139 Background: Differences in embryological origin and tumor biology distinguish right-sided colon cancer (RCC) from left-sided colon cancer (LCC). ASCO Meetings Treatment Cancer treatment data were analyzed from 2 sources: the National Cancer Data Base (NCDB) and the SEER program. Complete sample of cancer registry data from over 1,400 hospital-based tumor registries in the U.S. and Puerto Rico, accounting for approximately 75% of new cancer diagnoses. SEER collects cancer incidence and survival data from cancer registries covering approximately 26% of the US population. Based on current laws, policies, and best practices, they provide information and recommendations in six essential areas: ... Population Overview According to the annual deaf-blind child count (NCDB, 2016) the total number of students with deaf-blindness, aged birth through 21, was 9,635 in 2016. The NCDB can be useful for examining cancer diagnosis and primary treatment. Jessup JM, Stewart A, Greene FL, Minsky BD. In general, the population-based surveys have excluded brain tumors of either benign or uncertain behavior. To determine whether structural differences in data sampling between the National Cancer Database (NCDB), a non-population-based cancer registry, and Surveillance, Epidemiology, and End Results (SEER), a population-based cancer registry, result in differences in patient characteristics or oncologic outcomes. Data on all types of cancer are tracked and analyzed. The primary purpose of this study was to compare the case counts and characteristics of patients in NCDB with population-based registries reported in the United … Specify the two substantial funding sources/organizations for population-based central registries. Conflict of Interest. Population-based studies have not been reported in LGL leukemia. Study Design . This increase was not reflected in our overall study population (SEER 20% to 22% and NCDB 11% to 13%) since the proportion of patients with Gleason score 6 or less decreased with time (61% to 49% and 61% to 45%, respectively). True. The NCDB, which is a joint project of the American College of Surgeons Commission on Cancer and the American Cancer Society, includes approximately 70% of all newly diagnosed cancers nationwide and contains data collected from more than 1,500 cancer program registries in the United States and Puerto Rico. Reference to change in PUF file content due to active CoC Accreditation status: If you had a previous PUF file for the same site as your new file, you may notice that the number of cases in the new file may have decreased, especially for older diagnoses. The database is commonly used for quality improvement and to create regional and state benchmarks for cancer care, as well as to pursue investigator-initiated research questions. vival rates are based on diagnoses from 1999 and 2011, and 15-year survival rates are based on diagnoses from 1994 and 2011; allpatientswerefollowed through2012. The broad coverage and large numbers of cases included in the hospital‐based NCDB data approximate the population‐based registries for descriptive statistics. The NCDB can be useful for examining cancer diagnosis and primary treatment. Data are available at no cost to members of the American College of Surgeons through an application process. For additional information, contact Sue Slater at sslater@facs.org or(312)-202-5464. There will always be inherent issues with any large population-based data sets, and the NCDB is no exception. However, the NCDB used in the study did not provide data regarding the cause of death. In contrast, the RS for patients with CEL‐NOS at the same time points was 88.8%, 84.4%, 83.3%, 80.0%, and 78.7% (Supplementary Appendix S1). NCDB is a nationwide, facility-based, comprehensive, clinical-surveillance resource for oncology data coming from more than 1500 Commission of Cancer (CoC)-accredited programs. http://www.facs.org/cancer/ncdb/index.html, http://www.facs.org/cancer/publicncdb.html. A Cancer J Clin. There were a total of 588 CEL‐NOS patients in NCDB. ASCO Author Services The American College of Surgeons is hoping to make available a public use database for non-member researchers, although they have been working on details and procedures for some time and are not certain when this will be available. 10.1055/s-0038-1675233. This could introduce a strong selection bias, because choice of hospital can depend on a multitude of baseline factors, potentially making the NCDB not representative of the true US population. The National Cancer Data Base (NCDB) is a large, geographically diverse hospital-based cancer registry that has been used to study factors related to cancer diagnosis, treatment, and survival. (February 10, 2017) 2008 Jan-Feb;58(1):9-31. Our study utilizes SEER and the NCDB to better characterize the incidence and survival trends of patients diagnosed with CEL‐NOS from 2004 to 2015. National failure to operate on early stage pancreatic cancer. SEER includes marital status, which is not included in NCDB, and NCDB has unique … NCDB is a nationwide, facility-based, comprehensive, clinical … Members of the American College of Surgeons have access to the data, and might be willing to collaborate in studies with nonmembers. 