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 / Christina, Fotopoulou; Tabassum, Khan; Juraj, Bracinik; James, Glasbey; Nadeem, Abu-Rustum; Luis, Chiva; Anna, Fagotti; Keiichi, Fujiwara; Rahel, Ghebre; Murat, Gutelkin; Thomas O., Konney; Joseph, Ng; Rene, Pareja; Rajkumar, Kottayasamy Seenivasagam; Jalid, Sehouli; Shylasree T. S., Surappa; Aneel, Bhangu; Elaine, Leung; Sudha, Sundar; Dmitri, Nepogodiev; Kwabena, Siaw-Acheampong; Ruth A., Benson; Edward, Bywater; Daoud, Chaudhry; Brett E., Dawson; Jonathan P., Evans; James C., Glasbey; Rohan R., Gujjuri; Emily, Heritage; Conor S., Jones; Sivesh K., Kamarajah; Chetan, Khatri; Rachel A., Khaw; James M., Keatley; Andrew, Knight; Samuel, Lawday; Elizabeth, Li; Harvinder S., Mann; Ella J., Marson; Kenneth A., Mclean; Siobhan C., Mckay; Emily C., Mills; Gianluca, Pellino; Maria, Picciochi; Elliott H., Taylor; Abhinav, Tiwari; Joana Ff., Simoes; Isobel M., Trout; Mary L., Venn; Richard Jw., Wilkin; Aneel, Bhangu; Joana Ff., Simoes; Tom Ef., Abbott; Sadi, Abukhalaf; Michel, Adamina; Adesoji O., Ademuyiwa; Arnav, Agarwal; Murat, Akkulak; Ehab, Alameer; Derek, Alderson; Felix, Alakaloko; Markus, Albertsmeier; Osaid, Alser; Muhammad, Alshaar; Sattar, Alshryda; Alexis P., Arnaud; Knut Magne, Augestad; Faris, Ayasra; José, Azevedo; Brittany K., Bankhead-Kendall; Emma, Barlow; David, Beard; Ruth A., Benson; Ruth, Blanco-Colino; Amanpreet, Brar; Ana, Minaya-Bravo; Kerry A., Breen; Chris, Bretherton; Igor Lima, Buarque; Joshua, Burke; Edward J., Caruana; Mohammad, Chaar; Sohini, Chakrabortee; Peter, Christensen; Daniel, Cox; Moises, Cukier; Miguel F., Cunha; Giana H., Davidson; Anant, Desai; Salomone, Di Saverio; Thomas M., Drake; John G., Edwards; Muhammed, Elhadi; Sameh, Emile; Shebani, Farik; Marco, Fiore; J Edward, Fitzgerald; Samuel, Ford; Tatiana, Garmanova; Gaetano, Gallo; Dhruva, Ghosh; Gustavo Mendonça, Ataíde Gomes; Gustavo, Grecinos; Ewen A., Griffiths; Magdalena, Gruendl; Constantine, Halkias; Ewen M., Harrison; Intisar, Hisham; Peter J., Hutchinson; Shelley, Hwang; Arda, Isik; Michael D., Jenkinson; Pascal, Jonker; Haytham, Ma Kaafarani; Debby, Keller; Angelos, Kolias; Schelto, Kruijff; Ismail, Lawani; Hans, Lederhuber; Sezai, Leventoglu; Andrey, Litvin; Andrew, Loehrer; Markus W., Löffler; Maria Aguilera, Lorena; Maria Marta, Modolo; Piotr, Major; Janet, Martin; Hassan N., Mashbari; Dennis, Mazingi; Symeon, Metallidis; Ana, Minaya-Bravo; Helen M., Mohan; Rachel, Moore; David, Moszkowicz; Susan, Moug; Joshua S., Ng-Kamstra; Mayaba, Maimbo; Ionut, Negoi; Milagros, Niquen; Faustin, Ntirenganya; Maricarmen, Olivos; Kacimi, Oussama; Oumaima, Outani; Marie Dione, Parreno-Sacdalanm; Francesco, Pata; Carlos Jose, Perez Rivera; Thomas D., Pinkney; Willemijn, Van Der Plas; Peter, Pockney; Ahmad, Qureshi; Dejan, Radenkovic; Antonio, Ramos-De la Medina; Toby, Richards; Keith, Roberts; April C., Roslani; Martin, Rutegård; Juan José, Segura-Sampedro; Irène, Santos; Sohei, Satoi; Raza, Sayyed; Andrew, Schache; Andreas A., Schnitzbauer; Justina O., Seyi-Olajide; Neil, Sharma; Catherine A., Shaw; Richard, Shaw; Sebastian, Shu; Kjetil, Soreide; Antonino, Spinelli; Grant D., Stewart; Malin, Sund; Sudha, Sundar; Stephen, Tabiri; Philip, Townend; Georgios, Tsoulfas; Gabrielle H., Van Ramshorst; Raghavan, Vidya; Dale, Vimalachandran; Oliver J., Warren; Duane, Wedderburn; Naomi, Wright; Lesley, Booth; Neil, Barker; Shirley, Cooke; Suzanne, Doré; Nigel, Horwood; Emmy, Runigamugabo; Carrie Tierney, Weir; Albania:, Dajti I; Allemand, C; Boccalatte, La; Figari, M; Lamm, M; Larrañaga, J; Marchitelli, C; Noll, F; Odetto, D; Perrotta, M; Saadi, J; Zamora, L; A. 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M., James; Jesudason, Mr; Mittal, R; Moorthy, M; Riju, J; Sebastian, A; Sen, S; Singh, S; Sreekar, D; Thomas, V; Titus, Dk; Yezzaji, Hs; Aggarwal, M; Dhamija, P; Kumar, A; Chisthi, Mm; Gejoe, G; Gopakumar, D; Kollengode, Vv; Kuttanchettiyar, Kg; Yadev, I; Balasubramanian, A; Chaturvedula, L; Dharanipragada, K; Kalayarasan, R; Manikandan, R; Penumadu, P; Lakshminarayana, B; Mathew, S; Reddihalli, Pv; Shivdas, S; Akhtar, N; Chaturvedi, A; Gupta, S; Kumar, V; Rajan, S; Agrawal, N; Ahluwalia, P; Arora, A; K., Batra-Modi; Biswas, M; Chaturvedi, A; Chaturvedi, H; Gautam, G; Jain, M; Jain, S; Kumar, S; Nayyar, R; Singh, S; Tiwari, A; Bhushan, Rangappa V; Kadapathri, A; Kolur, T; Pethkar, R; Pillai, V; Popli, G; Sharma, J; Shetty, V; Subramaniam, N; Williams, J; Agarwal, P; Agarwal, V; Baghel, A; Sharma, Db; Silodia, A; Singh, Kn; Yadav, Sk; Aziz, G; Chowdri, N; Mehraj, A; Parray, Fq; Shah, Za; Wani, Ra; Ahmed, Z; Bali, Rs; M. A., Bhat; Laharwal, Ar; Mahmood, M; Mir, Is; Muzamil, J; Najar, Fa; Rashid, A; Rather, Mh; Zaieem, M; Aggarwal, G; Agrawal, V; Ahmed, A; Ahmed, R; Bhaumik, J; Ghosh, A; Gupta, S; Jain, D; Jain, Pv; Kewlani, V; Pipara, A; Shakya, S; Sharma, A; Thambudorai, R; Badwe, Ra; Bakshi, G; Chandankhede, U; Chaudhari, V; Chaukar, D; Chitkara, G; Dash, B; Deshmukh, A; Null, Desoouza A; Gulia, A; Maheshwari, A; Moiyadi, A; Nair, D; Nair, Ns; Niyogi, D; Pal, M; Pandey, D; Patkar, S; Poddar, P; Pramesh, Cs; Puri, A; Saklani, A; Shetty, P; Shrikhande, Sv; Shylasree, Ts; Singh, V; Thiagarajan, S; Islam, Aa; Kembuan, G; Pajan, H; Rahim, F; Brouki, Milan P; Mozafari, M; Rezaei, Tavirani M; Tizmaghz, A; Safari, H; Aremu, M; A., Canas-Martinez; Cullivan, O; Murphy, C; Owens, P; Pickett, L; Akmenkalne, L; Byrne, J; Corrigan, M; Cullinane, C; Daly, A; Fleming, C; Jordan, P; Kayyal, My; Killeen, S; Lynch, N; Mccarthy, A; Mustafa, H; O'Brien, S; O'Leary, P; Syed, Was; Vernon, L; O'Duffy, F; Mchugh, A; Moran, T; Callanan, D; Dias, A; Huang, L; Ionescu, A; Sheahan, P; Balasubramanian, I; Boland, M; Carrington, E; Conlon, K; Cullinane, C; Evoy, D; Fagan, J; Fearon, N; Gallagher, T; Geary, E; Geraghty, J; Hanly, A; Heneghan, H; Kennedy, N; Kennelly, R; Maguire, D; Martin, St; Mccartan, D; Mcdermott, Ew; Mcpartland, D; Ng, Kc; Prichard, Rs; Stafford, T; Winter, D; Alazawi, D; Barry, C; Boyle, T; Butt, W; Connolly, E; Donlon, N; Donohue, C; B. A., Fahey; Farrell, R; Fitzgerald, C; Kinsella, J; Larkin, J; Lennon, P; Maguire, Pj; Mccormick, P; Mehigan, Bj; Mohan, H; Nugent, Ts; O'Sullivan, H; Ravi, N; Reynolds, Jv; Rogers, A; Shokuhi, P; Smith, J; Smith, La; Timon, C; Bashir, Y; Bass, G; Conlon, K; Connelly, T; Creavin, B; Earley, H; Elliott, Ja; Gillis, A; Kavanagh, D; Madden, A; Manecksha, Rp; Neary, P; O'Connell, C; O'Riordan, J; Reynolds, Is; Rice, D; Ridgway, P; Thomas, A; Umair, M; Whelan, M; Carroll, P; Collins, C; Corless, K; Finnegan, L; Fowler, Al; Hogan, A; Kerin, M; Lowery, A; Mcanena, P; Mckevitt, K; Nugent, E; Ryan, É; Coffey, Jc; Cunningham, Rm; Devine, M; D. M., Nally; Peirce, C; Tormey, S; Hardy, N; Neary, P; O'Malley, S; Ryan, M; Gaziants, V; Gold-, Deutch