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Ailsa Maria Main Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

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Maria Rossing Center for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

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Line Borgwardt Center for Genomic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

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Birgitte Grønkær Toft Department of Pathology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

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Åse Krogh Rasmussen Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark

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Ulla Feldt-Rasmussen Department of Medical Endocrinology and Metabolism, Copenhagen University Hospital, Rigshospitalet, and Faculty of Health, Institute of Clinical and Scientific Research, Copenhagen, Denmark

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? in exon 1) F1 PGL X X NA F6 PGL X X X X X X Chromogranin A (P) M3 PGL X Noradrenaline (U) Adrenaline (U) Metanephrines (P) B4 (c.3G

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Kate E Lines Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK

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Mahsa Javid Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK

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Anita A C Reed Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK

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Gerard V Walls Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK

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Mark Stevenson Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK

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Michelle Simon MRC Harwell Institute, Mammalian Genetics Unit, Harwell Campus, Oxfordshire, UK

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Kreepa G Kooblall Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK

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Sian E Piret Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK

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Paul T Christie Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK

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Paul J Newey Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK

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Ann-Marie Mallon MRC Harwell Institute, Mammalian Genetics Unit, Harwell Campus, Oxfordshire, UK

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Rajesh V Thakker Academic Endocrine Unit, Radcliffe Department of Medicine, University of Oxford, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), Churchill Hospital, Headington, Oxford, UK

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); anti-chromogranin A (AbCam ab301704); anti-insulin (AbCam ab7842); anti-glucagon (AbCam ab10561971) and anti-Kras (AbCam ab84573). All HRP-conjugated secondary antibodies (Jackson Laboratories) were applied for 1 h, followed by 3,3′-diaminobenzidine

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Carole Morin Hospices Civils de Lyon, Hôpital Edouard Herriot, Oncologie Digestive, Lyon Cedex 03, France

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Keo-Morakort Benedetto Hospices Civils de Lyon, Hôpital Edouard Herriot, Oncologie Digestive, Lyon Cedex 03, France

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Agathe Deville Hospices Civils de Lyon, Hôpital Louis Pradel, Médecine Nucléaire, Bron, France
Centre de Recherche en Cancérologie de Lyon, UMR Inserm 1052 CNRS 5286, Lyon Cedex 08, France

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Laurent Milot Hospices Civils de Lyon, Hôpital Edouard Herriot, Radiologie, Lyon Cedex 03, France
University of Lyon, Université Lyon 1, France

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Aurélie Theillaumas Hospices Civils de Lyon, Hôpital Edouard Herriot, Oncologie Digestive, Lyon Cedex 03, France

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Valérie Hervieu Centre de Recherche en Cancérologie de Lyon, UMR Inserm 1052 CNRS 5286, Lyon Cedex 08, France
University of Lyon, Université Lyon 1, France
Hospices Civils de Lyon, Institut de Pathologie Est, Bron Cedex, France

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Mathieu Pioche University of Lyon, Université Lyon 1, France
Hospices Civils de Lyon, Hôpital Edouard Herriot, Gastroentérologie, Lyon Cedex 03, France

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Gilles Poncet Centre de Recherche en Cancérologie de Lyon, UMR Inserm 1052 CNRS 5286, Lyon Cedex 08, France
University of Lyon, Université Lyon 1, France
Hospices Civils de Lyon, Hôpital Edouard Herriot, Chirurgie Digestive, Lyon Cedex 03, France

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Julien Forestier Hospices Civils de Lyon, Hôpital Edouard Herriot, Oncologie Digestive, Lyon Cedex 03, France

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Laurent François Hospices Civils de Lyon, Hôpital Louis Pradel, Exploration Fonctionnelle, Bron Cedex, France

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Francoise Borson-Chazot University of Lyon, Université Lyon 1, France
Hospices Civils de Lyon, Hôpital Louis Pradel, Endocrinologie, Bron Cedex, France

