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Prognosis and Prognostic Factors of Lung Cancer

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Abstract

Lung cancer is the most common cause of deaths related with cancer worldwide and the disease is often at an advanced stage at diagnosis. According to the recent Tumor Node Metastasis classification scheme the vital factor that effects the prognosis and the survival for lung cancer has been known to be the stage of the disease at the time of diagnosis. Besides the stage, histological type and molecular characterization of the tumor and the patient’s performance status are other important prognostic factors in lung cancer patients. According to the new treatment options developed in line with the developments in the molecular and genetic analysis, treatment options and thus the prognosis of lung cancer is affected. Therefore, the prognosis of lung cancer is evaluated and reported in this part considering all these novel developments.

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References

  1. Nasim F, Sabath BF, Eapen GA. Lung cancer. Med Clin North Am. 2019;103(3):463–73. https://doi.org/10.1016/j.mcna.2018.12.006.

    Article  PubMed  Google Scholar 

  2. Bryan S, Masoud H, Weir HK, et al. Cancer in Canada: stage at diagnosis. Health Rep. 2018;29(12):21–5.

    PubMed  Google Scholar 

  3. Önal Ö, Koçer M, Eroğlu HN, et al (2020) Survival analysis and factors affecting survival in patients who presented to the medical oncology unit with non-small cell lung cancer. Turk J Med Sci. https://doi.org/10.3906/sag-1912-205.

  4. Göksel S, Karadoğan D. Prevalence and predictors of symptoms in lung cancer patients staged at diagnosis by 18 FDG PET/CT. Turk Thorac J. 2019;20:Supplement 219. https://doi.org/10.5152/TurkThoracJ.2019.219.

    Article  Google Scholar 

  5. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. Non-small cell lung cancer. NCCN Version 6.2020-June 15, 2020.

    Google Scholar 

  6. Huang J, Ostroff J. Overview of approach to lung cancer survivors. Uptodate. May 2020.

    Google Scholar 

  7. Glisson BS, Byers LA, Gay MC. Pathobiology and staging of small cell carcinoma of the lung. Uptodate. June 2020.

    Google Scholar 

  8. Wainer Z, Wright GM, Gough K, et al. Impact of sex on prognostic host factors in surgical patients with lung cancer. ANZ J Surg. 2017;87(12):1015–20. https://doi.org/10.1111/ans.13728.

    Article  PubMed  Google Scholar 

  9. Owonikoko TK, Ragin CC, Belani CP, et al. Lung cancer in elderly patients: an analysis of the surveillance, epidemiology, and end results database. J Clin Oncol. 2007;25:5570–7.

    Article  PubMed  Google Scholar 

  10. Chapman AM, Sun KY, Ruestow P, et al. Lung cancer mutation profile of EGFR, ALK, and KRAS: meta-analysis and comparison of never and ever smokers. Lung Cancer. 2016;102:122–34. https://doi.org/10.1016/j.lungcan.2016.10.010.

    Article  PubMed  Google Scholar 

  11. Chansky K, Sculier J-P, Crowley JJ, et al. The International Association for the Study of Lung Cancer Staging Project: prognostic factors and pathologic TNM stage in surgically managed non-small cell lung cancer. J Thorac Oncol. 2009;4:792–801.

    Article  PubMed  Google Scholar 

  12. Sakurai H, Asamura H, Goya T, et al. Survival differences by gender for resected non-small cell lung cancer a retrospective analysis of 12,509 cases in a Japanese lung cancer registry study. J Thorac Oncol. 2010;5:1594–601.

    Article  PubMed  Google Scholar 

  13. Gester F, Paulus A, Sibille AL, et al. Prognostic factors in non small cell lung cancer. Rev Med Liege. 2016;71(1):34–9.

    CAS  PubMed  Google Scholar 

  14. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology. Small cell lung cancer. NCCN Version 3.2020. 5 Feb 2020.

    Google Scholar 

  15. Kawaguchi T, Takada M, Kubo A, et al. Performance status and smoking status are independent favorable prognostic factors for survival in non-small cell lung cancer: a comprehensive analysis of 26,957 patients with NSCLC. J Thorac Oncol. 2010;5(5):620–30. https://doi.org/10.1097/JTO.0b013e3181d2dcd9.