R; Lavy, R; L., Kalmovich-Muallem; Zmora, O; Macina, S; Mariani, Nm; Opocher, E; Pisani, Ceretti A; Ferrari, F; Odicino, F; Sartori, E; Cotsoglou, C; Granieri, S; Bianco, F; Camillo', A; Colledan, M; Tornese, S; M. F., Zambelli; Bissolotti, G; Fusetti, S; Lemma, F; Marino, M; Marino, Mv; Mirabella, A; Vaccarella, G; Sena, G; Agostini, C; Alemanno, G; Bartolini, I; Bergamini, C; Bruscino, A; Checcucci, C; De, Vincenti R; Di, Bella A; Fambrini, M; Fortuna, L; Maltinti, G; Muiesan, P; Petraglia, F; Prosperi, P; M. N., Ringressi; Risaliti, M; Sorbi, F; Taddei, A; Tucci, R; Bassi, C; Bortolasi, L; Campagnaro, T; Casetti, L; Conci, S; De, Pastena M; Esposito, A; Fontana, M; Guglielmi, A; Landoni, L; Malleo, G; Marchegiani, G; Nobile, S; Paiella, S; Pedrazzani, C; Rattizzato, S; Ruzzenente, A; Salvia, R; Turri, G; Tuveri, M; Altomare, Df; Papagni, V; Picciariello, A; Bellora, P; D'Aloisio, G; Ferrari, M; Francone, E; Gentilli, S; Nikaj, H; Andreani, L; Bianchini, M; Capanna, R; Caretto, M; Chiarugi, M; Coccolini, F; Cremonini, C; Di, Franco G; Domenici, L; Furbetta, N; Gadducci, A; Garibaldi, S; Gianardi, D; Giannini, A; Guadagni, S; Morelli, L; Musetti, S; Palmeri, M; Perutelli, A; Simoncini, T; Tartaglia, D; Anania, G; Carcoforo, P; Chiozza, M; De, Troia A; Koleva, Radica M; Portinari, M; Sibilla, Mg; Urbani, A; Fabbri, N; Feo, Cv; Gennari, S; Parini, S; Righini, E; Ampollini, L; M. F., Arcuri; Bellanti, L; Bergonzani, M; Bertoli, G; Bocchialini, G; Cattelani, L; D'Angelo, G; Gussago, F; Lanfranco, D; Manigrasso, E; Musini, L; Poli, T; Polotto, S; Santoro, Gp; Varazzani, A; Aguzzoli, L; Annessi, V; Borgonovo, G; Castro, Ruiz C; Coiro, S; Falco, G; Mandato, Vd; Mastrofilippo, V; M. T., Montella; Zizzo, M; Grossi, U; Novello, S; Romano, M; Rossi, S; Zanus, G; Esposito, G; Frongia, F; Pisanu, A; Podda, M; Belluco, C; Lauretta, A; Montori, G; Moras, L; Olivieri M., Irccs; Null, Aviano; Bussu, F; Carta, Ag; Cossu, Ml; Cottu, P; Fancellu, A; Feo, Cf; Ginesu, Gc; Giuliani, G; Madonia, M; Perra, T; Piras, A; Porcu, A; Rizzo, D; A. M., Scanu; Tedde, A; Tedde, M; Aversano, A; Carbone, F; Delrio, P; Di, Lauro K; Fares, Bucci A; Rega, D; Spiezio, G; Pirozzolo, G; Recordare, A; Vignotto, C; Badalamenti, G; Campisi, G; Cordova, A; Franza, M; Maniaci, G; Rinaldi, G; Toia, F; Calabrò, M; Farnesi, F; Lunghi, Eg; Muratore, A; Pipitone, Federico Ns; D'Andrea, G; Familiari, P; Picotti, V; De, Palma G; Luglio, G; Pagano, G; Tropeano, Fp; Antonelli, B; Baldari, L; Beltramini, Ga; Boni, L; Cassinotti, E; Gianni', A; Pignataro, L; Rossi, G; Torretta, S; Abatini, C; Baia, M; Biasoni, D; Bogani, G; Cadenelli, P; Capizzi, V; Cioffi, Spb; Citterio, D; Comini, Lv; Cosimelli, M; Fiore, M; Folli, S; Gennaro, M; Giannini, L; Gronchi, A; Guaglio, M; Macchi, A; Martinelli, F; Mazzaferro, V; Mosca, A; Pasquali, S; Piazza, C; Raspagliesi, F; Rolli, L; Salvioni, R; Sarpietro, G; Sarre, C; Sorrentino, L; Agnes, A; Alfieri, S; Belia, F; Biondi, A; Cauteruccio, M; Cozza, V; D'Ugo, D; De, Simone V; Fagotti, A; Gasparini, G; Gordini, L; Litta, F; Lombardi, Cp; Lorenzon, L; Maccauro, G; Marra, Aa; Marzi, F; Moro, A; Parello, A; Perrone, E; Persiani, R; Ratto, C; Rosa, F; Saponaro, G; Scambia, G; Scrima, O; Sganga, G; Tudisco, R; Vitiello, R; Ziranu, A; Belli, A; Granata, V; Izzo, F; Palaia, R; Patrone, R; Carrano, Fm; Carvello, Mm; De, Virgilio A; Di, Candido F; Ferreli, F; Gaino, F; Mercante, G; Rossi, V; Spinelli, A; Spriano, G; Santos, Pmdd; De, Nardi C; D. M., Donati; Frisoni, T; Palmerini, E; Aprile, A; Barra, F; Batistotti, P; Ferrero, S; Fregatti, P; Massobrio, A; Pertile, D; Scabini, S; Soriero, D; Sparavigna, M; Adamoli, L; Ansarin, M; Cenciarelli, S; Chu, F; De, Berardinis R; Fumagalli, Romario U; Mastrilli, F; Pietrobon, G; Tagliabue, M; Badellino, E; Biglia, N; Chiado', Piat F; Ferrero, A; Massobrio, R; De Manzoni, Garberini A; Mazzotti, F; Pasini, F; Ugolini, G; Barone, R; Birolo, Sl; Caccetta, M; Deirino, A; Garino, M; Grasso, M; Marafante, C; Masciandaro, A; Moggia, E; Mungo, S; Murgese, A; Raggio, E; Federico, P; Maida, P; Marra, E; Marte, G; Petrillo, A; Tammaro, T; Tufo, A; Berselli, M; Borroni, G; Cocozza, E; Conti, L; Desio, M; Livraghi, L; Marchionni, V; Quintodei, V; Rizzi, A; Baldi, C; Corbellini, C; Sampietro, Gm; Bordoni, P; Clarizia, G; Fleres, F; Franzini, M; Grechi, A; Longhini, A; Spolini, A; Cellerino, P; Galfrascoli, E; Iacob, G; Baldini, E; Capelli, P; Conti, L; S. M., Isolani; Ribolla, M; Bondurri, A; Colombo, F; Ferrario, L; Guerci, C; Maffioli, A; Armao, T; Ballabio, M; Bisagni, P; Gagliano, A; Longhi, M; Madonini, M; Pizzini, P; A. M., Baietti; Biasini, M; Maremonti, P; Neri, F; Prucher, Gm; Ricci, S; Ruggiero, F; Zarabini, Ag; Impellizzeri, H; Inama, M; Moretto, G; Barmasse, R; Mochet, S; Morelli, L; Usai, A; Bianco, F; Incollingo, P; Giacometti, M; Zonta, S; Marino, Cosentino L; Sagnotta, A; Dell'Oro, C; Fruscio, R; Grassi, T; Negri, S; Nespoli, Lc; Tamini, N; Zambetti, B; Anastasi, A; Bartalucci, B; Bellacci, A; Canonico, G; Capezzuoli, L; Di, Martino C; Ipponi, P; Linari, C; Montelatici, M; Nelli, T; Spagni, G; Tirloni, L; Vitali, A; Abate, E; Casati, M; Casiraghi, T; Laface, L; Schiavo, M; Arminio, A; Cotoia, A; Lizzi, V; Vovola, F; Vergari, R; D'Ugo, S; Depalma, N; M. G., Spampinato; Annicchiarico, A; Catena, F; Giuffrida, M; Perrone, G; Baronio, G; Carissimi, F; Montuori, M; Pinotti, E; Bartolucci, P; Binda, B; Brachini, G; Bruzzaniti, P; Chiappini, A; Chiarella, V; Ciccarone, F; Cicerchia, Pm; Cirillo, B; Crocetti, D; De, Toma