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Mustapha Adham University of Lyon, Université Lyon 1, France
Hospices Civils de Lyon, Hôpital Edouard Herriot, Chirurgie Digestive, Lyon Cedex 03, France

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Catherine Lombard-Bohas Hospices Civils de Lyon, Hôpital Edouard Herriot, Oncologie Digestive, Lyon Cedex 03, France

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Thomas Walter Hospices Civils de Lyon, Hôpital Edouard Herriot, Oncologie Digestive, Lyon Cedex 03, France
Centre de Recherche en Cancérologie de Lyon, UMR Inserm 1052 CNRS 5286, Lyon Cedex 08, France
University of Lyon, Université Lyon 1, France

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-up and the initial treatments was defined according to ENETS guidelines (French guidelines are similar) ( 3 , 6 ). Minimal work-up included laboratory test (chromogranin A), endoscopy along with endoscopic ultrasound (EUS), imaging (CT scan, MRI, and

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Joakim Crona Departments of Surgical Sciences, Medical Sciences, Uppsala University, S-751 85 Uppsala, Sweden

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Alberto Delgado Verdugo Departments of Surgical Sciences, Medical Sciences, Uppsala University, S-751 85 Uppsala, Sweden

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Dan Granberg Departments of Surgical Sciences, Medical Sciences, Uppsala University, S-751 85 Uppsala, Sweden

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Staffan Welin Departments of Surgical Sciences, Medical Sciences, Uppsala University, S-751 85 Uppsala, Sweden

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Peter Stålberg Departments of Surgical Sciences, Medical Sciences, Uppsala University, S-751 85 Uppsala, Sweden

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Per Hellman Departments of Surgical Sciences, Medical Sciences, Uppsala University, S-751 85 Uppsala, Sweden

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Peyman Björklund Departments of Surgical Sciences, Medical Sciences, Uppsala University, S-751 85 Uppsala, Sweden

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demonstrated expression for chromogranin A and a Ki67 index of 1%. Exome sequencing revealed seven SNVs, one was classified as benign and six as unknown. There was one missense variant in SDHC located at position 477C<T, resulting in amino acid substitution

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Paweł Komarnicki Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland

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Paweł Gut Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland

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Jan Musiałkiewicz Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland

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Maja Cieślewicz Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland

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Adam Maciejewski Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland

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Prachi Patel Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland

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George Mastorakos Unit of Endocrinology, Diabetes Mellitus and Metabolism, Aretaieion University Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece

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Marek Ruchała Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznań, Poland

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biomarkers for both prognostic and diagnostic purposes (e.g. 5-hydroxyindoleacetic acid, neuron-specific enolase, chromogranin A (CgA), and beta subunit of human chorionic gonadotropin) ( 5 , 6 , 7 , 8 ). Identification of an optimal biomarker for a given

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Ashley K Clift Department of Surgery and Cancer, Imperial College London, London, UK

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Omar Faiz Department of Surgery, St Mark’s Hospital, London, UK

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Robert Goldin Centre for Pathology, Imperial College London, London, UK

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John Martin Department of Gastroenterology, Imperial College London, London, UK

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Harpreet Wasan Department of Surgery and Cancer, Imperial College London, London, UK

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Marc-Olaf Liedke Department of Surgery, Westkuesten Klinikum Heide, Heide, Germany

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Erik Schloericke Department of Surgery, Westkuesten Klinikum Heide, Heide, Germany

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Anna Malczewska Department of Surgery and Cancer, Imperial College London, London, UK
Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland

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Guido Rindi Institute of Anatomic Pathology, Universita Cattolica del Sacro Cuore, Rome, Italy

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Mark Kidd Wren Laboratories, Branford, Connecticut, USA

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Irvin M Modlin Emeritus Professor Gastrointestinal Surgery, School of Medicine, Yale University, New Haven, Connecticut, USA

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Andrea Frilling Department of Surgery and Cancer, Imperial College London, London, UK

