as candidates for fibular reconstructions.</p></sec></abstract><funding-group><funding-statement>This study was supported by grant no. CMRPG1B0591, Chang Gung Memorial Hospital. The funder had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.</funding-statement></funding-group><counts><page-count count="8"></page-count></counts></article-meta></front></pmc><affiliations><list><country><li>République populaire de Chine</li></country></list><tree><country name="République populaire de Chine"><noRegion><name sortKey="Lin, Chih Hung" sort="Lin, Chih Hung" uniqKey="Lin C" first="Chih-Hung" last="Lin">Chih-Hung Lin</name></noRegion><name sortKey="Kang, Chung Jan" sort="Kang, Chung Jan" uniqKey="Kang C" first="Chung-Jan" last="Kang">Chung-Jan Kang</name><name sortKey="Kang, Chung Jan" sort="Kang, Chung Jan" uniqKey="Kang C" first="Chung-Jan" last="Kang">Chung-Jan Kang</name><name sortKey="Lee, Li Yu" sort="Lee, Li Yu" uniqKey="Lee L" first="Li-Yu" last="Lee">Li-Yu Lee</name><name sortKey="Lee, Li Yu" sort="Lee, Li Yu" uniqKey="Lee L" first="Li-Yu" last="Lee">Li-Yu Lee</name><name sortKey="Liao, Chun Ta" sort="Liao, Chun Ta" uniqKey="Liao C" first="Chun-Ta" last="Liao">Chun-Ta Liao</name><name sortKey="Liao, Chun Ta" sort="Liao, Chun Ta" uniqKey="Liao C" first="Chun-Ta" last="Liao">Chun-Ta Liao</name><name sortKey="Lin, Chien Yu" sort="Lin, Chien Yu" uniqKey="Lin C" first="Chien-Yu" last="Lin">Chien-Yu Lin</name><name sortKey="Lin, Chien Yu" sort="Lin, Chien Yu" uniqKey="Lin C" first="Chien-Yu" last="Lin">Chien-Yu Lin</name><name sortKey="Lin, Chih Hung" sort="Lin, Chih Hung" uniqKey="Lin C" first="Chih-Hung" last="Lin">Chih-Hung Lin</name><name sortKey="Ng, Shu Hang" sort="Ng, Shu Hang" uniqKey="Ng S" first="Shu-Hang" last="Ng">Shu-Hang Ng</name><name sortKey="Ng, Shu Hang" sort="Ng, Shu Hang" uniqKey="Ng S" first="Shu-Hang" last="Ng">Shu-Hang Ng</name><name sortKey="Tsao, Chung Kan" sort="Tsao, Chung Kan" uniqKey="Tsao C" first="Chung-Kan" last="Tsao">Chung-Kan Tsao</name><name sortKey="Tsao, Chung Kan" sort="Tsao, Chung Kan" uniqKey="Tsao C" first="Chung-Kan" last="Tsao">Chung-Kan Tsao</name><name sortKey="Wallace, Christopher Glenn" sort="Wallace, Christopher Glenn" uniqKey="Wallace C" first="Christopher Glenn" last="Wallace">Christopher Glenn Wallace</name><name sortKey="Wallace, Christopher Glenn" sort="Wallace, Christopher Glenn" uniqKey="Wallace C" first="Christopher Glenn" last="Wallace">Christopher Glenn Wallace</name><name sortKey="Wallace, Christopher Glenn" sort="Wallace, Christopher Glenn" uniqKey="Wallace C" first="Christopher Glenn" last="Wallace">Christopher Glenn Wallace</name><name sortKey="Wang, Hung Ming" sort="Wang, Hung Ming" uniqKey="Wang H" first="Hung-Ming" last="Wang">Hung-Ming Wang</name><name sortKey="Wang, Hung Ming" sort="Wang, Hung Ming" uniqKey="Wang H" first="Hung-Ming" last="Wang">Hung-Ming Wang</name><name sortKey="Yen, Tzu Chen" sort="Yen, Tzu Chen" uniqKey="Yen T" first="Tzu-Chen" last="Yen">Tzu-Chen Yen</name><name sortKey="Yen, Tzu Chen" sort="Yen, Tzu Chen" uniqKey="Yen T" first="Tzu-Chen" last="Yen">Tzu-Chen Yen</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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