G; Di Bartolomeo, A; Duranti, G; Fiori, E; Fonsi, Gb; Franco, G; Frati, A; Giugliano, M; Iannone, I; La, Torre F; Lapolla, P; Leonardo, C; Marruzzo, G; Meneghini, S; Mingoli, A; Ribuffo, D; Salvati, M; Santoro, A; Sapienza, P; Scafa, Ak; Simonelli, L; Zanacana, G; Zambon, M; Zuppi, E; Capolupo, Gt; Carannante, F; Caricato, M; Mascianà, G; Mazzotta, E; Gattolin, A; Migliore, M; Rimonda, R; Sasia, D; Travaglio, E; Chessa, A; Fiorini, A; Norcini, C; Colletti, G; Confalonieri, M; Costanzi, A; Frattaruolo, C; Mari, G; Monteleone, M; Bandiera, A; Bocciolone, L; Bonavina, G; Candiani, M; Candotti, G; De, Nardi P; Gagliardi, F; Medone, M; Mortini, P; Negri, G; Parise, P; Piloni, M; Sileri, P; Vignali, A; Belvedere, A; Bernante, P; Bertoglio, P; Boussedra, S; Brunocilla, E; Cervellera, M; Cescon, M; Cipriani, R; Cisternino, G; De, Crescenzo E; De, Iaco P; Del, Gaudio M; Dondi, G; Droghetti, M; Germinario, G; Gori, A; Frio, F; Jovine, E; Mineo, Bianchi F; Morezzi, D; Neri, J; Parlanti, D; A. M., Perrone; Pezzuto, Ap; Pignatti, M; Pinto, V; Poggioli, G; Ravaioli, M; Rottoli, M; Russo, Is; Sartarelli, L; Schiavina, R; Serenari, M; Serra, M; Solli, P; Tonini, V; Taffurelli, M; Tanzanu, M; Tesei, M; Violante, T; Zanotti, S; Borghi, F; Cianflocca, D; Di Maria, Grimaldi S; Donati, D; Gelarda, E; Geretto, P; Giraudo, G; Giuffrida, Mc; Maione, F; Marano, A; Palagi, S; Pellegrino, L; Peluso, C; Giaccardi, S; Testa, V; Agresta, F; Prando, D; Zese, M; Aquila, F; Gambacciani, C; Lippa, L; Pieri, F; Santonocito, Os; Armatura, G; Bertelli, G; Frena, A; Marinello, P; Notte, F; Patauner, S; Scotton, G; Fulginiti, S; Gallo, G; Sammarco, G; Vescio, G; Balercia, P; Catarzi, L; Consorti, G; Asti, Elg; Bernardi, D; Bonavina, L; Lovece, A; Di, Marzo F; Fujiwara, H; Hashimoto, D; Yamaki, S; Yamamoto, T; Daiko, H; Ishikawa, M; Ishiyama, K; Iwata, S; Kanematsu, K; Kanemitsu, Y; Kato, T; Kawai, A; Kobayashi, E; Kobayashi, Kato M; Moritani, K; Nakagawa, M; Nakatani, F; Oguma, J; Tanase, Y; Uno, M; Hada, T; Iwahashi, H; Miyamoto, M; Suminokura, J; Takano, M; Fujiwara, K; Fujiwara, N; Kurosaki, A; Ababneh, H; Al, Abdallah M; Ayasra, F; Ayasra, Y; Hammad, F; Qasem, A; Abu, Za'Nouneh Fj; A. A., Al-Shraideh; Fahmawee, T; Hmedat, A; Ibrahim, A; Obeidat, K; Abdel, Al S; Abdel, Jalil R; Abou, Chaar Mk; M., Al-Masri; H., Al-Najjar; Alawneh, F; Alsaraireh, O; Elayyan, M; Ghanem, R; Lataifeh, I; Fakhradiyev, I; Saliev, T; Tanabayeva, S; Almahmeed, H; Almazeedi, S; Alsabah, S; Jamal, M; Aldokali, N; Senossi, O; M. T., Subhi; Algallai, M; Alwarfly, S; Alzaede., S; Gahwagi, M; Moftah, M; Abusannoga, M; Alawami, A; Alawami, M; Albashri, M; Malek, A; Burgan, D; Kamoka, E; Kilani, Ai; Salamah, A; Salem, M; Shuwayyah, A; Abdelkabir, M; Altomi, I; Altoumi, M; Bouhuwaish, A; Elmabri, A; Omar, M; Taher, As; Abdulwahed, E; Alshareea, E; Aribi, N; Aribi, S; Biala, M; Ghamgh, R; Morgom, M; Alansari, Saa; Aldayri, Z; Alsoufi, A; Elhadi, A; Elhajdawe, F; Ellojli, I; Ergebi, Aad; Kredan, A; Msherghi, A; Nagib, T; Abudher, A; Alshareef, K; Elamin, F; Bradulskis, S; Dainius, E; Kubiliute, E; Kutkevičius, J; Parseliunas, A; Subocius, A; Venskutonis, D; Rasoaherinomenjanahary, F; Razafindrahita, Jb; Samison, Lh; Ong, Ec; Abdul, Maei N; Ngo, Cw; Ramasamy, S; Hamdan, Kh; Ibrahim, Mr; Tan, Ja; Thanapal, Mr; Choong, E; Lim, Rzm; Amin, Sahid N; Hayati, F; Jayasilan, J; Sriram, Rk; Subramaniam, S; Ibrahim, Af; Che Jusoh, A; Hussain, Ah; Mohamed, Sidek As; Mohd, Yunus; Soh, Jy; Wong, Mp; Zakaria, Ad; Zakaria, Z; Kampan, N; Mohd, Azman Za; Nur, Azurah Ag; Zainuddin, Aa; Fadzli, An; Fathi, Nq; Koh, Ps; Liew, Yt; Roslani, Ac; Tang, Cy; Teoh, Ly; Wong, Wj; Xavier, R; Yahaya, As; Alvarez, Mr; Arrangoiz, R; Cordera, F; M. A., De La Rosa Abaroa; A., Gómez-Pedraza; Hernandez, R; A., Maffuz-Aziz; Posada, Ja; A. I., Lupián-Angulo; Soulé, Martínez Ce; Aboharp, Hasan Z; Alvarado Silva, C; Bazan, Soto A; Hernández, Rubio A; Jiménez, Villanueva X; Otoniel, Lr; Sosa, Duran Ee; Becerra, García Fc; J., Melchor-Ruan; Romero, Bañuelos E; D., Vilar-Compte; A., Alfaro-Goldaracena; Buerba, Ga; R. A., Castillejos-Molina; Chan, C; I., Dominguez-Rosado; H., Medina-Franco; Mercado, Má; M., Oropeza-Aguilar; Peña Gómez, Portugal E; O. E., Posadas-Trujillo; F., Rodriguez-Covarrubias; N., Salgado-Nesme; Sarre, C; Vilatoba, M; Arkha, Y; Bechri, H; El, Ouahabi A; Oudrhiri, My; El, Azhari A; S. M., Louraoui; Rghioui, M; Bougrine, M; Derkaoui Hassani, F; El Abbadi, N; Amrani, L; Belkhadir, Zh; Benkabbou, A; Chakib, O; El, Ahmadi B; El, Bouazizi Y; Essangri, H; Ghannam, A; A. M., Majbar; Mohsine, R; Souadka, A; Borgstein, Abj; Gisbertz, Ss; Van Berge, Henegouwen MI (Amsterdam UMC; Cancer Center, Amsterdam; University Of, Amsterdam; Hompes, R; Meima-van, Praag Em; Pronk, A; Sharabiany, S; Grotenhuis, B; Hartveld, L; Reijers, S; W., Van Houdt; Baaij, J; Bolster-van, Eenennaam M; De, Graaff M; Sloothaak, D; Van, Duijvendijk P; Ebben, Lda; Kuiper, Sz; Melenhorst, J; Poeze, M; Sluijpers, Nrf; Vaassen, Laa; L., Posma-Bouman; Derksen, T; Franken, J; Oosterling, S; De, Bree R; Konsten, J; Van, Heinsbergen M; Adeyeye, A; Akinmade, A; Enoch, E; Fayose, S; Abur, P; Fidelis, L; Nwabuoku, Se; Oyelowo, N; Sholadoye, Tt; M. A., Tolani; Olaogun, J; Abiyere, H; Adebara, I; Adeniyi, A; Adeyemo, O; Babalola, O; Bakare, A; Banjo, O; Okunlola, A; Adeniran, A; Atobatele, K; Eke, G; Faboya, O; Ogunyemi, A; Omisanjo, O; Oshodi, O; Oshodi, Y; Williams, O; Ademuyiwa, A; Afolabi, B; Akinajo, O; Alakaloko, F; Atoyebi, O; Balogun, O; Belie, O; Bode, C; Chibuike, George I; Elebute, O; O., Ladipo-Ajayi; Ohazurike, E; Okunowo, A; Olajide, To; J., Seyi-Olajide; Daniel, A; Egbuchulem, Ik; Lawal, Ta; Nwaorgu, O; Ogundoyin, O; Olulana, D; Onakoya, P; Oyelakin, O; Abdullahi, H; Agida, E; O., Aisuodionoe-Shadrach; Ajibola, H; Akaba, G; Sani, As; Chinda, J; Dawang, Y; Garba, S; Mshelbwala, P; Obande, J; Olori, S; Olute, A; Osagie, O; Pius, Ogolekwu