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disseminated disease ( 10 , 11 , 12 ). Furthermore, the limitations of currently available mono-analyte biomarkers for predicting disease activity and behaviour; for example, the poor sensitivity and specificity of chromogranin A, are appreciated in the

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Irasema Mendieta Facultad de Química, Universidad Autónoma de Querétaro, Querétaro, Mexico

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Rosa Elvira Nuñez-Anita Facultad de Medicina Veterinaria y Zootecnia, Universidad Michoacana de San Nicolás Hidalgo, Morelia, Michoacán, Mexico

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Gilberto Pérez-Sánchez Departmento de Psicoimunología, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico

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Lenin Pavón Departmento de Psicoimunología, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico

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Alfredo Rodríguez-Cruz Facultad de Química, Universidad Autónoma de Querétaro, Querétaro, Mexico

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Guadalupe García-Alcocer Facultad de Química, Universidad Autónoma de Querétaro, Querétaro, Mexico

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Laura Cristina Berumen Facultad de Química, Universidad Autónoma de Querétaro, Querétaro, Mexico

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-like structures ( 5 ). Such tumours also express neuroendocrine markers such as chromogranin A (CgA) ( 6 ), synaptophysin, neuronal enolase and CD56 ( 7 , 8 , 9 , 10 ). A key aspect of the neuroendocrine phenotype is the formation of granules that secrete

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Dirk-Jan van Beek Department of Endocrine Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands

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Rachel S van Leeuwaarde Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands

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Carolina R C Pieterman Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands

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Menno R Vriens Department of Endocrine Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands

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Gerlof D Valk Department of Endocrine Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
Parelsnoer Institute, Utrecht, The Netherlands

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the DutchMEN Study Group
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an association between blood type O and the occurrence of neuroendocrine tumors in the national Dutch MEN1 cohort?  pNET, tumor markers Evidence-based screening DMSGPatient advocacy group What is the diagnostic accuracy of chromogranin A

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Anna Malczewska Department of Endocrinology and Neuroendocrine Tumors, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland

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Magdalena Witkowska Department of Endocrinology and Neuroendocrine Tumors, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland

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Karolina Makulik Department of Endocrinology and Neuroendocrine Tumors, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland

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Agnes Bocian Department of Endocrinology and Neuroendocrine Tumors, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland

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Agata Walter Department of Endocrinology and Neuroendocrine Tumors, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland

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Joanna Pilch-Kowalczyk Department of Radiology and Nuclear Medicine, Medical University of Silesia, Katowice, Poland

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Wojciech Zajęcki Department of Pathology in Zabrze, Medical University of Silesia, Katowice, Poland

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Lisa Bodei Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA

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Kjell Oberg Department of Endocrine Oncology, University Hospital, Uppsala, Sweden

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Beata Kos-Kudła Department of Endocrinology and Neuroendocrine Tumors, Department of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland

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clinically limited. Chromogranin A (CgA), previously considered the neuroendocrine pan-biomarker, reflects secretory activity rather than tumor biology, heterogeneity or plasticity ( 7 , 8 ). It has limited clinical utility as well as methodological

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Olof Joakim Pettersson Radiology and Molecular Imaging, Uppsala University Hospital, Uppsala, Sweden
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

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Katarzyna Fröss-Baron Radiology and Molecular Imaging, Uppsala University Hospital, Uppsala, Sweden
Department of Medical Sciences, Uppsala University, Uppsala, Sweden

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Joakim Crona Department of Medical Sciences, Uppsala University, Uppsala, Sweden

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Anders Sundin Radiology and Molecular Imaging, Uppsala University Hospital, Uppsala, Sweden
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden

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tumor grade at baseline were collected from the pathologists’ reports on biopsies of liver metastases or the primary PanNETs. Data on Chromogranin-A at baseline were obtained from the patients’ laboratory reports. Tumor measurements In each

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