    Article  PubMed  Google Scholar 

  16. Norum J, Nieder C. Tobacco smoking and cessation and PD-L1 inhibitors in non-small cell lung cancer (NSCLC): a review of the literature. ESMO Open. 2018;3(6):e000406. https://doi.org/10.1136/esmoopen-2018-000406.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Pallis AG, Gridelli C. Is age a negative prognostic factor for the treatment of advanced/metastatic non-small-cell lung cancer? Cancer Treat Rev. 2010;36:436–41.

    Article  CAS  PubMed  Google Scholar 

  18. O’Mahony S, Nathan S, Mohajer R, et al. Survival prediction in ambulatory patients with stage III/IV non-small cell lung cancer using the palliative performance scale, ECOG, and lung cancer symptom scale. Am J Hosp Palliat Care. 2016;33(4):374–80. https://doi.org/10.1177/1049909115570707.

    Article  PubMed  Google Scholar 

  19. Huemer F, Lang D, Westphal T, et al. Baseline absolute lymphocyte count and ECOG performance score are associated with survival in advanced non-small cell lung cancer undergoing PD-1/PD-L1 blockade. J Clin Med. 2019;8(7):1014. https://doi.org/10.3390/jcm8071014.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. ECOG. Performance status. Available from: https://ecog-acrin.org/resources/ecog-performance-status.

  21. Diem S, Schmid S, Krapf M, et al. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as prognostic markers in patients with non-small cell lung cancer (NSCLC) treated with nivolumab. Lung Cancer. 2017;111:176–81. https://doi.org/10.1016/j.lungcan.2017.07.024.

    Article  PubMed  Google Scholar 

  22. Ferrigno D, Buccheri G. Hematologic counts and clinical correlates in 1201 newly diagnosed lung cancer patients. Monaldi Arch Chest Dis. 2003;59(3):193–8.

    CAS  PubMed  Google Scholar 

  23. Finkelstein DM, Ettinger DS, Ruckdeschel JC. Long-term survivors in metastatic non-small-cell lung cancer: an Eastern Cooperative Oncology Group Study. J Clin Oncol. 1986;4(5):702–9. https://doi.org/10.1200/JCO.1986.4.5.702.

    Article  CAS  PubMed  Google Scholar 

  24. Lipford EH 3rd, Eggleston JC, Lillemoe KD, et al. Prognostic factors in surgically resected limited stage, nonsmall cell carcinoma of the lung. Am J Surg Pathol. 1984;8:357.

    Article  PubMed  Google Scholar 

  25. Takise A, Kodama T, Shimosato Y, et al. Histopathologic prognostic factors in adenocarcinomas of the peripheral lung less than 2 cm in diameter. Cancer. 1988;61:2083.

    Article  CAS  PubMed  Google Scholar 

  26. Cagini L, Monacelli M, Giustozzi G, et al. Biological prognostic factors for early stage completely resected non-small cell lung cancer. J Surg Oncol. 2000;74:53.

    Article  CAS  PubMed  Google Scholar 

  27. Kwiatkowski DJ, Harpole DH Jr, Godleski J, et al. Molecular pathologic substaging in 244 stage I nonsmall- cell lung cancer patients: clinical implications. J Clin Oncol. 1998;16:2468.

    Article  CAS  PubMed  Google Scholar 

  28. Rusch VW, Hawes D, Decker PA, et al. Occult metastases in lymph nodes predict survival in resectable non-small-cell lung cancer: report of the ACOSOG Z0040 trial. J Clin Oncol. 2011;29:4313.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Brambilla E, Le Teuff G, Marguet S, et al. Prognostic effect of tumor lymphocytic infiltration in resectable non-small-cell lung cancer. J Clin Oncol. 2016;34:1223.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Ruffini E, Asioli S, Filosso PL, et al. Significance of the presence of microscopic vascular invasion after complete resection of stage I-II pT1-T2N0 non-small cell lung cancer and its relation with T-size categories: did the 2009 7th edition of the TNM staging system miss something? J Thorac Oncol. 2011;6:319.

    Article  PubMed  Google Scholar 

  31. Naito Y, Goto K, Nagai K, et al. Vascular invasion is a strong prognostic factor after complete resection of node-negative non-small cell lung cancer. Chest. 2010;138:1411.

    Article  PubMed  Google Scholar 

  32. Noma D, Inamura K, Matsuura Y, et al. Prognostic effect of lymphovascular invasion on TNM staging in stage I non-small-cell lung cancer. Clin Lung Cancer. 2018;19(1):e109–22. https://doi.org/10.1016/j.cllc.2017.06.001.