I; Umar, A; L., Abdur-Rahman; Adeleke, N; Adeyeye, A; Aremu, I; Bello, J; Olasehinde, O; Popoola, A; Raji, Ho; Massoud, Jg; Massoud, R; Sorour, Tm; Abassy, J; Ahmed, K; Alvi, A; Arshad, M; Khan, S; Pirzada, A; Saleem, A; Siddiqui, T; Turk, K; Hanif, F; Haroon, M; Khan, Mi; Jamal, A; Kerawala, Aa; Memon, As; Nafees, Ahmed R; Rai, L; Javed, S; Mahmood, U; Shabbir, Rk; Yaqoob, E; Afzal, A; Ahmed, Riaz S; Akbar, A; Ali, Aa; Ali, G; Janjua, A; Mohsin, M; Naqi, Sa; Saleem, I; Shaukat, A; Sohail, M; M. F., Afzal; Khokhar, Mi; Latif, F; Ayub, B; Hassan, N; Martins, Rs; Ramesh, P; Sayyed, R; Ayyaz, M; Butt, U; Kashif, M; Khan, Wh; Qureshi, Au; Umar, M; Waris, Farooka M; Wasim, T; Bhatti, Abh; Ayubi, A; Rashid, I; Waqar, Sh; I., Al-Slaibi; I. A., Alzeerelhouseini H; Jobran, F; Abukhalaf, Sa; Arrue, E; Cukier, M; H., Rodriguez-Zentner; G., Borda-Luque; León, Palacios Jl; Lizzetti, G; Vasquez, Ojeda Xp; Falcon, Pacheco Gm; Robles, R; Jocson, R; Teh, C; Uy, Magadia E; Major, P; Bąk, M; Dubieńska, K; Ławnicka, A; Murawa, D; Bobiński, M; Kotarski, J; K., Rasoul-Pelińska; Brociek, A; Chloupek, A; Janik, M; Kowalewski, P; Kwiatkowski, A; Panasiewicz, P; Roszkowski, R; Rot, P; Sroczyński, P; Walędziak, M; Azevedo, C; Machado, D; Mendes, F; De, Sousa X; Fernandes, U; Ferreira, C; Guidi, G; Leal, C; Marçal, A; Marques, R; Martins, D; Melo, A; Tenreiro, N; Vaz, Pereira R; Vieira, B; Almeida, Ji; R., Almeida-Reis; Correia, De Sá T; Costa, Mjma; Fernandes, V; Ferraz, I; Lima, Da Cruz L; Lima, Da Silva C; Lopes, L; Machado, N; Marialva, J; Nunes, Coelho M; Pedro, J; Pereira, C; Ribeiro, A; Ribeiro, Cg; Santos, R; Saraiva, P; Silva, Rl; Tavares, F; Teixeira, M; Valente, P; Almeida, Ac; Amaral, Mj; Andrade, R; Athayde, Nemésio R; Breda, D; Camacho, C; Canhoto, C; Colino, M; Correia, S; Costa, M; De, Barros J; De Oliveira, López Al; Duque, M; Garrido, S; Guerreiro, P; Guimarães, A; Lázaro, A; Lopes, C; Martins, R; Nogueira, O; Oliveira, A; Oliveira, Jm; Rodrigues, M; Ruivo, A; Santos, E; Silva, M; Simões, J; Valente, Da Costa A; Almeida, A; Castanheira, Rodrigues S; Cavaleiro, Leitão De Carvalho As; Devezas, V; Faria, Cs; Jácome, F; Magalhães, Maia M; Nogueiro, J; Pereira, A; A., Pereira-Neves; T., Pina-Vaz; H., Santos-Sousa; Silveira, H; Vaz, S; Vieira, P; Gomes, Da Costa A; Lobo, Antunes I; Pinto, J; Tojal, A; Cardoso, N; Cardoso, P; Domingues, Jc; Henriques, P; Manso, Mi; Martins Dos Santos, G; Martins, R; Morais, H; Pereira, R; Revez, T; Ribeiro, R; Null, Ribeiro; Soares, A; Sousa, S; Teixeira, J; Amorim, E; Baptista, Vh; M. F., Cunha; Dias, B; Fazenda, A; Melo, Neves Jp; Policarpo, F; Sampaio, Da Nóvoa Gomes Miguel; Veiga, D; Bandovas, Jp; Borges, N; Branquinho, A; Chumbinho, B; Correia, J; Fidalgo, H; Figueiredo, De Barros I; Frade, S; Gomes, J; Kam, Da Silva Andrade A; Maciel, J; Pereira, Rodrigues A; Pina, S; Silva, N; Silveira, Nunes I; Sousa, R; Ascensão, J; Azevedo, P; Costeira, B; Cunha, C; Garrido, R; Gomes, H; Lourenço, I; Mendinhos, G; Miranda, P; Nobre, Pinto A; Peralta, Ferreira M; Ribeiro, J; Rio, Rodrigues L; Sousa, Fernandes M; Azevedo, J; Galvão, D; Soares, Ac; Vieira, A; Vieira, B; Patrício, B; Vieira Paiva, Lopes Ac; Cunha, R; Faustino, A; Freitas, A; Jacob, Oliveira B; A. B., Martins; Mendes, Jr; Parreira, R; Rosa, J; Teves, M; Abreu, Da Silva A; Claro, M; Costa, Santos D; Deus, Ac; Grilo, Jv; Castro, Borges F; Corte, Real J; Henriques, S; Lima, Mj; Matos, Costa P; Alagoa, Joao A; Azevedo, P; Camarneiro, R; Capunge, I; Fragoso, M; Frazão, J; Martins, A; Pedro, V; Pera, R; Ramalho, De Almeida F; Sampaio, Soares A; Vale, R; Vasconcelos, M; Brito, Da Silva F; Caiado, A; Fonseca, F; Ângelo, M; Baiao, Jm; Martins, Jordão D; Vieira, Caroço T; Messias, J; Millan, A; Salgado, I; Santos, P; Baía, C; Canotilho, R; A. M., Correia; Ferreira, Pinto Ap; Peyroteo, M; Videira, Jf; Escobar, P; Maldonado, Santiago M; Kassir, R; Sauvat, F; Bonci, E; Gata, V; Titu, S; Bezede, C; Chitul, A; Ciofic, E; Cristian, D; Grama, F; Pirtea, L; Secosan, C; Ciubotaru, C; Negoi, I; Negoita, Vm; Stoica, B; Ginghina, O; Iordache, N; Iosifescu, Rv; Mardare, M; Mirica, Rm; Spanu, A; A. B., Văcărașu; Zamfir-Chiru-Anton, M; Garmanova, T; Kazachenko, E; Markaryan, D; Rodimov, S; Tsarkov, P; Tulina, I; Abelevich, A; Bazaev, A; Kokobelyan, Ak; A., Yanishev; Litvin, A; Litvina, Y; Provozina, A; Agapov, M; Galliamov, E; Kakotkin, V; Kubyshkin, V; Semina, E; Камалов, А; Novikova, A; Zakharenko, A; Alshahrani, M; Alsharif, F; Eskander, M; Al, Raddadi R; Majrashi, S; Mashat, A; Akeel, N; Alharthi, M; Aljiffry, M; Basendowah, M; Farsi, A; Ghunaim, M; Khoja, A; Maghrabi, A; Malibary, N; Nassif, M; Nawawi, A; Saleem, A; Samkari, A; Trabulsi, N; A., Azab M; Aldosri, M; Alghanem, A; Alguraigari, A; Aljohani, K; Alqahtani, D; Alzaidi, Tm; Basyouni, A; Elhussain, E; Jaloun, H; Mudawi, I; Shafei, M; Al, Awwad S; Alghamdi, M; Alnumani, T; Nasser, M; Said Bayazeed, A; Abdelrhman, S; Awad, S; Ghedan, S; I., Sharara M; Mashaly, A; Aburahmah, M; Al, Otaibi F; Al-alem, I; I. A., Al-Badawi; Aldahash, H; Alhazzaa, N; Alhefdhi, A; Alhelal, B; Alkattan, K; Almalik, O; Alomair, A; Alomar, O; Alotaibi, Nh; Alresaini, F; Alrifai, O; Alsakka, M; Alsalamah, R; Alsemari, M; Alsobhi, S; Alsumai, T; Farrash, F; Khan, P; Mahasin, Z; Othman, E; Pant, R; Robaidi, H; Saleh, W; Salem, H; Shaheen, M; Spangenberg, P; Velagapudi, S; Al, Habes H; Alamri, A; Alkarak, S; Alqannas, M; Alyami, M; Alzamanan, M; D., Cortés-Guiral; Elawad, A; Adi, H; Al Ahmad, F; Al, Ayed A; Al Zahrani, A; Alalawi, Y; Alishi, Y; Alqahtani, B; Alaamer, O; Alriyees, L; Alselaim, N; Alfaifi, J; Alkreedees, N; Almutrafi, Sn; Alramadhan, M; Alshitwi, A; D'Souza, J; Abdulkareem, A; Ajlan, A; Akkour, K; A., Al-Habib; K., Al-Khayal; Alatar, A; Alburakan, A; Alhalal, H; Alhassan, B; Alhassan, N; Aljassir, F; Alobeed, O; Alsaif, A; Alsaif, F; Alshammari, S; Alshaygy, I; Barry, M; Bin, Nasser A; Bin, Traiki T; Bokhari, A; Elwatidy, S; Helmi, H; Madkhali, A; Nouh, T; P. D., Rabah; Zubaidi, A; Al, Amri A; Abdulfattah, F; Al, Hasan