Background: The CovidSurg-Cancer Consortium aimed to explore the impact of COVID-19 in surgical patients and services for solid cancers at the start of the pandemic. The CovidSurg-Gynecologic Oncology Cancer subgroup was particularly concerned about the magnitude of adverse outcomes caused by the disrupted surgical gynecologic cancer care during the COVID-19 pandemic, which are currently unclear. Objective: This study aimed to evaluate the changes in care and short-term outcomes of surgical patients with gynecologic cancers during the COVID-19 pandemic. We hypothesized that the COVID-19 pandemic had led to a delay in surgical cancer care, especially in patients who required more extensive surgery, and such delay had an impact on cancer outcomes. Study design: This was a multicenter, international, prospective cohort study. Consecutive patients with gynecologic cancers who were initially planned for nonpalliative surgery, were recruited from the date of first COVID-19-related admission in each participating center for 3 months. The follow-up period was 3 months from the time of the multidisciplinary tumor board decision to operate. The primary outcome of this analysis is the incidence of pandemic-related changes in care. The secondary outcomes included 30-day perioperative mortality and morbidity and a composite outcome of unresectable disease or disease progression, emergency surgery, and death. Results: We included 3973 patients (3784 operated and 189 nonoperated) from 227 centers in 52 countries and 7 world regions who were initially planned to have cancer surgery. In 20.7% (823/3973) of the patients, the standard of care was adjusted. A significant delay (>8 weeks) was observed in 11.2% (424/3784) of patients, particularly in those with ovarian cancer (213/1355; 15.7%; P<.0001). This delay was associated with a composite of adverse outcomes, including disease progression and death (95/424; 22.4% vs 601/3360; 17.9%; P=.024) compared with those who had operations within 8 weeks of tumor board decisions. One in 13 (189/2430; 7.9%) did not receive their planned operations, in whom 1 in 20 (5/189; 2.7%) died and 1 in 5 (34/189; 18%) experienced disease progression or death within 3 months of multidisciplinary team board decision for surgery. Only 22 of the 3778 surgical patients (0.6%) acquired perioperative SARS-CoV-2 infections; they had a longer postoperative stay (median 8.5 vs 4 days; P<.0001), higher predefined surgical morbidity (14/22; 63.6% vs 717/3762; 19.1%; P<.0001) and mortality (4/22; 18.2% vs 26/3762; 0.7%; P<.0001) rates than the uninfected cohort. Conclusion: One in 5 surgical patients with gynecologic cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations, and coordinated mitigating strategies are urgently needed.
Outcomes of gynecologic cancer surgery during the COVID-19 pandemic: an international, multicenter, prospective CovidSurg-Gynecologic Oncology Cancer study / Fotopoulou, Christina; Khan, Tabassum; Bracinik, Juraj; Glasbey, James; Abu-Rustum, Nadeem; Chiva, Luis; Fagotti, Anna; Fujiwara, Keiichi; Ghebre, Rahel; Gutelkin, Murat; Konney, Thomas O.; Ng, Joseph; Pareja, Rene; Kottayasamy Seenivasagam, Rajkumar; Sehouli, Jalid; Surappa, Shylasree T. S.; Bhangu, Aneel; Leung, Elaine; Sundar, Sudha; Nepogodiev, Dmitri; Siaw-Acheampong, Kwabena; Benson, Ruth A.; Bywater, Edward; Chaudhry, Daoud; Dawson, Brett E.; Evans, Jonathan P.; Glasbey, James C.; Gujjuri, Rohan R.; Heritage, Emily; Jones, Conor S.; Kamarajah, Sivesh K.; Khatri, Chetan; Khaw, Rachel A.; Keatley, James M.; Knight, Andrew; Lawday, Samuel; Li, Elizabeth; Mann, Harvinder S.; Marson, Ella J.; Mclean, Kenneth A.; Mckay, Siobhan C.; Mills, Emily C.; Pellino, Gianluca; Picciochi, Maria; Taylor, Elliott H.; Tiwari, Abhinav; Simoes, Joana FF.; Trout, Isobel M.; Venn, Mary L.; Wilkin, Richard JW.; Bhangu, Aneel; Simoes, Joana FF.; Abbott, Tom EF.; Abukhalaf, Sadi; Adamina, Michel; Ademuyiwa, Adesoji O.; Agarwal, Arnav; Akkulak, Murat; Alameer, Ehab; Alderson, Derek; Alakaloko, Felix; Albertsmeier, Markus; Alser, Osaid; Alshaar, Muhammad; Alshryda, Sattar; Arnaud, Alexis P.; Augestad, Knut Magne; Ayasra, Faris; Azevedo, José; Bankhead-Kendall, Brittany K.; Barlow, Emma; Beard, David; Benson, Ruth A.; Blanco-Colino, Ruth; Brar, Amanpreet; Minaya-Bravo, Ana; Breen, Kerry A.; Bretherton, Chris; Buarque, Igor Lima; Burke, Joshua; Caruana, Edward J.; Chaar, Mohammad; Chakrabortee, Sohini; Christensen, Peter; Cox, Daniel; Cukier, Moises; Cunha, Miguel F.; Davidson, Giana H.; Desai, Anant; Di Saverio, Salomone; Drake, Thomas M.; Edwards, John G.; Elhadi, Muhammed; Emile, Sameh; Farik, Shebani; Fiore, Marco; Fitzgerald, J Edward; Ford, Samuel; Garmanova, Tatiana; Gallo, Gaetano; Ghosh, Dhruva; Ataíde Gomes, Gustavo Mendonça; Grecinos, Gustavo; Griffiths, Ewen A.; Gruendl, Magdalena; Halkias, Constantine; Harrison, Ewen M.; Hisham, Intisar; Hutchinson, Peter J.; Hwang, Shelley; Isik, Arda; Jenkinson, Michael D.; Jonker, Pascal; MA Kaafarani, Haytham; Keller, Debby; Kolias, Angelos; Kruijff, Schelto; Lawani, Ismail; Lederhuber, Hans; Leventoglu, Sezai; Litvin, Andrey; Loehrer, Andrew; Löffler, Markus W.; Lorena, Maria Aguilera; Modolo, Maria Marta; Major, Piotr; Martin, Janet; Mashbari, Hassan N.; Mazingi, Dennis; Metallidis, Symeon; Minaya-Bravo, Ana; Mohan, Helen M.; Moore, Rachel; Moszkowicz, David; Moug, Susan; Ng-Kamstra, Joshua S.; Maimbo, Mayaba; Negoi, Ionut; Niquen, Milagros; Ntirenganya, Faustin; Olivos, Maricarmen; Oussama, Kacimi; Outani, Oumaima; Parreno-Sacdalanm, Marie Dione; Pata, Francesco; Perez Rivera, Carlos Jose; Pinkney, Thomas D.; van der Plas, Willemijn; Pockney, Peter; Qureshi, Ahmad; Radenkovic, Dejan; Ramos-De la Medina, Antonio; Richards, Toby; Roberts, Keith; Roslani, April C.; Rutegård, Martin; Segura-Sampedro, Juan José; Santos, Irène; Satoi, Sohei; Sayyed, Raza; Schache, Andrew; Schnitzbauer, Andreas A.; Seyi-Olajide, Justina O.; Sharma, Neil; Shaw, Catherine A.; Shaw, Richard; Shu, Sebastian; Soreide, Kjetil; Spinelli, Antonino; Stewart, Grant D.; Sund, Malin; Sundar, Sudha; Tabiri, Stephen; Townend, Philip; Tsoulfas, Georgios; van Ramshorst, Gabrielle H.; Vidya, Raghavan; Vimalachandran, Dale; Warren, Oliver J.; Wedderburn, Duane; Wright, Naomi; Booth, Lesley; Barker, Neil; Cooke, Shirley; Doré, Suzanne; Horwood, Nigel; Runigamugabo, Emmy; Weir, Carrie Tierney; Dajti I, Albania:; C, Allemand; La, Boccalatte; M, Figari; M, Lamm; J, Larrañaga; C, Marchitelli; F, Noll; D, Odetto; M, Perrotta; J, Saadi; L, Zamora; Ballester, A. 