    Article  PubMed  Google Scholar 

  33. Goldstraw P, Chansky K, Crowley J, et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016;11:39.

    Article  PubMed  Google Scholar 

  34. Sequist LV, Yang JC, Yamamoto N, et al. Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol. 2013;31(27):3327–34. https://doi.org/10.1200/JCO.2012.44.2806.

    Article  CAS  PubMed  Google Scholar 

  35. Rosell R, Carcereny E, Gervais R, et al. Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol. 2012;13(3):239–46. https://doi.org/10.1016/S1470-2045(11)70393-X.

    Article  CAS  PubMed  Google Scholar 

  36. Yu PP, Vose JM, Hayes DF. Genetic cancer susceptibility testing: increased technology, increased complexity. J Clin Oncol. 2015;33(31):3533–4. https://doi.org/10.1200/JCO.2015.63.3628.

    Article  PubMed  Google Scholar 

  37. Herbst RS, Baas P, Kim DW, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet. 2016;387(10027):1540–50. https://doi.org/10.1016/S0140-6736(15)01281-7.

    Article  CAS  PubMed  Google Scholar 

  38. Hong L, Negrao MV, Dibaj SS, et al. Programmed death-ligand 1 heterogeneity and its impact on benefit from immune checkpoint inhibitors in NSCLC. J Thorac Oncol. 2020;S1556-0864(20):30373–7. https://doi.org/10.1016/j.jtho.2020.04.026.

    Article  CAS  Google Scholar 

  39. Cao C, Manganas C, Ang SC, et al. Video-assisted thoracic surgery versus open thoracotomy for non-small cell lung cancer: a meta-analysis of propensity score-matched patients. Interact Cardiovasc Thorac Surg. 2013;16(3):244–9. https://doi.org/10.1093/icvts/ivs472.

    Article  PubMed  Google Scholar 

  40. Albain KS, Swann RS, Rusch VW, et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet. 2009;374(9687):379–86. https://doi.org/10.1016/S0140-6736(09)60737-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. van Meerbeeck JP, Kramer GW, Van Schil PE, et al. Randomized controlled trial of resection versus radiotherapy after induction chemotherapy in stage IIIA-N2 non-small-cell lung cancer. J Natl Cancer Inst. 2007;99(6):442–50. https://doi.org/10.1093/jnci/djk093.

    Article  PubMed  Google Scholar 

  42. Shah AA, Berry MF, Tzao C, et al. Induction chemoradiation is not superior to induction chemotherapy alone in stage IIIA lung cancer. Ann Thorac Surg. 2012;93(6):1807–12. https://doi.org/10.1016/j.athoracsur.

    Article  PubMed  Google Scholar 

  43. Bradbury P, Sivajohanathan D, Chan A, et al. Postoperative adjuvant systemic therapy in completely resected non-small-cell lung cancer: a systematic review. Clin Lung Cancer. 2017;18(3):259–273.e8. https://doi.org/10.1016/j.cllc.2016.07.002.

    Article  PubMed  Google Scholar 

  44. Westeel V, Quoix E, Puyraveau M, et al. A randomised trial comparing preoperative to perioperative chemotherapy in early-stage non-small-cell lung cancer (IFCT 0002 trial). Eur J Cancer. 2013;49(12):2654–64. https://doi.org/10.1016/j.ejca.2013.04.013.

    Article  CAS  PubMed  Google Scholar 

  45. Curran WJ Jr, Paulus R, Langer CJ, et al (2011) Sequential vs. concurrent chemoradiation for stage III non-small cell lung cancer: randomized phase III trial RTOG 9410 [published correction appears in J Natl Cancer Inst. 104(1):79]. J Natl Cancer Inst 103(19):1452–1460. https://doi.org/10.1093/jnci/djr325.

  46. Sun B, Brooks ED, Komaki RU, et al. 7-year follow-up after stereotactic ablative radiotherapy for patients with stage I non-small cell lung cancer: results of a phase 2 clinical trial. Cancer. 2017;123(16):3031–9. https://doi.org/10.1002/cncr.30693.

    Article  PubMed  Google Scholar 

  47. Widder J, Postmus D, Ubbels JF, et al. Survival and quality of life after stereotactic or 3D-conformal radiotherapy for inoperable early-stage lung cancer. Int J Radiat Oncol Biol Phys. 2011;81(4):e291–7. https://doi.org/10.1016/j.ijrobp.2011.03.052.

    Article  PubMed  Google Scholar 

  48. Senthi S, Lagerwaard FJ, Haasbeek CJ, et al. Patterns of disease recurrence after stereotactic ablative radiotherapy for early stage non-small-cell lung cancer: a retrospective analysis. Lancet Oncol. 2012;13(8):802–9. https://doi.org/10.1016/S1470-2045(12)70242-5.