I; E., Al-Kharashi; Alanazi, F; Albaqami, F; Alghamdi, A; Alghuliga, A; Aljaber, F; Alsowaina, K; Alsuhaibani, A; Arab, N; Badahdah, F; Alobaysi, S; Alshahrani, A; Alzahrani, A; Paunovic, I; Slijepcevic, N; Aleksić, L; Antic, A; Barisic, G; Ceranic, M; Ebrahimi, K; Galun, D; Grubač, Ž; Ivanović, N; Jelenkovic, J; Kecmanović, D; Kmezić, S; Knezevic, D; Krivokapic, Z; Latinčić, S; Markovic, V; Matić, S; Miladinov, M; Pavlov, M; Pejovic, I; Radenkovic, D; Sabljak, P; Skrobić, O; Šljukić, V; Tadic, B; Vasljević, J; Velickovic, D; Zivanovic, M; Doklestic, K; Gregoric, P; Ivancevic, N; Loncar, Z; Micic, D; Perovic, M; Srbinovic, L; Andrijasevic, S; Bozanovic, T; Cerovic, Popovic R; Dokic, M; Janjic, T; Jeremic, K; Kadija, S; Ladjevic, Likic I; Mirkovic, L; Pantovic, S; Pilic, I; Radojevic, M; Stefanovic, A; Vidakovic, S; Vilendecic, Z; Antic, S; Dunđerović, D; Jelovac, D; Jezdic, Z; Konstantinovic, V; Kotlar, B; Kuzmanovic, C; Lazić, M; Pajić, S; Petrovic, M; Popovic, F; Pucar, A; Romic, M; Sumrak, S; Vujanac, V; Bascarevic, V; Bogdanovic, I; Grujičić, D; Ilic, R; Jokovic, M; Milićević, M; Milisavljević, F; Miljković, A; Paunovic, A; Šćepanović, V; Stanimirovic, A; Todorovic, M; Folic, M; Jotic, A; Krejovic, Trivic S; Milovanovic, J; Trivic, A; Bumbasirevic, U; Dzamic, Z; Kajmaković, B; Prijović, N; Zivkovic, M; Buta, M; Cvetkovic, A; Djurisic, I; Gacic, S; Goran, M; Inic, Z; Jeftic, N; Jevric, M; Jokic, V; Markovic, I; Milanović, M; Nikolic, S; Pejnovic, L; Savković, N; Spurnic, I; Stevic, D; Stojiljkovic, D; Vucic, N; Zegarac, M; Karamarkovic, A; Kenic, M; Kovacevic, B; Krdzic, I; Milutinović, V; Savic, G; Chan, Cw; Lieske, B; Gális, B; Šimko, K; Cokan, A; Crnobrnja, B; Dovnik, A; Knez, J; Pakiž, M; Almgla, N; Bernon, M; Boutall, A; Cairncross, L; Chinnery, G; Herman, A; Hilton, T; Jonas, E; Kloppers, C; Malherbe, F; Mugla, W; Nel, D; Rayamajhi, S; Scriba, M; Van, Wyngaard T; Vogel, J; A. M., Castaño-Leon; Delgado, Fernandez J; Eiriz, Fernandez C; Espino, Segura-Illa M; Esteban, Sinovas O; Garcia, Perez D; Gomez, P; L., Jimenez-Roldan; Lagares, A; L., Moreno-Gomez; Paredes, I; Pérez, Núñez A; Sánchez, Aniceto G; Santas, Alegret M; Fernández, Rodríguez P; Paniagua García, Señorans M; R., Sanchez-Santos; Vigorita, V; Acrich, E; Baena, Sanfeliu E; Barrios, O; Golda, T; Santanach, C; M., Serrano-Navidad; Sorribas, Grifell M; Vives, Rv; Arce, Gil J; Escolà, D; Jiménez, A; Alcázar, Ja; M., Angoso-Clavijo; F., Blanco-Antona; A., Carabias-Orgaz; Díaz, Maag R; Eguía, Larrea M; Esteban, Velasco C; Garcia, J; A. G. P., García-Plaza; J. I., Gonzalez-Muñoz; L., Muñoz-Bellvis; F. C., Parreño-Manchado; Sánchez, Tocino Jm; A. B., Sanchez-Casado; Trebol, J; Hernandez, Gutierrez J; Tébar, Zamora A; Sánchez, Mozo A; Cayetano, Paniagua L; Gomez, Fernandez L; Artigues, E; J. C., Bernal-Sprekelsen; Catalá, Bauset Jc; J., Gilabert-Estellés; Collera, P; Diaz, Del Gobbo R; Farre, Font R; Flores, Clotet R; Gómez, Díaz Cj; Guàrdia, N; Guariglia, Ca; Osorio, A; Sanchez, Jimenez R; Sanchon, L; Soto, Montesinos C; Albi, Martin B; García, Villayzán Je; L., Alonso-Lamberti; Assaf, M; Baeza, Pintado N; Carabias, A; J., García-Quijada; Huertas, Fernandez; Jimenez, Miramón J; Jimenez, V; Jover, Jm; Landeo, Agüero Sa; Leon, R; M. B., Martín Salamanca; Pérez, Simón V; Ponce, S; Rodriguez, Jl; Salazar, A; Valle, Rubio A; Aguado, H; Aldecoa, Ansorregui I; Bravo, Infante R; De, Lacy Fb; Di, Somma A; B., Díaz-Feijoo; Enseñat, Nora J; Fabregas, N; Ferrés, A; Gil, Ibañez B; Gonzalez, Sanchez Jj; Gracia, I; Hoyos, Castro Ja; A. M., Lacy; Langdon, C; Momblán, D; Morales, X; Oleaga, L; Otero, A; Pedrosa, L; Poblete, Carrizo J; Reyes, Figueroa La; P., Roldan Ramos; J., Rumia-Arboix; A. I., Tercero-Uribe; Topczewski, Te; Torales, J; Torne, A; Torné, R; V., Turrado-Rodriguez; Valero, R; Valverde, S; Anula, R; Avellana, R; Camarero, Rodríguez E; Catalán, Garza V; Dziakova, J; García, Alonso M; Lasses, Martínez B; López, Antoñanzas L; Muguerza, Jm; Ochagavía, S; Peña, Soria Mj; D., Rivera-Alonso; Saez, Carlin P; Sánchez Del Pueblo, C; Sanz, Ortega G; R., Sanz-Lopez; Torres, A; M., Garcés-Albir; Lopez, F; J., Martín-Arévalo; D., Moro-Valdezate; V., Pla-Marti; Beltrán, De Heredia J; De, Andrés-Asenjo B; Gómez, Sanz T; Jezieniecki, C; Nuñez, Del Barrio H; Ortiz, De Solórzano Aurusa Fj; Romero, De Diego A; Ruiz, Soriano M; Trujillo, Díaz J; Vazquez, Fernandez A; P., Lora-Cumplido; Sosa, Mv; Balague, C; Ballester, E; Moral, A; Sánchez, López A; Targarona, Em; A., Galvan-Perez; E., Gonzalez-Gonzalez; A. M., Minaya Bravo; San, Miguel-Mendez C; Alonso De La Fuente, N; Cazador, Labat M; Cecchini, L; Espinosa, Ca; Jimenez, Toscano M; López, Campillo A; Mancebo, G; Martorell, P; Munarriz, M; E. J., Grau-Talens; B., Martin-Perez; Benavides, Buleje Ja; Carrasco, Prats M; Fernández, Pv; A., Fernández-López; García, Escudero D; García, Porcel Vj; Garcia, Soria V; Giménez, Francés C; González, Valverde Fm; E., Gurrea-Almela; P., López-Morales; Marco, Garrido A; Martínez, Alonso Ja; Medina, E; Muñoz, Camarena Jm; P. A., Parra Baños; Peña, Ros E; Ramirez, Faraco M; M., Ruiz-Marín; Sanchez, Rodriguez C; Valero, Soriano M; Allué, Cabañuz M; Colsa, Gutiérrez P; García, Domínguez M; Gimenez, Maurel T; Martín, Anoro Lf; Ponchietti, L; Rodriguez, Artigas Jm; Roldón, Golet M; Utrilla, Fornals A; Estaire, Gómez M; Fernández, Camuñas Á; Garcia, Santos Ep; Jimenez, Higuera E; López De La Manzanara Cano, Ca; C., Martínez-Pinedo; Moreno, Pérez A; V., Muñoz-Atienza; D., Padilla-Valverde; Picón, Rodríguez R; Redondo, Calvo Fj; S., Sánchez-García; D., Sanchez-Pelaez; Curtis, Martínez C; A., Fernández-Candela; L., Sánchez-Guillén; Colombari, Rc; Del Valle, E; Fernández, M; Lozano, Lominchar P; Martín, L; Rey, Valcarcel C; M. A., Steiner; Tudela, M; Zorrilla, Ortúzar J; Alcaide, Matas F; García, Pérez Jm; Troncoso, Pereira P; Blas, Laina Jl; Cros, B; Escartin, J; Garcia, Egea J; Nogués, A; Talal, El-Abur I; Yánez, C; I., Mora-Guzmán; Cárdenas, Puiggrós L; Abellán, M; Achalandabaso, Boira M; Jorba, R; Memba, Ikuga R; Olona, C; Sales, Mallafré R; Aguilo, O; Cavallé, Busquets P; Gavalda, Pellice Mgp; Jorda, Sole M; Mateu, I; Miralles, Curto