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A. V.; Ll, Matos; Ks, Nunes; G, Laporte; M, Salem; Awada J, Barakat; Tr, Ijichi; Nj, Kim; A, Marreiro; B, Muller; R, Nunes; B, Bodanese; Er, Eidt; Jc, Isoton; Vieira da Cunha M, Lemos; de Sampaio L, Regina; C, Vendrame; M, Zeni; Ja, Zortéa; Mr, Zortéa; M, Sokolov; B, Kidane; S, Srinathan; A, Munro; L, Helyer; D, Mckeen; M, Boutros; Ng, Caminsky; G, Ghitulescu; G, Jamjoum; J, Moon; J, Pelletier; T, Vanounou; S, Wong; D, Cheng; Sd, Macneil; J, Martin; M, Boutros; S, Dumitra; A, Kouyoumdjian; S, Schmid; J, Spicer; A, Agarwal; A, Brar; J, Dada; A, Dare; U, Hameed; F, Osman; B, Johnston; C, Russell; G, Groot; A, Persad; H, Pham; M, Wood; A, Brar; M, Ko; L, Rajendran; M, Boutros; S, Demyttenaere; R, Garfinkle; C, Brown; A, Karimuddin; N, Lee; J, Liu; Kia T, Madani; Phang, P. 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D.; V, Papadopoulos; A, Tooulias; D, Tsolakidis; G, Tsoulfas; D, Zouzoulas; E, Athanasakis; E, Chrysos; I, Tsiaoussis; S, Xenaki; E, Xynos; Duarte A, Barrios; Muralles I, Lopez; Mj, Lowey; Al, Portilla; G, Recinos; Jyk, Chan; Chan, S. M.; Ccn, Chong; K, Futaba; Ho, M. F.; Sf, Hon; Rwh, Lau; Twc, Mak; Cf, Ng; Csh, Ng; Kkc, Ng; Ssm, Ng; Ayb, Teoh; Jy, Teoh; Cc, Foo; B, Banky; N, Suszták; S, Misra; P, Pareek; Jr, Vishnoi; S, Ambre; V, Balasubiramaniyan; P, Chappity; I, Chaudhary; L, Colney; Mk, Das; M, Imaduddin; A, Jain; Sk, Jena; M, Kar; S, Mandal; A, Mishra; Ss, Mishra; Ts, Mishra; Jk, Mitra; Y, Mittal; Dk, Muduly; P, Nayak; Pk, Parida; P, Pradhan; Dk, Rajan; E, Rebba; Dk, Samal; A, Singh; M, Sultania; Sp, Agarwal; A, Agrawal; Rk, Arora; J, Chaturvedi; Pk, Garg; A, Gaurav; A, Gupta; Seenivasagam R, Kottayasamy; Maharaj, D. D.; Ks, Majumdar; N, Mishra; A, Mittal; Ta, Narain; R, Nirjhar; Dr, Poonia; S, Sadhasivam; Mp, Singh; Ar, Tiwari; Ak, Akula; Sk, Bandegudda; Rp, Bindlish; A, Chaitanya; Rao LM, Chandrasekhara; P, Dalakoti; S, Dasu; A, Giridhar; Nb, Gorijavolu; Rr, Iyer; Y, Jayakarthik; Gt, Jonathan; Kalla, M. B.; Y, Kheni; Cs, Kumar; Sa, Murtuza; Cck, Naidu; Rk, Nalukurthi; Ho, Nemade; S, Nusrath; Sc, Patnaik; Kvvn, Raju; Pr, Ramalingam; Kv, Rao; Bk, Rayani; Kallam, Reddy; Srr, Reddy; Ar, Saksena; Ja, Sebastian; Rm, Sharma; Sr, Thammineedi; A, Krishnamurthy; S, Madhupriya; A, Raja; Chennai, Ramakrishnan AS.; Uk, Dutt; Ghosh, D. N.; S, Grewal; P, Hans; Haque, P. D.; R, Jain; Kingsley, P. A.; A, Mahajan; K, Mandrelle; V, Michael; P, Mukherjee; A, Varghese; Ss, Varghese; Sk, Veetil; P, Gaikwad; Aj, George; James, S. M.; Mr, Jesudason; R, Mittal; M, Moorthy; J, Riju; A, Sebastian; S, Sen; S, Singh; D, Sreekar; V, Thomas; Dk, Titus; Hs, Yezzaji; M, Aggarwal; P, Dhamija; A, Kumar; Mm, Chisthi; G, Gejoe; D, Gopakumar; Vv, Kollengode; Kg, Kuttanchettiyar; I, Yadev; A, Balasubramanian; L, Chaturvedula; K, Dharanipragada; R, Kalayarasan; R, Manikandan; P, Penumadu; B, Lakshminarayana; S, Mathew; Pv, Reddihalli; S, Shivdas; N, Akhtar; A, Chaturvedi; S, Gupta; V, Kumar; S, Rajan; N, Agrawal; P, Ahluwalia; A, Arora; Batra-Modi, K.; M, Biswas; A, Chaturvedi; H, Chaturvedi; G, Gautam; M, Jain; S, Jain; S, Kumar; R, Nayyar; S, Singh; A, Tiwari; Rangappa V, Bhushan; A, Kadapathri; T, Kolur; R, Pethkar; V, Pillai; G, Popli; J, Sharma; V, Shetty; N, Subramaniam; J, Williams; P, Agarwal; V, Agarwal; A, Baghel; Db, Sharma; A, Silodia; Kn, Singh; Sk, Yadav; G, Aziz; N, Chowdri; A, Mehraj; Fq, Parray; Za, Shah; Ra, Wani; Z, Ahmed; Rs, Bali; Bhat, M. A.; Ar, Laharwal; M, Mahmood; Is, Mir; J, Muzamil; Fa, Najar; A, Rashid; Mh, Rather; M, Zaieem; G, Aggarwal; V, Agrawal; A, Ahmed; R, Ahmed; J, Bhaumik; A, Ghosh; S, Gupta; D, Jain; Pv, Jain; V, Kewlani; A, Pipara; S, Shakya; A, Sharma; R, Thambudorai; Ra, Badwe; G, Bakshi; U, Chandankhede; V, Chaudhari; D, Chaukar; G, Chitkara; B, Dash; A, Deshmukh; deSoouza A, Null; A, Gulia; A, Maheshwari; A, Moiyadi; D, Nair; Ns, Nair; D, Niyogi; M, Pal; D, Pandey; S, Patkar; P, Poddar; Cs, Pramesh; A, Puri; A, Saklani; P, Shetty; Sv, Shrikhande; Ts, Shylasree; V, Singh; S, Thiagarajan; Aa, Islam; G, Kembuan; H, Pajan; F, Rahim; Milan P, Brouki; M, Mozafari; Tavirani M, Rezaei; A, Tizmaghz; H, Safari; M, Aremu; Canas-Martinez, A.; O, Cullivan; C, Murphy; P, Owens; L, Pickett; L, Akmenkalne; J, Byrne; M, Corrigan; C, Cullinane; A, Daly; C, Fleming; P, Jordan; My, Kayyal; S, Killeen; N, Lynch; A, Mccarthy; H, Mustafa; S, O’Brien; P, O’Leary; Was, Syed; L, Vernon; F, O'Duffy; A, Mchugh; T, Moran; D, Callanan; A, Dias; L, Huang; A, Ionescu; P, Sheahan; I, Balasubramanian; M, Boland; E, Carrington; K, Conlon; C, Cullinane; D, Evoy; J, Fagan; N, Fearon; T, Gallagher; E, Geary; J, Geraghty; A, Hanly; H, Heneghan; N, Kennedy; R, Kennelly; D, Maguire; St, Martin; D, Mccartan; Ew, Mcdermott; D, Mcpartland; Kc, Ng; Rs, Prichard; T, Stafford; D, Winter; D, Alazawi; C, Barry; T, Boyle; W, Butt; E, Connolly; N, Donlon; C, Donohue; Fahey, B. A.; R, Farrell; C, Fitzgerald; J, Kinsella; J, Larkin; P, Lennon; Pj, Maguire; P, Mccormick; Bj, Mehigan; H, Mohan; Ts, Nugent; H, O’Sullivan; N, Ravi; Jv, Reynolds; A, Rogers; P, Shokuhi; J, Smith; La, Smith; C, Timon; Y, Bashir; G, Bass; K, Conlon; T, Connelly; B, Creavin; H, Earley; Ja, Elliott; A, Gillis; D, Kavanagh; A, Madden; Rp, Manecksha; P, Neary; C, O’Connell; J, O’Riordan; Is, Reynolds; D, Rice; P, Ridgway; A, Thomas; M, Umair; M, Whelan; P, Carroll; C, Collins; K, Corless; L, Finnegan; Al, Fowler; A, Hogan; M, Kerin; A, Lowery; P, Mcanena; K, Mckevitt; E, Nugent; É, Ryan; Jc, Coffey; Rm, Cunningham; M, Devine; Nally, D. M.; C, Peirce; S, Tormey; N, Hardy; P, Neary; S, O’Malley; M, Ryan; V, Gaziants; Deutch R, Gold-; R, Lavy; Kalmovich-Muallem, L.; O, Zmora; S, Macina; Nm, Mariani; E, Opocher; Ceretti A, Pisani; F, Ferrari; F, Odicino; E, Sartori; C, Cotsoglou; S, Granieri; F, Bianco; A, Camillo’; M, Colledan; S, Tornese; Zambelli, M. F.; G, Bissolotti; S, Fusetti; F, Lemma; M, Marino; Mv, Marino; A, Mirabella; G, Vaccarella; G, Sena; C, Agostini; G, Alemanno; I, Bartolini; C, Bergamini; A, Bruscino; C, Checcucci; Vincenti R, De; Bella A, Di; M, Fambrini; L, Fortuna; G, Maltinti; P, Muiesan; F, Petraglia; P, Prosperi; Ringressi, M. N.; M, Risaliti; F, Sorbi; A, Taddei; R, Tucci; C, Bassi; L, Bortolasi; T, Campagnaro; L, Casetti; S, Conci; Pastena M, De; A, Esposito; M, Fontana; A, Guglielmi; L, Landoni; G, Malleo; G, Marchegiani; S, Nobile; S, Paiella; C, Pedrazzani; S, Rattizzato; A, Ruzzenente; R, Salvia; G, Turri; M, Tuveri; Df, Altomare; V, Papagni; A, Picciariello; P, Bellora; G, D’Aloisio; M, Ferrari; E, Francone; S, Gentilli; H, Nikaj; L, Andreani; M, Bianchini; R, Capanna; M, Caretto; M, Chiarugi; F, Coccolini; C, Cremonini; Franco G, Di; L, Domenici; N, Furbetta; A, Gadducci; S, Garibaldi; D, Gianardi; A, Giannini; S, Guadagni; L, Morelli; S, Musetti; M, Palmeri; A, Perutelli; T, Simoncini; D, Tartaglia; G, Anania; P, Carcoforo; M, Chiozza; Troia A, De; Radica M, Koleva; M, Portinari; Mg, Sibilla; A, Urbani; N, Fabbri; Cv, Feo; S, Gennari; S, Parini; E, Righini; L, Ampollini; Arcuri, M. F.; L, Bellanti; M, Bergonzani; G, Bertoli; G, Bocchialini; L, Cattelani; G, D’Angelo; F, Gussago; D, Lanfranco; E, Manigrasso; L, Musini; T, Poli; S, Polotto; Gp, Santoro; A, Varazzani; L, Aguzzoli; V, Annessi; G, Borgonovo; Ruiz