    Article  PubMed  Google Scholar 

  49. Fakiris AJ, McGarry RC, Yiannoutsos CT, et al. Stereotactic body radiation therapy for early-stage non-small-cell lung carcinoma: four-year results of a prospective phase II study. Int J Radiat Oncol Biol Phys. 2009;75(3):677–82. https://doi.org/10.1016/j.ijrobp.2008.11.042.

    Article  PubMed  Google Scholar 

  50. Matsuo Y, Shibuya K, Nagata Y, et al. Preliminary report of late recurrences, at 5 years or more, after stereotactic body radiation therapy for non-small cell lung cancer. J Thorac Oncol. 2012;7(2):453–6. https://doi.org/10.1097/JTO.0b013e31823c5b29.

    Article  PubMed  Google Scholar 

  51. Arriagada R, Dunant A, Pignon JP, et al. Long-term results of the international adjuvant lung cancer trial evaluating adjuvant cisplatin-based chemotherapy in resected lung cancer. J Clin Oncol. 2010;28(1):35–42. https://doi.org/10.1200/JCO.2009.23.2272.

    Article  CAS  PubMed  Google Scholar 

  52. Butts CA, Ding K, Seymour L, et al. Randomized phase III trial of vinorelbine plus cisplatin compared with observation in completely resected stage IB and II non-small-cell lung cancer: updated survival analysis of JBR-10. J Clin Oncol. 2010;28(1):29–34.

    Article  CAS  PubMed  Google Scholar 

  53. NSCLC Meta-analysis Collaborative Group. Preoperative chemotherapy for non-small-cell lung cancer: a systematic review and meta-analysis of individual participant data. Lancet. 2014;383(9928):1561–71. https://doi.org/10.1016/S0140-6736(13)62159-5.

    Article  CAS  PubMed Central  Google Scholar 

  54. Martins RG, D’Amico TA, Loo BW Jr, et al. The management of patients with stage IIIA non-small cell lung cancer with N2 mediastinal node involvement. J Natl Compr Canc Netw. 2012;10(5):599–613. https://doi.org/10.6004/jnccn.2012.0062.

    Article  CAS  PubMed  Google Scholar 

  55. Socinski MA, Evans T, Gettinger S, et al. Treatment of stage IV non-small cell lung cancer: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(5 Suppl):e341S–68S. https://doi.org/10.1378/chest.12-2361.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Bakitas MA, El-Jawahri A, Farquhar M, et al. The TEAM approach to improving oncology outcomes by incorporating palliative care in practice. J Oncol Pract. 2017;13(9):557–66. https://doi.org/10.1200/JOP.2017.022939.

    Article  PubMed  Google Scholar 

  57. Aizer AA, Chen MH, McCarthy EP, et al. Marital status and survival in patients with cancer. J Clin Oncol. 2013;31(31):3869–76. https://doi.org/10.1200/JCO.2013.49.6489.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Rodrigues G, Videtic GM, Sur R, et al. Palliative thoracic radiotherapy in lung cancer: an American Society for Radiation Oncology evidence-based clinical practice guideline. Pract Radiat Oncol. 2011;1(2):60–71. https://doi.org/10.1016/j.prro.2011.01.005.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Ashworth AB, Senan S, Palma DA, et al. An individual patient data metaanalysis of outcomes and prognostic factors after treatment of oligometastatic non-small-cell lung cancer. Clin Lung Cancer. 2014;15(5):346–55. https://doi.org/10.1016/j.cllc.2014.04.003.

    Article  PubMed  Google Scholar 

  60. Tallet AV, Azria D, Barlesi F, et al. Neurocognitive function impairment after whole brain radiotherapy for brain metastases: actual assessment. Radiat Oncol. 2012;7:77. https://doi.org/10.1186/1748-717X-7-77.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Chang EL, Wefel JS, Hess KR, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009;10(11):1037–44. https://doi.org/10.1016/S1470-2045(09)70263-3.

    Article  PubMed  Google Scholar 

  62. Nakagawa K, Garon EB, Seto T, et al. Ramucirumab plus erlotinib in patients with untreated, EGFR-mutated, advanced non-small-cell lung cancer (RELAY): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol. 2019;20(12):1655–69. https://doi.org/10.1016/S1470-2045(19)30634-5.