M; Salinas, Peña J; Fernández, Martínez D; García, Flórez Lj; L., Solar-Garcia; Aragon, Achig Ej; Barbier, L; Caja, Vivancos P; Gainza, A; García, Gutierrez Jj; G., García-Operé; J., Gómez-Suárez; M., Jiménez-Jiménez; Mallabiabarrena, Ormaechea G; Marín, H; Martin, Playa P; Melchor, Corcóstegui I; J. A., Municio-Martín; Oñate, M; L. A., Pascua-Gómez; M. A., Pesántez Peralta; Prieto, Calvo M; Rodriguez, Fraga A; Villalabeitia, Ateca I; De Andres, Olabarria U; Durán, Ballesteros M; Fernández, Pablos Fj; F. J., Ibáñez-Aguirre; Sanz, Larrainzar A; B., Ugarte-Sierra; M. A., Acosta Mérida; Ortiz, López D; Yepes, Cano Af; Correa, Bonito A; De, La Hoz Rodríguez Á; Delgado, Búrdalo L; Di, Martino M; García, Sánz I; García, Septiem J; Maqueda, González R; E., Martin-Perez; Muñoz, De Nova Jl; Calvo, Espino P; Guillamot, Ruano P; Colao, García L; Díaz, Pérez D; Esteban, Agustí E; Galindo, Jara P; Gutierrez, Samaniego M; M. A., Hernandez Bartolome; Serrano, González J; Alonso, Poza A; Diéguez, B; M., García-Conde; M., Hernández-García; Losada, M; C. M., Chiesa-Estomba; González García, Já; Larruscain, E; J. A., Sistiaga-Suárez; Alvarez, E; Chavarrias, N; Frías, L; García, Pineda V; Gegúndez, Simón A; Gómez, Rivas J; Gortázar De Las Casas, S; Gracia, M; Guevara, J; Hernández, Gutierrez A; Loayza, A; María, Dolores Dt; Martí, C; Melendez, M; E., Moreno-Palacios; Perez, Y; Prieto, Nieto Mi; P., Ramos-Martín; I., Rubio-Perez; Saavedra, J; Sánchez, Méndez Ji; Siegrist, Ridruejo J; Toribio, Vazquez C; Urbieta, A; Yebes, A; Zapardiel, I; D., Aparicio-López; Cantalejo Diaz, M; M. D. C., De Miguel Ardevines; Dobón Rascón, Má; V., Duque-Mallén; Gascon, Ferrer I; M. T., González-Nicolás Trébol; C., Gracia-Roche; Herrero, Lopez M; Jariod, Ferrer Um; Kälviäinen, H; Lanzon, A; Martinez, German A; Matute, M; Redondo, C; Sánchez, Fuentes N; M. S., Santero-Ramirez; Saudí, S; Simón, Sanz Mv; Uson, T; Blazquez, Martin A; Diez, Alonso M; García, Rico E; Garcia-Loarte, Gomez E; Garcia-Moreno, Nisa F; Gutierrez, Calvo A; Hernandez, P; Lasa, I; F., Mendoza-Moreno; Morales, Palacios N; Ovejero, Merino E; Vera, Mansilla C; Acero, J; Haddad, A; Barranquero, Ag; Caballero, Silva U; Cabañero, Sánchez A; Cavestany, Garcia-Matres C; Cerro, Zaballos C; Fra, Fernández S; Moreno, Mata N; Muñoz, Molina Gm; Núñez, J; Ocaña, J; Ramos, D; Acebes, García F; Bailón, M; Bueno, Cañones Ad; Choolani, Bhojwani E; P., Marcos-Santos; Miguel, T; Pacheco, Sánchez D; B., Pérez-Saborido; Sanchez, Gonzalez J; F. J., Tejero-Pintor; Alconchel, F; Conesa, A; Gil, Martínez J; Gutiérrez, Fernández Ai; Lopez, Abad A; T., Nicolás-López; Ramirez, Romero P; Roca, Calvo Mj; Rodrigues, K; Ruiz, Manzanera Jj; Soriano, Ai; Cano, A; L., Capitan-Morales; Cintas, Catena J; J., Gomez-Rosado; Oliva, Mompean F; Pérez, Sánchez; Río, Lafuente Fd; Torres, Arcos C; J., Valdes-Hernandez; Bruna, Esteban M; Cholewa, H; Domingo, S; Frasson, M; Lago, V; Marina, Martin T; Martínez, Chicote C; J., Sancho-Muriel; B., Estraviz-Mateos; Fernández Gómez, Cruzado L; González, De Miguel M; Landaluce-olavarria, A; Lecumberri, D; Abad, Gurumeta A; A., Abad-Motos; E., Martínez-Hurtado; J., Ripollés-Melchor; Ruiz, Escobar A; A., Cuadrado-García; Garcia-Sancho, Tellez L; Heras, Aznar J; Maté, Mate P; Ortega, Vázquez I; Picardo, Al; Rojo, López Ja; Sanchez Cabezudo, Noguera F; Serralta, De Colsa D; Anchuelo, Latorre J; Cagigas, Fernandez C; Caiña, Ruiz R; Fernandez, Diaz Mj; Gomez, Ruiz M; Hernanz, F; Jimeno, Fraile J; P., Martínez-Pérez; Poch, C; Santarrufina, Martinez S; Valbuena, Jabares V; C., Moliner-Sachez; L., Pingarron-Martin; J., Rey-Biel; Ruiz, Martin I; Cagigal, Ortega Ep; Cervera, I; Díaz, Peña P; Garcia, De Castro Rubio E; Enjuto, D; Fernández, Bernabé P; Garcés, García R; Gonzalez, J; Hernández, I; N., Herrera-Merino; Marqueta, De Salas M; Martinez, Pascual P; Perez, Gonzalez M; Ramos, Bonilla A; Rodríguez, Gómez L; Alfonso, Garcia M; A., Craus-Miguel; Fernández, Vega L; E., Ferrer-Inaebnit; Gil, Catalán A; González, Argente Fx; Jeri, S; Oseira, A; Pujol, Cano N; J. J., Segura-Sampedro; Soldevila, Verdeguer C; Villalonga, B; Bescós, C; R., Blanco-Colino; Brana, I; Caimari, B; De Pablo, García-Cuenca A; F., Duran-Valles; E., Espin-Basany; Giralt, López De Sagredo J; Pamias, J; Pellino, G; Prat, N; Pujol, Pina R; Saez Barba, M; Arulanantham, A; Bandara, Gbkd; Jayarajah, U; Ravindrakumar, S; Rodrigo, Vsd; Ali, Adil Aa; Elhafiz, Mhy; Ali, Ee; Awadelkarim, M; Bakheit, I; Elbahri, H; Hamid, Hks; M. E. A., Essa; Ahmed, Aa; Abubakr, Hassan; Momin Majed, Yousuf Hilles; Saleh, M; Arkani, S; Freedman, J; Elbe, P; Lindqvist, Ek; Angenete, E; Park, J; Taflin, H; Greiff, L; Hagander, L; Älgå, A; Heinius, G; Nordberg, M; Pieniowski, E; Gkekas, I; Löfgren, N; Rutegård, M; Sund, M; Arigoni, M; Bernasconi, M; Christoforidis, D; Di, Giuseppe M; La, Regina D; Mongelli, F; Chevallay, M; Dwidar, O; Gialamas, E; Sauvain, M; Giger, R; Hool, S; Klenke, F; Kollàr, A; Kurze, C; Mueller, Sa; Kiessling, S; Stoeckli, S; Adamina, M; Bächler, T; Crugnale, As; Giardini, M; Guglielmetti, L; Peros, G; Solimene, F; Gass, M; Metzger, J; Scheiwiller, A; Gutschow, C; Turina, M; Al, Asadi T; Alkhateb, S; Altom, R; Bakkar, B; Maa, Albared S; Melhem, S; Hamdan, A; Hammed, A; Hammed, S; Hossain, M; Mahfoud, M; Moussa, A; Alsayyad, R; Alsrouji, S; Ashour, G; Hareth, Al-Nahr M; Slitin, A; Tanos, C; Kacem, Mj; Maghrebi, H; Sebai, A; Aghayeva, A; Hamzaoglu, I; Sahin, I; Akaydin, E; Aliyeva, Z; Aytac, E; Baca, B; Dülgeroğlu, O; Ozben, V; Ozmen, Bb; Uras, C; Arikan, Ae; Bilgin, Ia; Bozkırlı, B; Ceyhan, Go; Kara, H; Karahasanoğlu, T; Uras, C; Celik, H; Meydanli, Mm; Akbas, A; Altinel, Y; Calikoglu, F; Ercan, G; Ercetin, C; Hacım, Na; Meriç, S; Tokocin, M; Vartanoglu, T; Yigitbas, H; Akilli, H; Ayhan, A; Kuscu, E; Doğangün, M; Iflazoğlu, N; Yalkın, Ö; Turna, A; M. A., Onan; Akgor, U; Cennet, O; Dincer, Ha; Erol, T; Gultekin, M; Orhan, N; Ozgul, N; Salman, Mc; Soyak, B; Aydemir, L; Başaran, B; Kara, H; Sen, C; Ulusan, M; Açıkgöz, As; Alhamed, A; Aykanat, Y; Bese, T; Cebi, S; Demirkıran, F; Ergün, S; Kayan, B; M. F., Ozcelık; Sanli, An; Uludağ, Ss; Velidedeoglu, M; Zengin, Ak; M. A., Bozkurt; Kara, Y; Kocatas, A; Candas, Altinbas