C, Castro; S, Coiro; G, Falco; Vd, Mandato; V, Mastrofilippo; Montella, M. T.; M, Zizzo; U, Grossi; S, Novello; M, Romano; S, Rossi; G, Zanus; G, Esposito; F, Frongia; A, Pisanu; M, Podda; C, Belluco; A, Lauretta; G, Montori; L, Moras; Irccs, Olivieri M.; Aviano, Null; F, Bussu; Ag, Carta; Ml, Cossu; P, Cottu; A, Fancellu; Cf, Feo; Gc, Ginesu; G, Giuliani; M, Madonia; T, Perra; A, Piras; A, Porcu; D, Rizzo; Scanu, A. M.; A, Tedde; M, Tedde; A, Aversano; F, Carbone; P, Delrio; Lauro K, Di; Bucci A, Fares; D, Rega; G, Spiezio; G, Pirozzolo; A, Recordare; C, Vignotto; G, Badalamenti; G, Campisi; A, Cordova; M, Franza; G, Maniaci; G, Rinaldi; F, Toia; M, Calabrò; F, Farnesi; Eg, Lunghi; A, Muratore; Federico NS, Pipitone; G, D’Andrea; P, Familiari; V, Picotti; Palma G, De; G, Luglio; G, Pagano; Fp, Tropeano; B, Antonelli; L, Baldari; Ga, Beltramini; L, Boni; E, Cassinotti; A, Gianni’; L, Pignataro; G, Rossi; S, Torretta; C, Abatini; M, Baia; D, Biasoni; G, Bogani; P, Cadenelli; V, Capizzi; Spb, Cioffi; D, Citterio; Lv, Comini; M, Cosimelli; M, Fiore; S, Folli; M, Gennaro; L, Giannini; A, Gronchi; M, Guaglio; A, Macchi; F, Martinelli; V, Mazzaferro; A, Mosca; S, Pasquali; C, Piazza; F, Raspagliesi; L, Rolli; R, Salvioni; G, Sarpietro; C, Sarre; L, Sorrentino; A, Agnes; S, Alfieri; F, Belia; A, Biondi; M, Cauteruccio; V, Cozza; D, D’Ugo; Simone V, De; A, Fagotti; G, Gasparini; L, Gordini; F, Litta; Cp, Lombardi; L, Lorenzon; G, Maccauro; Aa, Marra; F, Marzi; A, Moro; A, Parello; E, Perrone; R, Persiani; C, Ratto; F, Rosa; G, Saponaro; G, Scambia; O, Scrima; G, Sganga; R, Tudisco; R, Vitiello; A, Ziranu; A, Belli; V, Granata; F, Izzo; R, Palaia; R, Patrone; Fm, Carrano; Mm, Carvello; Virgilio A, De; Candido F, Di; F, Ferreli; F, Gaino; G, Mercante; V, Rossi; A, Spinelli; G, Spriano; Pmdd, Santos; Nardi C, De; Donati, D. M.; T, Frisoni; E, Palmerini; A, Aprile; F, Barra; P, Batistotti; S, Ferrero; P, Fregatti; A, Massobrio; D, Pertile; S, Scabini; D, Soriero; M, Sparavigna; L, Adamoli; M, Ansarin; S, Cenciarelli; F, Chu; Berardinis R, De; Romario U, Fumagalli; F, Mastrilli; G, Pietrobon; M, Tagliabue; E, Badellino; N, Biglia; Piat F, Chiado’; A, Ferrero; R, Massobrio; Garberini A, De Manzoni; F, Mazzotti; F, Pasini; G, Ugolini; R, Barone; Sl, Birolo; M, Caccetta; A, Deirino; M, Garino; M, Grasso; C, Marafante; A, Masciandaro; E, Moggia; S, Mungo; A, Murgese; E, Raggio; P, Federico; P, Maida; E, Marra; G, Marte; A, Petrillo; T, Tammaro; A, Tufo; M, Berselli; G, Borroni; E, Cocozza; L, Conti; M, Desio; L, Livraghi; V, Marchionni; V, Quintodei; A, Rizzi; C, Baldi; C, Corbellini; Gm, Sampietro; P, Bordoni; G, Clarizia; F, Fleres; M, Franzini; A, Grechi; A, Longhini; A, Spolini; P, Cellerino; E, Galfrascoli; G, Iacob; E, Baldini; P, Capelli; L, Conti; Isolani, S. M.; M, Ribolla; A, Bondurri; F, Colombo; L, Ferrario; C, Guerci; A, Maffioli; T, Armao; M, Ballabio; P, Bisagni; A, Gagliano; M, Longhi; M, Madonini; P, Pizzini; Baietti, A. M.; M, Biasini; P, Maremonti; F, Neri; Gm, Prucher; S, Ricci; F, Ruggiero; Ag, Zarabini; H, Impellizzeri; M, Inama; G, Moretto; R, Barmasse; S, Mochet; L, Morelli; A, Usai; F, Bianco; P, Incollingo; M, Giacometti; S, Zonta; Cosentino L, Marino; A, Sagnotta; C, Dell’Oro; R, Fruscio; T, Grassi; S, Negri; Lc, Nespoli; N, Tamini; B, Zambetti; A, Anastasi; B, Bartalucci; A, Bellacci; G, Canonico; L, Capezzuoli; Martino C, Di; P, Ipponi; C, Linari; M, Montelatici; T, Nelli; G, Spagni; L, Tirloni; A, Vitali; E, Abate; M, Casati; T, Casiraghi; L, Laface; M, Schiavo; A, Arminio; A, Cotoia; V, Lizzi; F, Vovola; R, Vergari; S, D’Ugo; N, Depalma; Spampinato, M. G.; A, Annicchiarico; F, Catena; M, Giuffrida; G, Perrone; G, Baronio; F, Carissimi; M, Montuori; E, Pinotti; P, Bartolucci; B, Binda; G, Brachini; P, Bruzzaniti; A, Chiappini; V, Chiarella; F, Ciccarone; Pm, Cicerchia; B, Cirillo; D, Crocetti; Toma G, De; A, Di bartolomeo; G, Duranti; E, Fiori; Gb, Fonsi; G, Franco; A, Frati; M, Giugliano; I, Iannone; Torre F, La; P, Lapolla; C, Leonardo; G, Marruzzo; S, Meneghini; A, Mingoli; D, Ribuffo; M, Salvati; A, Santoro; P, Sapienza; Ak, Scafa; L, Simonelli; G, Zanacana; M, Zambon; E, Zuppi; Gt, Capolupo; F, Carannante; M, Caricato; G, Mascianà; E, Mazzotta; A, Gattolin; M, Migliore; R, Rimonda; D, Sasia; E, Travaglio; A, Chessa; A, Fiorini; C, Norcini; G, Colletti; M, Confalonieri; A, Costanzi; C, Frattaruolo; G, Mari; M, Monteleone; A, Bandiera; L, Bocciolone; G, Bonavina; M, Candiani; G, Candotti; Nardi P, De; F, Gagliardi; M, Medone; P, Mortini; G, Negri; P, Parise; M, Piloni; P, Sileri; A, Vignali; A, Belvedere; P, Bernante; P, Bertoglio; S, Boussedra; E, Brunocilla; M, Cervellera; M, Cescon; R, Cipriani; G, Cisternino; Crescenzo E, De; Iaco P, De; Gaudio M, Del; G, Dondi; M, Droghetti; G, Germinario; A, Gori; F, Frio; E, Jovine; Bianchi F, Mineo; D, Morezzi; J, Neri; D, Parlanti; Perrone, A. M.; Ap, Pezzuto; M, Pignatti; V, Pinto; G, Poggioli; M, Ravaioli; M, Rottoli; Is, Russo; L, Sartarelli; R, Schiavina; M, Serenari; M, Serra; P, Solli; V, Tonini; M, Taffurelli; M, Tanzanu; M, Tesei; T, Violante; S, Zanotti; F, Borghi; D, Cianflocca; Grimaldi S, Di Maria; D, Donati; E, Gelarda; P, Geretto; G, Giraudo; Mc, Giuffrida; F, Maione; A, Marano; S, Palagi; L, Pellegrino; C, Peluso; S, Giaccardi; V, Testa; F, Agresta; D, Prando; M, Zese; F, Aquila; C, Gambacciani; L, Lippa; F, Pieri; Os, Santonocito; G, Armatura; G, Bertelli; A, Frena; P, Marinello; F, Notte; S, Patauner; G, Scotton; S, Fulginiti; G, Gallo; G, Sammarco; G, Vescio; P, Balercia; L, Catarzi; G, Consorti; Elg, Asti; D, Bernardi; L, Bonavina; A, Lovece; Marzo F, Di; H, Fujiwara; D, Hashimoto; S, Yamaki; T, Yamamoto; H, Daiko; M, Ishikawa; K, Ishiyama; S, Iwata; K, Kanematsu; Y, Kanemitsu; T, Kato; A, Kawai; E, Kobayashi; Kato M, Kobayashi; K, Moritani; M, Nakagawa; F, Nakatani; J, Oguma; Y, Tanase; M, Uno; T, Hada; H, Iwahashi; M, Miyamoto; J, Suminokura; M, Takano; K, Fujiwara; N, Fujiwara; A, Kurosaki; H, Ababneh; Abdallah M, Al; F, Ayasra; Y, Ayasra; F, Hammad; A, Qasem; Za’nouneh FJ, Abu; Al-Shraideh, A. A.; T, Fahmawee; A, Hmedat; A, Ibrahim; K, Obeidat; Al S, Abdel; Jalil R, Abdel; Chaar MK, Abou; Al-Masri, M.; Al-Najjar, H.; F, Alawneh; O, Alsaraireh; M, Elayyan; R, Ghanem; I, Lataifeh; I, Fakhradiyev; T, Saliev; S, Tanabayeva; H, Almahmeed; S, Almazeedi; S, Alsabah; M, Jamal; N, Aldokali; O, Senossi; Subhi, M. T.; M, Algallai; S, Alwarfly; S, Alzaede.; M, Gahwagi; M, Moftah; M, Abusannoga; A, Alawami; M, Alawami; M, Albashri; A, Malek; D, Burgan; E, Kamoka; Ai, Kilani; A, Salamah; M, Salem; A, Shuwayyah; M, Abdelkabir; I, Altomi; M, Altoumi; A, Bouhuwaish; A, Elmabri; M, Omar; As, Taher; E, Abdulwahed; E, Alshareea; N, Aribi; S, Aribi; M, Biala; R, Ghamgh; M, Morgom; Saa, Alansari; Z, Aldayri; A, Alsoufi; A, Elhadi; F, Elhajdawe; I, Ellojli; Aad, Ergebi; A, Kredan; A, Msherghi; T, Nagib; A, Abudher; K, Alshareef; F, Elamin; S, Bradulskis; E, Dainius; E, Kubiliute; J, Kutkevičius; A, Parseliunas; A, Subocius; D, Venskutonis; F, Rasoaherinomenjanahary; Jb, Razafindrahita; Lh, Samison; Ec, Ong; Maei