    Article  CAS  PubMed  Google Scholar 

  63. Jackman DM, Miller VA, Cioffredi LA, et al. Impact of epidermal growth factor receptor and KRAS mutations on clinical outcomes in previously untreated non-small cell lung cancer patients: results of an online tumor registry of clinical trials. Clin Cancer Res. 2009;15(16):5267–73. https://doi.org/10.1158/1078-0432.CCR-09-0888.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Soria JC, Ohe Y, Vansteenkiste J, et al. Osimertinib in untreated EGFR-mutated advanced non-small-cell lung cancer. N Engl J Med. 2018;378(2):113–25. https://doi.org/10.1056/NEJMoa1713137.

    Article  CAS  PubMed  Google Scholar 

  65. Ramalingam SS, Vansteenkiste J, Planchard D, et al. Overall survival with Osimertinib in untreated, EGFR-mutated advanced NSCLC. N Engl J Med. 2020;382(1):41–50. https://doi.org/10.1056/NEJMoa1913662.

    Article  CAS  PubMed  Google Scholar 

  66. Mok TS, Cheng Y, Zhou X, et al. Improvement in overall survival in a randomized study that compared dacomitinib with Gefitinib in patients with advanced non-small-cell lung cancer and EGFR-activating mutations. J Clin Oncol. 2018;36(22):2244–50. https://doi.org/10.1200/JCO.2018.78.7994.

    Article  CAS  PubMed  Google Scholar 

  67. Reck M, Rodríguez-Abreu D, Robinson AG, et al. Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med. 2016;375(19):1823–33. https://doi.org/10.1056/NEJMoa1606774.

    Article  CAS  PubMed  Google Scholar 

  68. Reck M, Rodríguez-Abreu D, Robinson AG, et al. Updated analysis of KEYNOTE-024: pembrolizumab versus platinum-based chemotherapy for advanced non-small-cell lung cancer with PD-L1 tumor proportion score of 50% or greater. J Clin Oncol. 2019;37(7):537–46.

    Article  CAS  PubMed  Google Scholar 

  69. Hong X, Xu Q, Yang Z, et al. The value of prognostic factors in Chinese patients with small cell lung cancer: a retrospective study of 999 patients. Clin Res. 2018;J12(2):433–47. https://doi.org/10.1111/crj.12534.

    Article  CAS  Google Scholar 

  70. Faivre-Finn C, Snee M, Ashcroft L, et al. Concurrent once-daily versus twice-daily chemoradiotherapy in patients with limited-stage small-cell lung cancer (CONVERT): an open-label, phase 3, randomised, superiority trial. Lancet Oncol. 2017;18(8):1116–25. https://doi.org/10.1016/S1470-2045(17)30318-2.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Horn L, Mansfield AS, Szczęsna A, et al. First-line Atezolizumab plus chemotherapy in extensive-stage small-cell lung cancer. N Engl J Med. 2018;379(23):2220–9. https://doi.org/10.1056/NEJMoa1809064.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Recep Tayyip Erdoğan University, Medical Faculty, Department of Pulmonology, Rize, Turkey

    Dilek Karadoğan

  2. Ondokuz Mayıs University, Medical Faculty, Department of Pulmonology, Samsun, Turkey

    Meftun Ünsal

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  1. Dilek Karadoğan
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  2. Meftun Ünsal
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Editor information

Editors and Affiliations

  1. Department of Otorhinolaryngology, Eskişehir Osmangazi University, Eskisehir, Türkiye

    Cemal Cingi

  2. Department of Pulmonology, Celal Bayar University, Manisa, Türkiye

    Arzu Yorgancıoğlu

  3. Department of Otorhinolaryngology, Kırıkkale University, Kırıkkale, Türkiye

    Nuray Bayar Muluk

  4. Federal University of Bahia School of Medicine and ProAR Foundation, Salvador - Bahia, Brazil

    Alvaro A. Cruz

Section Editor information

  1. Department of Chest Disease, Eskisehir Osmangazi University Medical Faculty, Eskisehir, Turkey

    Muzaffer Metintaş MD

  2. Department of Chest Disease, Eskisehir Osmangazi University, Eskisehir, Turkey

    Guntulu Ak

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Karadoğan, D., Ünsal, M. (2023). Prognosis and Prognostic Factors of Lung Cancer. In: Cingi, C., Yorgancıoğlu, A., Bayar Muluk, N., Cruz, A.A. (eds) Airway diseases. Springer, Cham. https://doi.org/10.1007/978-3-031-22483-6_75-1

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