B; A. B., Çekiç; Eyuboglu, K; Guner, A; Türkyılmaz, S; M. A., Usta; Cimenoglu, B; Demirhan, R; Saracoglu, K; Azamat, İf; Balik, E; Buğra, D; Giray, B; C. B., Kulle; Taskiran, C; Vatansever, D; Güler, Sa; Güreşin, A; Tatar, Oc; Utkan, Nz; Yildirim, A; Yüksel, E; Abbasov, A; Yanar, H; Ugurlu, Mu; Akin, E; Altintoprak, F; Bayhan, Z; Cakmak, G; Çapoğlu, R; Çelebi, F; Demir, H; Dikicier, E; Firat, N; Gönüllü, E; M. B., Kamburoğlu; Kocer, B; Küçük, If; Mantoglu, B; Çolak, E; Kucuk, Go; M. S., Uyanik; Goksoy, B; Bozkurt, E; Citgez, B; Mihmanli, M; Tanal, M; Yetkin, G; Akalin, M; Arican, C; Avci, Ek; Aydin, C; Demirli, Atıcı S; Emiroglu, M; Kaya, T; Kebabçı, E; Kilinc, G; Kirmizi, Y; Öğücü, H; Salimoğlu, S; Sert, İ; Tugmen, C; Tuncer, K; Uslu, G; Yeşilyurt, D; Karaman, E; Kolusarı, A; Yildiz, A; Gultekin, Fa; Lule, H; Oguttu, B; Abdelgalil, K; Agilinko, J; Ahmeidat, A; Barabasz, M; Bekheit, M; Cheung, Lk; Colloc, T; Cymes, W; Elhusseini, M; Gradinariu, G; Hannah, A; B. S., Kamera; Mignot, G; Shaikh, S; Sharma, P; I., Abu-Nayla; Agrawal, A; A., Al-Mohammad; Ali, S; Ashcroft, J; Azizi, A; Baker, O; Balakrishnan, A; Byrne, M; Colquhoun, A; Cotter, A; Coughlin, P; Davies, Rj; Durrani, A; Elshaer, M; Fordington, S; Forouhi, P; Georgiades, F; Grimes, H; Habeeb, A; Hudson, V; Hutchinson, P; Irune, E; Jah, A; Khan, Dz; Kolias, A; Kyriacou, H; Lamb, B; Liau, S; Luke, L; Mahmoud, R; Mannion, R; Masterson, L; Mitrofan, C; Mohan, M; Morris, A; Murphy, S; O'Neill, Jr; Price, S; Pushpa-rajah, J; W., Raby-Smith; Ramzi, J; S. M., Rooney; Santarius, T; Singh, Aa; Stewart, Gd; Tan, Xs; Townson, A; Tweedle, E; Walker, C; Waseem, S; Yordanov, S; Jones, T; Kattakayam, A; Loh, C; Lunevicius, R; Nunes, Q; Pringle, S; Schache, A; Shaw, R; Sheel, A; Sud, A; Sundhu, M; Rossborough, C; Angelou, D; Choynowski, M; Mcaree, B; Mccanny, A; Neely, D; Kamel, F; Kumar, L; Madani, R; Nisar, P; Tutoveanu, G; Ali, S; M. N., Bittar; Creanga, M; Elniel, M; Law, J; Youssef, M; Ahad, S; De, La Cruz Monroy Mfi; Hashem, M; Langlands, F; Mosley, F; Oktseloglou, V; Omar, I; Patel, F; Alanbuki, A; Patel, M; Shabana, A; Rathinaezhil, R; Perera, E; Raveendran, D; K., Ravi-Shankar; Thiruchelvam, J; Che, Bakri Na; Jawad, Z; Jiao, L; Nazarian, S; Vashisht, R; Arrowsmith, L; Campbell, W; Grove, T; Kontovounisios, C; Warren, O; Rolland, P; Aggarwal, A; Brown, S; Jelley, C; Neal, N; Kaur, R; Leung, E; Sundar, S; Doulias, T; Li, M; Martin, E; Rodwell, H; Clifford, R; Eardley, N; Krishnan, E; Manu, N; Martin, E; Roy, Mahapatra S; Serevina, Ol; Smith, C; Vimalachandran, D; Bordenave, M; Houston, R; Putnam, G; Robson, A; Tustin, H; Emslie, K; Labib, Pl; Marchbank, A; Miller, D; Minto, G; Natale, J; Nwinee, H; Panahi, P; Rogers, L; Abubakar, A; Akhter, Rahman Mm; Chan, E; O'Brien, H; Sasapu, K; Inglis, R; Ng, Hj; De Gea, Rico A; Ghazali, N; Lambert, J; Markose, G; Math, S; Sarantitis, I; Shreshtha, D; Simpson, R; Sonanis, S; Sultana, A; Taggarsi, M; Timbrell, S; Vaz, Op; Vitone, L; Day, A; Dent, H; Fahim, M; Waheed, S; Hunt, A; Laskar N., Hastings; Gupta, A; Steinke, J; Thrumurthy, S; Massie, E; Mcgivern, K; Rutherford, D; Wilson, M; Hardie, J; Kazzaz, S; T., Bacarese-Hamilton; Ip, M; James, A; Salerno, G; Stockdale, T; Handa, S; Kaushal, M; Kler, A; Patel, P; Redfern, J; Tezas, S; Aawsaj, Y; Amonkar, S; Barry, C; Blackwell, L; Blake, D; Carter, J; Emerson, H; Fisher, A; Katory, M; Korompelis, P; Mccormick, W; Mustafa, A; Pearce, L; Ratnavelu, N; Reehal, R; Damola, A; Kretzmer, L; Lalou, L; Lim, P; Manku, B; Parwaiz, I; Sandher, M; Stafford, J; Abdelkarim, M; Asqalan, A; Gala, T; Ibrahim, S; Maw, A; Mithany, R; Morgan, R; Sundaram, Venkatesan G; Holroyd, D; Jamieson, N; Jones, C; Shin, Js; Ang, K; Caruana, Ej; Chandarana, K; M. F., Chowdhry; Mohammad, A; Nakas, A; Rathinam, S; Banfield, D; Boal, M; Brown, O; Dean, H; Dwerryhouse, S; Higgs, S; Vallance, A; Boyd, E; Irvine, V; Kirk, A; Bakolas, G; Boulton, A; Chandock, A; Khan, T; Kumar, M; Agoston, P; Billè, A; Challacombe, B; Fraser, S; K., Harrison-Phipps; King, J; Mccrindle, S; Mehra, G; Mills, L; Najdy, M; Nath, R; Okiror, L; Pilling, J; Rizzo, V; Routledge, T; Sayasneh, A; Stroman, L; Wali, A; Fehervari, M; Fotopoulou, C; Habib, N; S., Hamrang-Yousefi; Jawad, Z; Jiao, L; Pai, M; Ploski, J; Rajagopal, P; Saso, S; Sodergren, M; Spalding, D; Laws, S; Hardie, C; Mcnaught, C; Alam, R; Budacan, A; Cahill, J; Kalkat, M; Karandikar, S; Kenyon, L; Naumann, D; Patel, A; Chen, F; Cheung, J; Ayorinde, J; Chase, T; Cuming, T; Ghanbari, A; Humphreys, L; Tayeh, S; Aboelkassem, Ibrahim A; Bichoo, R; Cao, H; Chai, Akw; Choudhury, J; Evans, C; Fitzjohn, H; Ikram, H; Khalifa, E; Langstroth, M; Loubani, M; Mcmillan, A; Nazir, S; Qadri, Ssa; Robinson, A; Ross, E; Sehgal, T; Wilkins, A; Dixon, J; Dunning, J; Freystaetter, K; Jha, M; Kusuma, Vrm; Lester, S; Madhavan, A; Thulasiraman, Sv; Viswanath, Y; T., Curl-Roper; Delimpalta, C; Liao, Ccl; Velchuru, V; Westwood, E; Belcher, E; G., Bond-Smith; Chidambaram, S; Di, Chiara F; Fasanmade, K; Fraser, L; Fu, H; Ganau, M; Gore, S; Goricar, M; Graystone, J; Jeyaretna, D; Khatkar, H; Lami, M; Maher, M; Mastoridis, S; Mcveigh, J; Mihai, R; Myatt, R; Piper, R; Prabhu, S; Risk, Obf; Selbong, U; Shah, K; Silva, P; Smillie, R; Soleymani