N, Abdul; Cw, Ngo; S, Ramasamy; Kh, Hamdan; Mr, Ibrahim; Ja, Tan; Mr, Thanapal; E, Choong; Rzm, Lim; Sahid N, Amin; F, Hayati; J, Jayasilan; Rk, Sriram; S, Subramaniam; Af, Ibrahim; A, Che jusoh; Ah, Hussain; Sidek AS, Mohamed; Yunus, Mohd; Jy, Soh; Mp, Wong; Ad, Zakaria; Z, Zakaria; N, Kampan; Azman ZA, Mohd; Azurah AG, Nur; Aa, Zainuddin; An, Fadzli; Nq, Fathi; Ps, Koh; Yt, Liew; Ac, Roslani; Cy, Tang; Ly, Teoh; Wj, Wong; R, Xavier; As, Yahaya; Mr, Alvarez; R, Arrangoiz; F, Cordera; De la Rosa Abaroa, M. A.; Gómez-Pedraza, A.; R, Hernandez; Maffuz-Aziz, A.; Ja, Posada; Lupián-Angulo, A. I.; Martínez CE, Soulé; Hasan Z, Aboharp; C, ALvarado Silva; Soto A, Bazan; Rubio A, Hernández; Villanueva X, Jiménez; Lr, Otoniel; Duran EE, Sosa; García FC, Becerra; Melchor-Ruan, J.; Bañuelos E, Romero; Vilar-Compte, D.; Alfaro-Goldaracena, A.; Ga, Buerba; Castillejos-Molina, R. A.; C, Chan; Dominguez-Rosado, I.; Medina-Franco, H.; Má, Mercado; Oropeza-Aguilar, M.; Portugal E, Peña Gómez; Posadas-Trujillo, O. E.; Rodriguez-Covarrubias, F.; Salgado-Nesme, N.; C, Sarre; M, Vilatoba; Y, Arkha; H, Bechri; Ouahabi A, El; My, Oudrhiri; Azhari A, El; Louraoui, S. M.; M, Rghioui; M, Bougrine; F, Derkaoui hassani; N, El abbadi; L, Amrani; Zh, Belkhadir; A, Benkabbou; O, Chakib; Ahmadi B, El; Bouazizi Y, El; H, Essangri; A, Ghannam; Majbar, A. M.; R, Mohsine; A, Souadka; Abj, Borgstein; Ss, Gisbertz; Henegouwen MI (Amsterdam UMC, Van Berge; Amsterdam, Cancer Center; Amsterdam, University of; R, Hompes; Praag EM, Meima-van; A, Pronk; S, Sharabiany; B, Grotenhuis; L, Hartveld; S, Reijers; Van Houdt, W.; J, Baaij; Eenennaam M, Bolster-van; Graaff M, De; D, Sloothaak; Duijvendijk P, Van; Lda, Ebben; Sz, Kuiper; J, Melenhorst; M, Poeze; Nrf, Sluijpers; Laa, Vaassen; Posma-Bouman, L.; T, Derksen; J, Franken; S, Oosterling; Bree R, De; J, Konsten; Heinsbergen M, Van; A, Adeyeye; A, Akinmade; E, Enoch; S, Fayose; P, Abur; L, Fidelis; Se, Nwabuoku; N, Oyelowo; Tt, Sholadoye; Tolani, M. A.; J, Olaogun; H, Abiyere; I, Adebara; A, Adeniyi; O, Adeyemo; O, Babalola; A, Bakare; O, Banjo; A, Okunlola; A, Adeniran; K, Atobatele; G, Eke; O, Faboya; A, Ogunyemi; O, Omisanjo; O, Oshodi; Y, Oshodi; O, Williams; A, Ademuyiwa; B, Afolabi; O, Akinajo; F, Alakaloko; O, Atoyebi; O, Balogun; O, Belie; C, Bode; George I, Chibuike; O, Elebute; Ladipo-Ajayi, O.; E, Ohazurike; A, Okunowo; To, Olajide; Seyi-Olajide, J.; A, Daniel; Ik, Egbuchulem; Ta, Lawal; O, Nwaorgu; O, Ogundoyin; D, Olulana; P, Onakoya; O, Oyelakin; H, Abdullahi; E, Agida; Aisuodionoe-Shadrach, O.; H, Ajibola; G, Akaba; As, Sani; J, Chinda; Y, Dawang; S, Garba; P, Mshelbwala; J, Obande; S, Olori; A, Olute; O, Osagie; Ogolekwu I, Pius; A, Umar; Abdur-Rahman, L.; N, Adeleke; A, Adeyeye; I, Aremu; J, Bello; O, Olasehinde; A, Popoola; Ho, Raji; Jg, Massoud; R, Massoud; Tm, Sorour; J, Abassy; K, Ahmed; A, Alvi; M, Arshad; S, Khan; A, Pirzada; A, Saleem; T, Siddiqui; K, Turk; F, Hanif; M, Haroon; Mi, Khan; A, Jamal; Aa, Kerawala; As, Memon; Ahmed R, Nafees; L, Rai; S, Javed; U, Mahmood; Rk, Shabbir; E, Yaqoob; A, Afzal; Riaz S, Ahmed; A, Akbar; Aa, Ali; G, Ali; A, Janjua; M, Mohsin; Sa, Naqi; I, Saleem; A, Shaukat; M, Sohail; Afzal, M. F.; Mi, Khokhar; F, Latif; B, Ayub; N, Hassan; Rs, Martins; P, Ramesh; R, Sayyed; M, Ayyaz; U, Butt; M, Kashif; Wh, Khan; Au, Qureshi; M, Umar; Farooka M, Waris; T, Wasim; Abh, Bhatti; A, Ayubi; I, Rashid; Sh, Waqar; Al-Slaibi, I.; Alzeerelhouseini H, I. A.; F, Jobran; Sa, Abukhalaf; E, Arrue; M, Cukier; Rodriguez-Zentner, H.; Borda-Luque, G.; Palacios JL, León; G, Lizzetti; Ojeda XP, Vasquez; Pacheco GM, Falcon; R, Robles; R, Jocson; C, Teh; Magadia E, Uy; P, Major; M, Bąk; K, Dubieńska; A, Ławnicka; D, Murawa; M, Bobiński; J, Kotarski; Rasoul-Pelińska, K.; A, Brociek; A, Chloupek; M, Janik; P, Kowalewski; A, Kwiatkowski; P, Panasiewicz; R, Roszkowski; P, Rot; P, Sroczyński; M, Walędziak; C, Azevedo; D, Machado; F, Mendes; Sousa X, De; U, Fernandes; C, Ferreira; G, Guidi; C, Leal; A, Marçal; R, Marques; D, Martins; A, Melo; N, Tenreiro; Pereira R, Vaz; B, Vieira; Ji, Almeida; Almeida-Reis, R.; de Sá T, Correia; Mjma, Costa; V, Fernandes; I, Ferraz; da Cruz L, Lima; da Silva C, Lima; L, Lopes; N, Machado; J, Marialva; Coelho M, Nunes; J, Pedro; C, Pereira; A, Ribeiro; Cg, Ribeiro; R, Santos; P, Saraiva; Rl, Silva; F, Tavares; M, Teixeira; P, Valente; Ac, Almeida; Mj, Amaral; R, Andrade; Nemésio R, Athayde; D, Breda; C, Camacho; C, Canhoto; M, Colino; S, Correia; M, Costa; Barros J, De; López AL, De Oliveira; M, Duque; S, Garrido; P, Guerreiro; A, Guimarães; A, Lázaro; C, Lopes; R, Martins; O, Nogueira; A, Oliveira; Jm, Oliveira; M, Rodrigues; A, Ruivo; E, Santos; M, Silva; J, Simões; da Costa A, Valente; A, Almeida; Rodrigues S, Castanheira; Leitão de Carvalho AS, Cavaleiro; V, Devezas; Cs, Faria; F, Jácome; Maia M, Magalhães; J, Nogueiro; A, Pereira; Pereira-Neves, A.; Pina-Vaz, T.; Santos-Sousa, H.; H, Silveira; S, Vaz; P, Vieira; da Costa A, Gomes; Antunes I, Lobo; J, Pinto; A, Tojal; N, Cardoso; P, Cardoso; Jc, Domingues; P, Henriques; Mi, Manso; G, Martins dos Santos; R, Martins; H, Morais; R, Pereira; T, Revez; R, Ribeiro; Ribeiro, Null; A, Soares; S, Sousa; J, Teixeira; E, Amorim; Vh, Baptista; Cunha, M. F.; B, Dias; A, Fazenda; Neves JP, Melo; F, Policarpo; da Nóvoa Gomes Miguel, Sampaio; D, Veiga; Jp, Bandovas; N, Borges; A, Branquinho; B, Chumbinho; J, Correia; H, Fidalgo; de Barros I, Figueiredo; S, Frade; J, Gomes; da Silva Andrade A, Kam; J, Maciel; Rodrigues A, Pereira; S, Pina; N, Silva; Nunes I, Silveira; R, Sousa; J, Ascensão; P, Azevedo; B, Costeira; C, Cunha; R, Garrido; H, Gomes; I, Lourenço; G, Mendinhos; P, Miranda; Pinto A, Nobre; Ferreira M, Peralta; J, Ribeiro; Rodrigues L, Rio; Fernandes M, Sousa; J, Azevedo; D, Galvão; Ac, Soares; A, Vieira; B, Vieira; B, Patrício; Lopes AC, Vieira Paiva; R, Cunha; A, Faustino; A, Freitas; Oliveira B, Jacob; Martins, A. B.; Jr, Mendes; R, Parreira; J, Rosa; M, Teves; da Silva A, Abreu; M, Claro; Santos D, Costa; Ac, Deus; Jv, Grilo; Borges F, Castro; Real J, Corte; S, Henriques; Mj, Lima; Costa P, Matos; Joao A, Alagoa; P, Azevedo; R, Camarneiro; I, Capunge; M, Fragoso; J, Frazão; A, Martins; V, Pedro; R, Pera; de Almeida F, Ramalho; Soares A, Sampaio; R, Vale; M, Vasconcelos; da Silva F, Brito; A, Caiado; F, Fonseca; M, Ângelo; Jm, Baiao; Jordão D, Martins; Caroço T, Vieira; J, Messias; A, Millan; I, Salgado; P, Santos; C, Baía; R, Canotilho; Correia, A. M.; Pinto AP, Ferreira; M, Peyroteo; Jf, Videira; P, Escobar; Santiago M, Maldonado; R, Kassir; F, Sauvat; E, Bonci; V, Gata; S, Titu; C, Bezede; A, Chitul; E, Ciofic; D, Cristian; F, Grama; L, Pirtea; C, Secosan; C, Ciubotaru; I, Negoi; Vm, Negoita; B, Stoica; O, Ginghina; N, Iordache; Rv, Iosifescu; M, Mardare; Rm, Mirica; A, Spanu; Văcărașu, A. B.; M, Zamfir-Chiru-Anton; T, Garmanova; E, Kazachenko; D, Markaryan; S, Rodimov; P, Tsarkov; I, Tulina; A, Abelevich; A, Bazaev; Ak, Kokobelyan; Yanishev, A.; A, Litvin; Y, Litvina; A, Provozina; M, Agapov; E, Galliamov; V, Kakotkin; V, Kubyshkin; E, Semina; А, Камалов; A, Novikova; A, Zakharenko; M, Alshahrani; F, Alsharif; M, Eskander; Raddadi R, Al; S, Majrashi; A, Mashat; N, Akeel; M, Alharthi; M, Aljiffry; M, Basendowah; A, Farsi; M, Ghunaim; A, Khoja; A, Maghrabi; N, Malibary; M, Nassif; A, Nawawi; A, Saleem; A, Samkari; N, Trabulsi; Azab M, A.; M, Aldosri; A, Alghanem; A, Alguraigari; K, Aljohani; D, Alqahtani; Tm, Alzaidi; A, Basyouni; E, Elhussain; H, Jaloun; I, Mudawi; M, Shafei; Awwad S, Al; M, Alghamdi; T, Alnumani; M, Nasser; A, Said bayazeed; S, Abdelrhman; S, Awad; S, Ghedan; Sharara M, I.; A, Mashaly; M, Aburahmah; Otaibi F, Al; I, Al-alem; Al-Badawi, I. A.; H, Aldahash; N, Alhazzaa; A, Alhefdhi; B, Alhelal; K, Alkattan; O, Almalik; A, Alomair; O, Alomar; Nh, Alotaibi; F, Alresaini; O, Alrifai; M, Alsakka; R, Alsalamah; M, Alsemari; S, Alsobhi; T, Alsumai; F, Farrash; P, Khan; Z, Mahasin; E, Othman; R, Pant; H, Robaidi; W, Saleh; H, Salem; M, Shaheen; P, Spangenberg; S, Velagapudi; Habes H, Al; A, Alamri; S, Alkarak; M, Alqannas; M, Alyami; M, Alzamanan; Cortés-Guiral, D.; A, Elawad; H, Adi; F, Al ahmad; Ayed A, Al; A, Al zahrani; Y, Alalawi; Y, Alishi; B, Alqahtani; O, Alaamer; L, Alriyees; N, Alselaim; J, Alfaifi; N, Alkreedees; Sn, Almutrafi; M, Alramadhan; A, Alshitwi; J, D’Souza; A, Abdulkareem; A, Ajlan; K, Akkour; Al-Habib, A.; Al-Khayal, K.; A, Alatar; A, Alburakan; H, Alhalal; B, Alhassan; N, Alhassan; F, Aljassir; O, Alobeed; A, Alsaif; F, Alsaif; S, Alshammari; I, Alshaygy; M, Barry; Nasser A, Bin; Traiki T, Bin; A, Bokhari; S, Elwatidy; H, Helmi; A, Madkhali; T, Nouh; Rabah, P. D.; A, Zubaidi; Amri A, Al; F, Abdulfattah; Hasan I, Al; Al-Kharashi, E.; F, Alanazi; F, Albaqami; A, Alghamdi; A, Alghuliga; F, Aljaber; K, Alsowaina; A, Alsuhaibani; N, Arab; F, Badahdah; S, Alobaysi; A, Alshahrani; A, Alzahrani; I, Paunovic; N, Slijepcevic; L, Aleksić; A, Antic; G, Barisic; M, Ceranic; K, Ebrahimi; D, Galun; Ž, Grubač; N, Ivanović; J, Jelenkovic; D, Kecmanović; S, Kmezić; D, Knezevic; Z, Krivokapic; S, Latinčić; V, Markovic; S, Matić; M, Miladinov; M, Pavlov; I, Pejovic; D, Radenkovic; P, Sabljak; O, Skrobić; V, Šljukić; B, Tadic; J, Vasljević; D, Velickovic; M, Zivanovic; K, Doklestic; P, Gregoric; N, Ivancevic; Z, Loncar; D, Micic; M, Perovic; L, Srbinovic; S, Andrijasevic; T, Bozanovic; Popovic R, Cerovic; M, Dokic; T, Janjic; K, Jeremic; S, Kadija; Likic I, Ladjevic; L, Mirkovic; S, Pantovic; I, Pilic; M, Radojevic; A, Stefanovic; S, Vidakovic; Z, Vilendecic; S, Antic; D, Dunđerović; D, Jelovac; Z, Jezdic; V, Konstantinovic; B, Kotlar; C, Kuzmanovic; M, Lazić; S, Pajić; M, Petrovic; F, Popovic; A, Pucar; M, Romic; S, Sumrak; V, Vujanac; V, Bascarevic; I, Bogdanovic; D, Grujičić; R, Ilic; M, Jokovic; M, Milićević; F, Milisavljević; A, Miljković; A, Paunovic; V, Šćepanović; A, Stanimirovic; M, Todorovic; M, Folic; A, Jotic; Trivic S, Krejovic; J, Milovanovic; A, Trivic; U, Bumbasirevic; Z, Dzamic; B, Kajmaković; N, Prijović; M, Zivkovic; M, Buta; A, Cvetkovic; I, Djurisic; S, Gacic; M, Goran; Z, Inic; N, Jeftic; M, Jevric; V, Jokic; I, Markovic; M, Milanović; S, Nikolic; L, Pejnovic; N, Savković; I, Spurnic; D, Stevic; D, Stojiljkovic; N, Vucic; M, Zegarac; A, Karamarkovic; M, Kenic; B, Kovacevic; I, Krdzic; V, Milutinović; G, Savic; Cw, Chan; B, Lieske; B, Gális; K, Šimko; A, Cokan; B, Crnobrnja; A, Dovnik; J, Knez; M, Pakiž; N, Almgla; M, Bernon; A, Boutall; L, Cairncross; G, Chinnery; A, Herman; T, Hilton; E, Jonas; C, Kloppers; F, Malherbe; W, Mugla; D, Nel; S, Rayamajhi; M, Scriba; Wyngaard T, Van; J, Vogel; Castaño-Leon, A. M.; Fernandez J, Delgado; Fernandez C, Eiriz; Segura-Illa M, Espino; Sinovas O, Esteban; Perez D, Garcia; P, Gomez; Jimenez-Roldan, L.; A, Lagares; Moreno-Gomez, L.; I, Paredes; Núñez A, Pérez; Aniceto G, Sánchez; Alegret M, Santas; Rodríguez P, Fernández; Señorans M, Paniagua García; Sanchez-Santos, R.; V, Vigorita; E, Acrich; Sanfeliu E, Baena; O, Barrios; T, Golda; C, Santanach; Serrano-Navidad, M.; Grifell M, Sorribas; Rv, Vives; Gil J, Arce; D, Escolà; A, Jiménez; Ja, Alcázar; Angoso-Clavijo, M.; Blanco-Antona, F.; Carabias-Orgaz, A.; Maag R, Díaz; Larrea M, Eguía; Velasco C, Esteban; J, Garcia; García-Plaza, A. G. P.; Gonzalez-Muñoz, J. I.; Muñoz-Bellvis, L.; Parreño-Manchado, F. C.; Tocino JM, Sánchez; Sanchez-Casado, A. B.; J, Trebol; Gutierrez J, Hernandez; Zamora A, Tébar; Mozo A, Sánchez; Paniagua L, Cayetano; Fernandez L, Gomez; E, Artigues; Bernal-Sprekelsen, J. C.; Bauset JC, Catalá; Gilabert-Estellés, J.; P, Collera; Del Gobbo R, Diaz; Font R, Farre; Clotet R, Flores; Díaz CJ, Gómez; N, Guàrdia; Ca, Guariglia; A, Osorio; Jimenez R, Sanchez; L, Sanchon; Montesinos C, Soto; Martin B, Albi; Villayzán JE, García; Alonso-Lamberti, L.; M, Assaf; Pintado N, Baeza; A, Carabias; García-Quijada, J.; Fernandez, Huertas; Miramón J, Jimenez; V, Jimenez; Jm, Jover; Agüero SA, Landeo; R, Leon; Martín Salamanca, M. B.; Simón V, Pérez; S, Ponce; Jl, Rodriguez; A, Salazar; Rubio A, Valle; H, Aguado; Ansorregui I, Aldecoa; Infante R, Bravo; Lacy FB, De; Somma A, Di; Díaz-Feijoo, B.; Nora J, Enseñat; N, Fabregas; A, Ferrés; Ibañez B, Gil; Sanchez JJ, Gonzalez; I, Gracia; Castro JA, Hoyos; Lacy, A. M.; C, Langdon; D, Momblán; X, Morales; L, Oleaga; A, Otero; L, Pedrosa; Carrizo J, Poblete; Figueroa LA, Reyes; Roldan Ramos, P.; Rumia-Arboix, J.; Tercero-Uribe, A. I.; Te, Topczewski; J, Torales; A, Torne; R, Torné; Turrado-Rodriguez, V.; R, Valero; S, Valverde; R, Anula; R, Avellana; Rodríguez E, Camarero; Garza V, Catalán; J, Dziakova; Alonso M, García; Martínez B, Lasses; Antoñanzas L, López; Jm, Muguerza; S, Ochagavía; Soria MJ, Peña; Rivera-Alonso, D.; Carlin P, Saez; C, Sánchez del Pueblo; Ortega G, Sanz; Sanz-Lopez, R.; A, Torres; Garcés-Albir, M.; F, Lopez; Martín-Arévalo, J.; Moro-Valdezate, D.; Pla-Marti, V.; de Heredia J, Beltrán; Andrés-Asenjo B, De; Sanz T, Gómez; C, Jezieniecki; Del Barrio H, Nuñez; de Solórzano Aurusa FJ, Ortiz; de Diego A, Romero; Soriano M, Ruiz; Díaz J, Trujillo; Fernandez A, Vazquez; Lora-Cumplido, P.; Mv, Sosa; C, Balague; E, Ballester; A, Moral; López A, Sánchez; Em, Targarona; Galvan-Perez, A.; Gonzalez-Gonzalez, E.; Minaya Bravo, A. 