Majd, H; Sravanam, S; Stavroulias, D; Tebala, Gd; Vatish, M; Verberne, C; Wallwork, K; M. A., Williams; Winter, Sc; Ahmed, I; Djouani, A; Eddy, B; Folkard, S; Hassan, F; Kommu, S; Papadopoulos, G; Simoes, A; Streeter, E; J., Tait-Bailey; Thomas, M; Wang, W; Yao, M; Anscomb, N; R., Baldwin-Smith; Davies, M; Grainger, C; Haji, A; Haq, A; J. W., Nunoo-Mensah; Rizk, M; Bhatti, Mi; H., Boyd-Carson; Elsey, E; Gemmill, E; Herrod, P; Jibreel, M; Lenzi, E; Saafan, T; Sapre, D; Sian, T; Watson, N; Athanasiou, A; Borg, E; Bourke, G; Bradshaw, L; Brunelli, A; Burke, J; Coe, P; Costigan, F; Elkadi, H; Ho, M; Johnstone, J; Kanatas, A; Kantola, V; Kaufmann, A; Laios, A; Lam, S; Macinnes, E; Munot, S; Nahm, C; Otify, M; Pompili, C; Raslan, M; Salminen, H; Smith, I; Theophilou, G; Toogood, G; Wade, R; Ward, D; West, C; A., Al-Harbawee; Alharawee, A; Annamalai, S; Ashmore, C; Boddy, A; Hossain, T; Irvine, E; Kassam, K; Kourdouli, A; Chean, Cs; Dharamavaram, S; Gvaramadze, A; Jibril, A; Kulkarni, N; Pereira, I; Prusty, L; Shanthakunalan, K; Srikumar, B; Thekkinkattil, D; Adegbola, S; Menakaya, C; Noel, J; Harky, A; Shackcloth, M; Askari, A; Chan, C; Cirocchi, N; Kudchadkar, S; Patel, K; Sagar, J; Shaw, S; Talwar, R; Abdalla, M; Edmondson, R; Ismail, O; Jones, D; Newton, K; Stylianides, N; Aderombi, A; Andaleeb, U; Bajomo, O; Beatson, K; Garrett, W; Mehmood, M; Ng, V; R., Al-Habsi; Brimioulle, M; Divya, Gs; Keeler, B; Soulsby, Re; Taylor, A; B., Al-Sarireh; Clancy, R; Cripps, P; Dobbs, T; Egan, R; Fabre, I; Harries, R; Henry, A; Kittur, M; Li, Z; Parkins, K; Soliman, F; Spencer, N; Thompson, D; Burgess, C; Gemmell, C; Grieco, C; Hollyman, M; Hunt, L; Morrison, J; Ojha, S; Abbadessa, F; Barnard, S; Chan, C; Dawe, N; Hammond, J; Koshy, Rm; Mahmoud, Ali F; Mcpherson, I; Mellor, C; Moir, J; Pandanaboyana, S; Powell, J; Rai, B; Rogers, A; Roy, C; Sachdeva, A; Saleh, C; Tingle, S; Williams, T; Manickavasagam, J; Mcdonald, C; Mcgrath, N; Mcsorley, N; Ragupathy, K; Ramsay, L; Solth, A; Aristotelous, C; Kakisi, O; Seebah, K; Shaikh, I; Sreedharan, L; Touil, L; Youssef, M; Shah, J; Ameerally, P; Baguley, M; Gnanachandran, C; Heer, B; Rogers, M; Woods, R; Aujayeb, A; Mills, S; Abu, J; E., Addae-Boateng; Bratt, D; Brock, L; Burnside, N; S., Cadwell-Sneath; Gajjar, K; Gan, C; Grundy, C; Hallam, K; Hassell, K; Hawari, M; Joshi, A; Khout, H; Konstantinidi, K; R. X. N., Lee; Nunns, D; Schiemer, R; Walton, T; Weaver, H; Whisker, L; Williamson, K; Mcveigh, J; Myatt, R; M. A., Williams; Ahmed, Me; Bukhari, Si; Illingworth, B; Kanthasamy, S; Knights, E; Ong, Sl; Pujari, R; Tan, Khm; Vanker, R; Michel, M; Patil, S; Ravindran, S; Sarveswaran, J; Scott, L; Biliatis, I; Edmond, M; King, E; Babawale, O; Hodgson, D; Ismail, M; Khan, J; Lokman, U; Phan, Yc; Almond, M; Bhangu, A; Breik, O; Cato, Ld; Chowdhury, Ya; Desai, A; Ford, S; Griffiths, E; Idle, M; Kamal, M; Karia, K; Kisiel, A; Kulkarni, R; Mak, Jkc; Martin, T; Nankivell, P; Parente, A; Parmar, S; A. M., Pathanki; Phelan, L; Praveen, P; Saeed, S; Sharma, N; Singh, J; Solomou, G; Soon, Wc; Stevens, A; Tirotta, F; Topham, C; Ughratdar, I; Vijayan, D; Ballantyne, K; Barker, L; Chapman, K; Charalambous, M; Chianakwalam, C; English, C; Evans, J; Fell, A; Frimpong, D; Halkias, C; Iyer, R; Merh, R; Neagu, G; Nikolaou, S; Poddar, A; Pronisceva, V; Reddy, V; Williams, N; Alakandy, L; Bhattathiri, P; Brown, J; Canty, M; Day, E; Geddes, A; Grivas, A; Hassan, S; Lammy, S; Littlechild, P; Maseland, C; Mathieson, C; Mccaul, J; Mcmahon, J; O'Kane, R; St., George E; Suttner, N; Taylor, W; Tilling, E; English, W; Kaul, S; Khan, Ah; Khan, F; Mansuri, A; Mukherjee, S; Patel, M; Sarigul, M; Singh, S; Smith, C; Tan, Kl; Vulliamy, P; Woodham, A; Yang, Yh; Adiamah, A; Brewer, H; Chowdhury, A; Evans, J; Humes, D; Jackman, J; Koh, A; C., Lewis-Lloyd; Navarro, A; Oyende, O; Reilly, J; Vohra, R; Worku, D; Cool, P; Cribb, G; Shepherd, K; Bisset, C; Moug, S; Chadha, R; Elson, N; Galleano, R; Faulkner, G; Langone, A; Panayi, Z; Saleh, P; Tuminello, F; Underwood, C; Brixton, G; Findlay, L; Klatte, T; Majkowska, A; Manson, J; Potter, R; W., Al-Khyatt; Awad, S; Bhalla, A; Chia, Z; Daliya, P; Goyal, A; Grimley, E; Hamad, A; Kumar, A; Malcolm, Fl; Ng, Jck; Phillips, A; Theophilidou, E; Williams, S; Bowden, J; Campain, N; Daniels, I; Evans, C; Fowler, G; John, J; Massey, L; Mcdermott, F; Mcgrath, J; Mclennan, A; Ng, M; Pascoe, J; Rajaretnam, N; Angamuthu, N; Bulathsinhala, S; Chowdhury, S; Davidson, B; Fusai, G; Gilliland, J; Hart, C; Hidalgo, Salinas C; Knowles, J; Machairas, N; Mirnezami, R; Pissanou, T; Pollok, Jm; Raptis, Da; Soggiu, F; Tzerbinis, H; Varcada, M; Xyda, S; Beamish, A; Davies, E; Foulkes, R; Magowan, D; Nassa, H; Ooi, R; Price, C; Smith, L; Solari, F; Tang, A; Williams, G; Abd, Kahar Nn; Y., Al-Tamimi; Bacon, A; Beasley, N; Catto, J; Chan, Lh; Chew, D; Crank, M; Ilenkovan, N; Macdonald, M; Narice, B; Rominiyi, O; Saad, S; Sinha, S; Thompson, A; Varley, I; Brennan, P; Drake, T; Harrison, Em; Linder, G; Mayes, J; Mcgregor, R; Pasricha, R; Skipworth, Rje; Zamvar, V; Davies, E; Hawkin, P; Raymond, T; Ryska, O; Baron, R; Dunne, D; Gahunia, S; Halloran, C; Howes, N; Mckinney, R; Mcnicol, F; Rajput, K; Russ, J; Sutton, R; Szatmary, P; Tan, Jr; Thomas, A; Whelan, P; Anzak, A; Banerjee, A; Fuwa, O; Hughes, F; J. D., Jayasinghe; Knowles, C; Kocher, Hm; Leal, Silva I; Ledesma, Fs; Minicozzi, A; Navaratne, L; Patki, P; Rahman, R; Ramamoorthy, R; Sohrabi, C; Tanabalan, C; Thaha, M; Thakur, B; Venn, M; Yip, V; Baumber, R; Parry, J; Evans, S; Jeys, L; Morris, G; Parry, M; Stevenson, J; Ahmadi, N; Aresu, G; Z. M., Barrett-Brown; Coonar, A; Durio, Yates H; Gearon, D; Hogan, J; King, M; Peryt, A; Pradeep, Is; Smith, C; Adishesh, M; Atherton, R; Baxter, K; Brocklehurst, M; Chaudhury, M; Krishnamohan, N; Mcaleer, J; Owens, G; Parkin, E; Patkar, P; Phang, I; Aladeojebi, A; Ali, M; Ali, S; Barmayehvar, B; Gaunt, A; Gowda, M; Halliday, E; Kitchen, M; Mansour, F; Nanjaiah, P; Thomas, M; Zakai, D; N., Abbassi-Ghadi; Assalaarachchi, H; Currie, A; Flavin, M; Frampton, A; Hague, M; Hammer, C; Hopper, J; Horsnell, J; Humphries, S; Kamocka, A; Madhuri, Tk; Preston, S; Singh, P; Stebbing, J; Tailor, A; Walker, D; Coomber, E; Jaunoo, S; Kennedy, L; Williams, O; Airey, A; Bunni, J; Crowley, R; Fairhurst, K; Frost, J; George, R; Lee, S; Mitchell, S; Phull, J; Richards, S; Aljanadi, F; Campbell, A; Glass, A; Hraishawi, I; Jones, M; Mcilmunn, C; Mcintosh, S; Mhandu, P; O'Donnell, C; Turkington, R; Z., Al-Ishaq; Bhasin, S; Bodla, As; Burahee, A; Crichton, A; A., El-Ghobashy; Fossett, R; Pigadas, N; Rahman, E; Snee, D; Vidya, R; Yassin, N; Colombo, F; Fountain, D; 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
A, AnnicchiaricoMembro del Collaboration Group
;
2022-01-01
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.