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A.; M, Tudela; Ortúzar J, Zorrilla; Matas F, Alcaide; Pérez JM, García; Pereira P, Troncoso; Laina JL, Blas; B, Cros; J, Escartin; Egea J, Garcia; A, Nogués; El-Abur I, Talal; C, Yánez; Mora-Guzmán, I.; Puiggrós L, Cárdenas; M, Abellán; Boira M, Achalandabaso; R, Jorba; Ikuga R, Memba; C, Olona; Mallafré R, Sales; O, Aguilo; Busquets P, Cavallé; Pellice MGP, Gavalda; Sole M, Jorda; I, Mateu; Curto M, Miralles; Peña J, Salinas; Martínez D, Fernández; Flórez LJ, García; Solar-Garcia, L.; Achig EJ, Aragon; L, Barbier; Vivancos P, Caja; A, Gainza; Gutierrez JJ, García; García-Operé, G.; Gómez-Suárez, J.; Jiménez-Jiménez, M.; Ormaechea G, Mallabiabarrena; H, Marín; Playa P, Martin; Corcóstegui I, Melchor; Municio-Martín, J. A.; M, Oñate; Pascua-Gómez, L. A.; Pesántez Peralta, M. A.; Calvo M, Prieto; Fraga A, Rodriguez; Ateca I, Villalabeitia; Olabarria U, De Andres; Ballesteros M, Durán; Pablos FJ, Fernández; Ibáñez-Aguirre, F. J.; Larrainzar A, Sanz; Ugarte-Sierra, B.; Acosta Mérida, M. A.; López D, Ortiz; Cano AF, Yepes; Bonito A, Correa; la Hoz Rodríguez Á, De; Búrdalo L, Delgado; Martino M, Di; Sánz I, García; Septiem J, García; González R, Maqueda; Martin-Perez, E.; de Nova JL, Muñoz; Espino P, Calvo; Ruano P, Guillamot; García L, Colao; Pérez D, Díaz; Agustí E, Esteban; Jara P, Galindo; Samaniego M, Gutierrez; Hernandez Bartolome, M. A.; González J, Serrano; Poza A, Alonso; B, Diéguez; García-Conde, M.; Hernández-García, M.; M, Losada; Chiesa-Estomba, C. M.; Já, González García; E, Larruscain; Sistiaga-Suárez, J. 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J.; F, Alconchel; A, Conesa; Martínez J, Gil; Fernández AI, Gutiérrez; Abad A, Lopez; Nicolás-López, T.; Romero P, Ramirez; Calvo MJ, Roca; K, Rodrigues; Manzanera JJ, Ruiz; Ai, Soriano; A, Cano; Capitan-Morales, L.; Catena J, Cintas; Gomez-Rosado, J.; Mompean F, Oliva; Sánchez, Pérez; Lafuente FD, Río; Arcos C, Torres; Valdes-Hernandez, J.; Esteban M, Bruna; H, Cholewa; S, Domingo; M, Frasson; V, Lago; Martin T, Marina; Chicote C, Martínez; Sancho-Muriel, J.; Estraviz-Mateos, B.; Cruzado L, Fernández Gómez; de Miguel M, González; A, Landaluce-olavarria; D, Lecumberri; Gurumeta A, Abad; Abad-Motos, A.; Martínez-Hurtado, E.; Ripollés-Melchor, J.; Escobar A, Ruiz; Cuadrado-García, A.; Tellez L, Garcia-Sancho; Aznar J, Heras; Mate P, Maté; Vázquez I, Ortega; Al, Picardo; López JA, Rojo; Noguera F, Sanchez Cabezudo; de Colsa D, Serralta; Latorre J, Anchuelo; Fernandez C, Cagigas; Ruiz R, Caiña; Diaz MJ, Fernandez; Ruiz M, Gomez; F, Hernanz; Fraile J, Jimeno; Martínez-Pérez, P.; C, Poch; Martinez S, Santarrufina; Jabares V, Valbuena; Moliner-Sachez, C.; Pingarron-Martin, L.; Rey-Biel, J.; Martin I, Ruiz; Ortega EP, Cagigal; I, Cervera; Peña P, Díaz; de Castro Rubio E, Garcia; D, Enjuto; Bernabé P, Fernández; García R, Garcés; J, Gonzalez; I, Hernández; Herrera-Merino, N.; De Salas M, Marqueta; Pascual P, Martinez; Gonzalez M, Perez; Bonilla A, Ramos; Gómez L, Rodríguez; Garcia M, Alfonso; Craus-Miguel, A.; Vega L, Fernández; Ferrer-Inaebnit, E.; Catalán A, Gil; Argente FX, González; S, Jeri; A, Oseira; Cano N, Pujol; Segura-Sampedro, J. J.; Verdeguer C, Soldevila; B, Villalonga; C, Bescós; Blanco-Colino, R.; I, Brana; B, Caimari; García-Cuenca A, De Pablo; Duran-Valles, F.; Espin-Basany, E.; López de Sagredo J, Giralt; J, Pamias; G, Pellino; N, Prat; Pina R, Pujol; M, Saez barba; A, Arulanantham; Gbkd, Bandara; U, Jayarajah; S, Ravindrakumar; Vsd, Rodrigo; Adil AA, Ali; Mhy, Elhafiz; Ee, Ali; M, Awadelkarim; I, Bakheit; H, Elbahri; Hks, Hamid; Essa, M. E. A.; Aa, Ahmed; Hassan, Abubakr; Yousuf Hilles, Momin Majed; M, Saleh; S, Arkani; J, Freedman; P, Elbe; Ek, Lindqvist; E, Angenete; J, Park; H, Taflin; L, Greiff; L, Hagander; A, Älgå; G, Heinius; M, Nordberg; E, Pieniowski; I, Gkekas; N, Löfgren; M, Rutegård; M, Sund; M, Arigoni; M, Bernasconi; D, Christoforidis; Giuseppe M, Di; Regina D, La; F, Mongelli; M, Chevallay; O, Dwidar; E, Gialamas; M, Sauvain; R, Giger; S, Hool; F, Klenke; A, Kollàr; C, Kurze; Sa, Mueller; S, Kiessling; S, Stoeckli; M, Adamina; T, Bächler; As, Crugnale; M, Giardini; L, Guglielmetti; G, Peros; F, Solimene; M, Gass; J, Metzger; A, Scheiwiller; C, Gutschow; M, Turina; Asadi T, Al; S, Alkhateb; R, Altom; B, Bakkar; Albared S, Maa; S, Melhem; A, Hamdan; A, Hammed; S, Hammed; M, Hossain; M, Mahfoud; A, Moussa; R, Alsayyad; S, Alsrouji; G, Ashour; Al-Nahr M, Hareth; A, Slitin; C, Tanos; Mj, Kacem; H, Maghrebi; A, Sebai; A, Aghayeva; I, Hamzaoglu; I, Sahin; E, Akaydin; Z, Aliyeva; E, Aytac; B, Baca; O, Dülgeroğlu; V, Ozben; Bb, Ozmen; C, Uras; Ae, Arikan; Ia, Bilgin; B, Bozkırlı; Go, Ceyhan; H, Kara; T, Karahasanoğlu; C, Uras; H, Celik; Mm, Meydanli; A, Akbas; Y, Altinel; F, Calikoglu; G, Ercan; C, Ercetin; Na, Hacım; S, Meriç; M, Tokocin; T, Vartanoglu; H, Yigitbas; H, Akilli; A, Ayhan; E, Kuscu; M, Doğangün; N, Iflazoğlu; Ö, Yalkın; A, Turna; Onan, M. A.; U, Akgor; O, Cennet; Ha, Dincer; T, Erol; M, Gultekin; N, Orhan; N, Ozgul; Mc, Salman; B, Soyak; L, Aydemir; B, Başaran; H, Kara; C, Sen; M, Ulusan; As, Açıkgöz; A, Alhamed; Y, Aykanat; T, Bese; S, Cebi; F, Demirkıran; S, Ergün; B, Kayan; Ozcelık, M. F.; An, Sanli; Ss, Uludağ; M, Velidedeoglu; Ak, Zengin; Bozkurt, M. A.; Y, Kara; A, Kocatas; Altinbas B, Candas; Çekiç, A. B.; K, Eyuboglu; A, Guner; S, Türkyılmaz; Usta, M. A.; B, Cimenoglu; R, Demirhan; K, Saracoglu; İf, Azamat; E, Balik; D, Buğra; B, Giray; Kulle, C. B.; C, Taskiran; D, Vatansever; Sa, Güler; A, Güreşin; Oc, Tatar; Nz, Utkan; A, Yildirim; E, Yüksel; A, Abbasov; H, Yanar; Mu, Ugurlu; E, Akin; F, Altintoprak; Z, Bayhan; G, Cakmak; R, Çapoğlu; F, Çelebi; H, Demir; E, Dikicier; N, Firat; E, Gönüllü; Kamburoğlu, M. B.; B, Kocer; If, Küçük; B, Mantoglu; E, Çolak; Go, Kucuk; Uyanik, M. S.; B, Goksoy; E, Bozkurt; B, Citgez; M, Mihmanli; M, Tanal; G, Yetkin; M, Akalin; C, Arican; Ek, Avci; C, Aydin; Atıcı S, Demirli; M, Emiroglu; T, Kaya; E, Kebabçı; G, Kilinc; Y, Kirmizi; H, Öğücü; S, Salimoğlu; İ, Sert; C, Tugmen; K, Tuncer; G, Uslu; D, Yeşilyurt; E, Karaman; A, Kolusarı; A, Yildiz; Fa, Gultekin; H, Lule; B, Oguttu; K, Abdelgalil; J, Agilinko; A, Ahmeidat; M, Barabasz; M, Bekheit; Lk, Cheung; T, Colloc; W, Cymes; M, Elhusseini; G, Gradinariu; A, Hannah; Kamera, B. S.; G, Mignot; S, Shaikh; P, Sharma; Abu-Nayla, I.; A, Agrawal; Al-Mohammad, A.; S, Ali; J, Ashcroft; A, Azizi; O, Baker; A, Balakrishnan; M, Byrne; A, Colquhoun; A, Cotter; P, Coughlin; Rj, Davies; A, Durrani; M, Elshaer; S, Fordington; P, Forouhi; F, Georgiades; H, Grimes; A, Habeeb; V, Hudson; P, Hutchinson; E, Irune; A, Jah; Dz, Khan; A, Kolias; H, Kyriacou; B, Lamb; S, Liau; L, Luke; R, Mahmoud; R, Mannion; L, Masterson; C, Mitrofan; M, Mohan; A, Morris; S, Murphy; Jr, O’Neill; S, Price; J, Pushpa-rajah; Raby-Smith, W.; J, Ramzi; Rooney, S. M.; T, Santarius; Aa, Singh; Gd, Stewart; Xs, Tan; A, Townson; E, Tweedle; C, Walker; S, Waseem; S, Yordanov; T, Jones; A, Kattakayam; C, Loh; R, Lunevicius; Q, Nunes; S, Pringle; A, Schache; R, Shaw; A, Sheel; A, Sud; M, Sundhu; C, Rossborough; D, Angelou; M, Choynowski; B, Mcaree; A, Mccanny; D, Neely; F, Kamel; L, Kumar; R, Madani; P, Nisar; G, Tutoveanu; S, Ali; Bittar, M. N.; M, Creanga; M, Elniel; J, Law; M, Youssef; S, Ahad; La Cruz Monroy MFI, De; M, Hashem; F, Langlands; F, Mosley; V, Oktseloglou; I, Omar; F, Patel; A, Alanbuki; M, Patel; A, Shabana; R, Rathinaezhil; E, Perera; D, Raveendran; Ravi-Shankar, K.; J, Thiruchelvam; Bakri NA, Che; Z, Jawad; L, Jiao; S, Nazarian; R, Vashisht; L, Arrowsmith; W, Campbell; T, Grove; C, Kontovounisios; O, Warren; P, Rolland; A, Aggarwal; S, Brown; C, Jelley; N, Neal; R, Kaur; E, Leung; S, Sundar; T, Doulias; M, Li; E, Martin; H, Rodwell; R, Clifford; N, Eardley; E, Krishnan; N, Manu; E, Martin; Mahapatra S, Roy; Ol, Serevina; C, Smith; D, Vimalachandran; M, Bordenave; R, Houston; G, Putnam; A, Robson; H, Tustin; K, Emslie; Pl, Labib; A, Marchbank; D, Miller; G, Minto; J, Natale; H, Nwinee; P, Panahi; L, Rogers; A, Abubakar; Rahman MM, Akhter; E, Chan; H, O’Brien; K, Sasapu; R, Inglis; Hj, Ng; Rico A, De Gea; N, Ghazali; J, Lambert; G, Markose; S, Math; I, Sarantitis; D, Shreshtha; R, Simpson; S, Sonanis; A, Sultana; M, Taggarsi; S, Timbrell; Op, Vaz; L, Vitone; A, Day; H, Dent; M, Fahim; S, Waheed; A, Hunt; Hastings, Laskar N.; A, Gupta; J, Steinke; S, Thrumurthy; E, Massie; K, Mcgivern; D, Rutherford; M, Wilson; J, Hardie; S, Kazzaz; Bacarese-Hamilton, T.; M, Ip; A, James; G, Salerno; T, Stockdale; S, Handa; M, Kaushal; A, Kler; P, Patel; J, Redfern; S, Tezas; Y, Aawsaj; S, Amonkar; C, Barry; L, Blackwell; D, Blake; J, Carter; H, Emerson; A, Fisher; M, Katory; P, Korompelis; W, Mccormick; A, Mustafa; L, Pearce; N, Ratnavelu; R, Reehal; A, Damola; L, Kretzmer; L, Lalou; P, Lim; B, Manku; I, Parwaiz; M, Sandher; J, Stafford; M, Abdelkarim; A, Asqalan; T, Gala; S, Ibrahim; A, Maw; R, Mithany; R, Morgan; Venkatesan G, Sundaram; D, Holroyd; N, Jamieson; C, Jones; Js, Shin; K, Ang; Ej, Caruana; K, Chandarana; Chowdhry, M. F.; A, Mohammad; A, Nakas; S, Rathinam; D, Banfield; M, Boal; O, Brown; H, Dean; S, Dwerryhouse; S, Higgs; A, Vallance; E, Boyd; V, Irvine; A, Kirk; G, Bakolas; A, Boulton; A, Chandock; T, Khan; M, Kumar; P, Agoston; A, Billè; B, Challacombe; S, Fraser; Harrison-Phipps, K.; J, King; S, Mccrindle; G, Mehra; L, Mills; M, Najdy; R, Nath; L, Okiror; J, Pilling; V, Rizzo; T, Routledge; A, Sayasneh; L, Stroman; A, Wali; M, Fehervari; C, Fotopoulou; N, Habib; Hamrang-Yousefi, S.; Z, Jawad; L, Jiao; M, Pai; J, Ploski; P, Rajagopal; S, Saso; M, Sodergren; D, Spalding; S, Laws; C, Hardie; C, Mcnaught; R, Alam; A, Budacan; J, Cahill; M, Kalkat; S, Karandikar; L, Kenyon; D, Naumann; A, Patel; F, Chen; J, Cheung; J, Ayorinde; T, Chase; T, Cuming; A, Ghanbari; L, Humphreys; S, Tayeh; Ibrahim A, Aboelkassem; R, Bichoo; H, Cao; Akw, Chai; J, Choudhury; C, Evans; H, Fitzjohn; H, Ikram; E, Khalifa; M, Langstroth; M, Loubani; A, Mcmillan; S, Nazir; Ssa, Qadri; A, Robinson; E, Ross; T, Sehgal; A, Wilkins; J, Dixon; J, Dunning; K, Freystaetter; M, Jha; Vrm, Kusuma; S, Lester; A, Madhavan; Sv, Thulasiraman; Y, Viswanath; Curl-Roper, T.; C, Delimpalta; Ccl, Liao; V, Velchuru; E, Westwood; E, Belcher; Bond-Smith, G.; S, Chidambaram; Chiara F, Di; K, Fasanmade; L, Fraser; H, Fu; M, Ganau; S, Gore; M, Goricar; J, Graystone; D, Jeyaretna; H, Khatkar; M, Lami; M, Maher; S, Mastoridis; J, Mcveigh; R, Mihai; R, Myatt; R, Piper; S, Prabhu; Obf, Risk; U, Selbong; K, Shah; P, Silva; R, Smillie; H, Soleymani majd; S, Sravanam; D, Stavroulias; Gd, Tebala; M, Vatish; C, Verberne; K, Wallwork; Williams, M. A.; Sc, Winter; I, Ahmed; A, Djouani; B, Eddy; S, Folkard; F, Hassan; S, Kommu; G, Papadopoulos; A, Simoes; E, Streeter; Tait-Bailey, J.; M, Thomas; W, Wang; M, Yao; N, Anscomb; Baldwin-Smith, R.; M, Davies; C, Grainger; A, Haji; A, Haq; Nunoo-Mensah, J. W.; M, Rizk; Mi, Bhatti; Boyd-Carson, H.; E, Elsey; E, Gemmill; P, Herrod; M, Jibreel; E, Lenzi; T, Saafan; D, Sapre; T, Sian; N, Watson; A, Athanasiou; E, Borg; G, Bourke; L, Bradshaw; A, Brunelli; J, Burke; P, Coe; F, Costigan; H, Elkadi; M, Ho; J, Johnstone; A, Kanatas; V, Kantola; A, Kaufmann; A, Laios; S, Lam; E, Macinnes; S, Munot; C, Nahm; M, Otify; C, Pompili; M, Raslan; H, Salminen; I, Smith; G, Theophilou; G, Toogood; R, Wade; D, Ward; C, West; Al-Harbawee, A.; A, Alharawee; S, Annamalai; C, Ashmore; A, Boddy; T, Hossain; E, Irvine; K, Kassam; A, Kourdouli; Cs, Chean; S, Dharamavaram; A, Gvaramadze; A, Jibril; N, Kulkarni; I, Pereira; L, Prusty; K, Shanthakunalan; B, Srikumar; D, Thekkinkattil; S, Adegbola; C, Menakaya; J, Noel; A, Harky; M, Shackcloth; A, Askari; C, Chan; N, Cirocchi; S, Kudchadkar; K, Patel; J, Sagar; S, Shaw; R, Talwar; M, Abdalla; R, Edmondson; O, Ismail; D, Jones; K, Newton; N, Stylianides; A, Aderombi; U, Andaleeb; O, Bajomo; K, Beatson; W, Garrett; M, Mehmood; V, Ng; Al-Habsi, R.; M, Brimioulle; Gs, Divya; B, Keeler; Re, Soulsby; A, Taylor; Al-Sarireh, B.; R, Clancy; P, Cripps; T, Dobbs; R, Egan; I, Fabre; R, Harries; A, Henry; M, Kittur; Z, Li; K, Parkins; F, Soliman; N, Spencer; D, Thompson; C, Burgess; C, Gemmell; C, Grieco; M, Hollyman; L, Hunt; J, Morrison; S, Ojha; F, Abbadessa; S, Barnard; C, Chan; N, Dawe; J, Hammond; Rm, Koshy; Ali F, Mahmoud; I, Mcpherson; C, Mellor; J, Moir; S, Pandanaboyana; J, Powell; B, Rai; A, Rogers; C, Roy; A, Sachdeva; C, Saleh; S, Tingle; T, Williams; J, Manickavasagam; C, Mcdonald; N, Mcgrath; N, Mcsorley; K, Ragupathy; L, Ramsay; A, Solth; C, Aristotelous; O, Kakisi; K, Seebah; I, Shaikh; L, Sreedharan; L, Touil; M, Youssef; J, Shah; P, Ameerally; M, Baguley; C, Gnanachandran; B, Heer; M, Rogers; R, Woods; A, Aujayeb; S, Mills; J, Abu; Addae-Boateng, E.; D, Bratt; L, Brock; N, Burnside; Cadwell-Sneath, S.; K, Gajjar; C, Gan; C, Grundy; K, Hallam; K, Hassell; M, Hawari; A, Joshi; H, Khout; K, Konstantinidi; Lee, R. X. N.; D, Nunns; R, Schiemer; T, Walton; H, Weaver; L, Whisker; K, Williamson; J, Mcveigh; R, Myatt; Williams, M. A.; Me, Ahmed; Si, Bukhari; B, Illingworth; S, Kanthasamy; E, Knights; Sl, Ong; R, Pujari; Khm, Tan; R, Vanker; M, Michel; S, Patil; S, Ravindran; J, Sarveswaran; L, Scott; I, Biliatis; M, Edmond; E, King; O, Babawale; D, Hodgson; M, Ismail; J, Khan; U, Lokman; Yc, Phan; M, Almond; A, Bhangu; O, Breik; Ld, Cato; Ya, Chowdhury; A, Desai; S, Ford; E, Griffiths; M, Idle; M, Kamal; K, Karia; A, Kisiel; R, Kulkarni; Jkc, Mak; T, Martin; P, Nankivell; A, Parente; S, Parmar; Pathanki, A. M.; L, Phelan; P, Praveen; S, Saeed; N, Sharma; J, Singh; G, Solomou; Wc, Soon; A, Stevens; F, Tirotta; C, Topham; I, Ughratdar; D, Vijayan; K, Ballantyne; L, Barker; K, Chapman; M, Charalambous; C, Chianakwalam; C, English; J, Evans; A, Fell; D, Frimpong; C, Halkias; R, Iyer; R, Merh; G, Neagu; S, Nikolaou; A, Poddar; V, Pronisceva; V, Reddy; N, Williams; L, Alakandy; P, Bhattathiri; J, Brown; M, Canty; E, Day; A, Geddes; A, Grivas; S, Hassan; S, Lammy; P, Littlechild; C, Maseland; C, Mathieson; J, Mccaul; J, Mcmahon; R, O’Kane; George E, St.; N, Suttner; W, Taylor; E, Tilling; W, English; S, Kaul; Ah, Khan; F, Khan; A, Mansuri; S, Mukherjee; M, Patel; M, Sarigul; S, Singh; C, Smith; Kl, Tan; P, Vulliamy; A, Woodham; Yh, Yang; A, Adiamah; H, Brewer; A, Chowdhury; J, Evans; D, Humes; J, Jackman; A, Koh; Lewis-Lloyd, C.; A, Navarro; O, Oyende; J, Reilly; R, Vohra; D, Worku; P, Cool; G, Cribb; K, Shepherd; C, Bisset; S, Moug; R, Chadha; N, Elson; R, Galleano; G, Faulkner; A, Langone; Z, Panayi; P, Saleh; F, Tuminello; C, Underwood; G, Brixton; L, Findlay; T, Klatte; A, Majkowska; J, Manson; R, Potter; Al-Khyatt, W.; S, Awad; A, Bhalla; Z, Chia; P, Daliya; A, Goyal; E, Grimley; A, Hamad; A, Kumar; Fl, Malcolm; Jck, Ng; A, Phillips; E, Theophilidou; S, Williams; J, Bowden; N, Campain; I, Daniels; C, Evans; G, Fowler; J, John; L, Massey; F, Mcdermott; J, Mcgrath; A, Mclennan; M, Ng; J, Pascoe; N, Rajaretnam; N, Angamuthu; S, Bulathsinhala; S, Chowdhury; B, Davidson; G, Fusai; J, Gilliland; C, Hart; Salinas C, Hidalgo; J, Knowles; N, Machairas; R, Mirnezami; T, Pissanou; Jm, Pollok; Da, Raptis; F, Soggiu; H, Tzerbinis; M, Varcada; S, Xyda; A, Beamish; E, Davies; R, Foulkes; D, Magowan; H, Nassa; R, Ooi; C, Price; L, Smith; F, Solari; A, Tang; G, Williams; Kahar NN, Abd; Al-Tamimi, Y.; A, Bacon; N, Beasley; J, Catto; Lh, Chan; D, Chew; M, Crank; N, Ilenkovan; M, Macdonald; B, Narice; O, Rominiyi; S, Saad; S, Sinha; A, Thompson; I, Varley; P, Brennan; T, Drake; Em, Harrison; G, Linder; J, Mayes; R, Mcgregor; R, Pasricha; Rje, Skipworth; V, Zamvar; E, Davies; P, Hawkin; T, Raymond; O, Ryska; R, Baron; D, Dunne; S, Gahunia; C, Halloran; N, Howes; R, Mckinney; F, Mcnicol; K, Rajput; J, Russ; R, Sutton; P, Szatmary; Jr, Tan; A, Thomas; P, Whelan; A, Anzak; A, Banerjee; O, Fuwa; F, Hughes; Jayasinghe, J. D.; C, Knowles; Hm, Kocher; Silva I, Leal; Fs, Ledesma; A, Minicozzi; L, Navaratne; P, Patki; R, Rahman; R, Ramamoorthy; C, Sohrabi; C, Tanabalan; M, Thaha; B, Thakur; M, Venn; V, Yip; R, Baumber; J, Parry; S, Evans; L, Jeys; G, Morris; M, Parry; J, Stevenson; N, Ahmadi; G, Aresu; Barrett-Brown, Z. M.; A, Coonar; Yates H, Durio; D, Gearon; J, Hogan; M, King; A, Peryt; Is, Pradeep; C, Smith; M, Adishesh; R, Atherton; K, Baxter; M, Brocklehurst; M, Chaudhury; N, Krishnamohan; J, Mcaleer; G, Owens; E, Parkin; P, Patkar; I, Phang; A, Aladeojebi; M, Ali; S, Ali; B, Barmayehvar; A, Gaunt; M, Gowda; E, Halliday; M, Kitchen; F, Mansour; P, Nanjaiah; M, Thomas; D, Zakai; Abbassi-Ghadi, N.; H, Assalaarachchi; A, Currie; M, Flavin; A, Frampton; M, Hague; C, Hammer; J, Hopper; J, Horsnell; S, Humphries; A, Kamocka; Tk, Madhuri; S, Preston; P, Singh; J, Stebbing; A, Tailor; D, Walker; E, Coomber; S, Jaunoo; L, Kennedy; O, Williams; A, Airey; J, Bunni; R, Crowley; K, Fairhurst; J, Frost; R, George; S, Lee; S, Mitchell; J, Phull; S, Richards; F, Aljanadi; A, Campbell; A, Glass; I, Hraishawi; M, Jones; C, Mcilmunn; S, Mcintosh; P, Mhandu; C, O’Donnell; R, Turkington; Al-Ishaq, Z.; S, Bhasin; As, Bodla; A, Burahee; A, Crichton; El-Ghobashy, A.; R, Fossett; N, Pigadas; E, Rahman; D, Snee; R, Vidya; N, Yassin; F, Colombo; D, Fountain; Hasan, M. 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[10.1016/j.ajog.2022.06.052]
Outcomes of gynecologic cancer surgery during the COVID-19 pandemic: an international, multicenter, prospective CovidSurg-Gynecologic Oncology Cancer study
Gallo, GaetanoProject Administration
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2022
Abstract
Background: The CovidSurg-Cancer Consortium aimed to explore the impact of COVID-19 in surgical patients and services for solid cancers at the start of the pandemic. The CovidSurg-Gynecologic Oncology Cancer subgroup was particularly concerned about the magnitude of adverse outcomes caused by the disrupted surgical gynecologic cancer care during the COVID-19 pandemic, which are currently unclear. Objective: This study aimed to evaluate the changes in care and short-term outcomes of surgical patients with gynecologic cancers during the COVID-19 pandemic. We hypothesized that the COVID-19 pandemic had led to a delay in surgical cancer care, especially in patients who required more extensive surgery, and such delay had an impact on cancer outcomes. Study design: This was a multicenter, international, prospective cohort study. Consecutive patients with gynecologic cancers who were initially planned for nonpalliative surgery, were recruited from the date of first COVID-19-related admission in each participating center for 3 months. The follow-up period was 3 months from the time of the multidisciplinary tumor board decision to operate. The primary outcome of this analysis is the incidence of pandemic-related changes in care. The secondary outcomes included 30-day perioperative mortality and morbidity and a composite outcome of unresectable disease or disease progression, emergency surgery, and death. Results: We included 3973 patients (3784 operated and 189 nonoperated) from 227 centers in 52 countries and 7 world regions who were initially planned to have cancer surgery. In 20.7% (823/3973) of the patients, the standard of care was adjusted. A significant delay (>8 weeks) was observed in 11.2% (424/3784) of patients, particularly in those with ovarian cancer (213/1355; 15.7%; P<.0001). This delay was associated with a composite of adverse outcomes, including disease progression and death (95/424; 22.4% vs 601/3360; 17.9%; P=.024) compared with those who had operations within 8 weeks of tumor board decisions. One in 13 (189/2430; 7.9%) did not receive their planned operations, in whom 1 in 20 (5/189; 2.7%) died and 1 in 5 (34/189; 18%) experienced disease progression or death within 3 months of multidisciplinary team board decision for surgery. Only 22 of the 3778 surgical patients (0.6%) acquired perioperative SARS-CoV-2 infections; they had a longer postoperative stay (median 8.5 vs 4 days; P<.0001), higher predefined surgical morbidity (14/22; 63.6% vs 717/3762; 19.1%; P<.0001) and mortality (4/22; 18.2% vs 26/3762; 0.7%; P<.0001) rates than the uninfected cohort. Conclusion: One in 5 surgical patients with gynecologic cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations, and coordinated mitigating strategies are urgently needed.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