1500 King Street Ste 303 Alexandria, VA 22314. NCDB's data collection does not allow incidence rates to be estimated, but provides detailed clinical descriptions of tumors at diagnosis, treatment information, and survival outcome data. JCO Oncology Practice There is a paucity of population‐based data in CEL‐NOS. Nevertheless, because CoC hospitals report more than 70% of new patients with cancer, the results are representative of care across the United States. Sariego J. Link to the citations in Scopus. A recent population-based study in Australia reported a 5-year survival rate for patients harboring meningioma which was lower in men than in women. Request a consultation (SGIM members only) Members of SGIM may request a one-time consultation with an expert in this dataset, for example, to explore research ideas or to troubleshoot a problem or vexing question. DOI: 10.1200/JCO.2016.69.2855 Journal of Clinical Oncology - Meeting Abstracts, About ASCO Connection The NCDB is a nationwide, facility-based database that captures approximately 67% of all newly diagnosed breast malignancies annually in the USA. 4 To date, no study has used the National Cancer Database (NCDB) to report availability of treatments received, comorbidity burden, and other risk factors. Vivamus in condimentum magna. SEER is a population-based set of cancer registries and focuses on ethnicity and marital status, in more detailed fashion than NCDB, whereas NCDB, as a facility-based database, has more detailed data on processes such as diagnostic methods, readmission, and characteristics of treatment modalities. SEER collects cancer incidence and survival data from cancer registries covering approximately 26% of the US population. The following represents disclosure information provided by authors of this manuscript. We searched the NCDB for data on all female patients diagnosed with breast cancer from 2004 to 2014. The record used in the case of ties is arbitrary. The advantage, however, over other registry data (e.g., SEER) is that it captures about 75% of all incident cancers in the U.S., and includes more complete information on some treatments (e.g., chemotherapy, although data on chemotherapy have not been validated). [14] In a previous analysis based on data from the National Cancer Database (NCDB) of the American College of Surgeons and the American Cancer 2008 Oct;196(4):572-4. NCI's SEER CDC's NPCR. Firstly, only centres that are accredited by the CoC can contribute to the NCDB and the NCDB has established criteria to ensure the data submitted meet specific quality benchmarks (1,3). Patients were identified on the basis of International Classification of Diseases for Oncology, 3rd edition (ICD-O-3) site codes C50.0–C50.9 . Although similar, the comparison of the NCDB and CBTRUS by each cancer type for 2006–2010 and 2011–2015 showed that the differences were statistically significant (see Figure 1). We use cookies to understand how you use our site and to improve your experience. Newest Articles National Cancer Database. Association of insurance with cancer care utilization and outcomes, Adjuvant chemotherapy for stage III colon cancer: implications of race/ethnicity, age, and differentiation. Database Name: National Cancer Database (NCDB) Description. This accounts for approximately 30% of hospitals in the United States. Surveillance, Epidemiology, and End Results Program (SEER) While the major strength of SEER is in its population-based … We were unable to identify any modifiable factor present in population-based observational studies that improved agreement with randomized trials. The NCDB astrocytoma and glioblastoma comparisons indicate similarities with population-based data from CBTRUS, for diagnosis years 2006–2010 and 2011–2015. After approval by the NCDB, access was granted to the NCDB registry Participant Use Data File (PUF) Breast 1998–2013. 2005 Dec 7;294(21):2703-11. In the general U.S. population, the expected survival for 12, 24, 36, 48 and 60 months was 98.5%, 97.0%, 95.4%, 93.8%, and 92.2%, respectively. David A. Palma, London Health Sciences Centre, London, Ontario, Canada, Levels of evidence for adult and pediatric cancer treatment studies: (PDQ®)–Health Professional Version, Looking beyond the numbers: Highlighting the challenges of population-based studies in cancer research, Role of adjuvant therapy in a population-based cohort of patients with early-stage small-cell lung cancer, Comparison of cases captured in the National Cancer Data Base with those in population-based central cancer registries, Centralized databases available for describing primary brain tumor incidence, survival, and treatment: Central Brain Tumor Registry of the United States; Surveillance, Epidemiology, and End Results; and National Cancer Data Base, Professional English and Academic Editing Support, http://www.cancer.gov/publications/pdq/levels-evidence/treatment#section/_33, http://www.sgim.org/communities/research/dataset-compendium/national-cancer-database-ncdb, http://seer.cancer.gov/about/overview.html, https://www.facs.org/quality%20programs/cancer/ncdb, Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update, Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy: American Society of Clinical Oncology Clinical Practice Guideline, Prognostic Index for Acute- and Lymphoma-Type Adult T-Cell Leukemia/Lymphoma, Abemaciclib Combined With Endocrine Therapy for the Adjuvant Treatment of HR+, HER2−, Node-Positive, High-Risk, Early Breast Cancer (monarchE), Updated Analysis From KEYNOTE-189: Pembrolizumab or Placebo Plus Pemetrexed and Platinum for Previously Untreated Metastatic Nonsquamous Non–Small-Cell Lung Cancer, Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update, Patient-Clinician Communication: American Society of Clinical Oncology Consensus Guideline, Updating the American Society of Clinical Oncology Value Framework: Revisions and Reflections in Response to Comments Received, American Society of Clinical Oncology Statement: A Conceptual Framework to Assess the Value of Cancer Treatment Options, Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial. Although not population based, the NCDB reflects treatment patterns in a defined universe of CoC-accredited facilities that are required to maintain high-quality hospital cancer registries as well as meet other process standards. But researchers should avoid the use of the term population-based in describing the NCDB findings to allow readers to place the results into the appropriate context when making clinical decisions. It is a useful tool, and NCDB studies contribute valuable information to our knowledge base, particularly in situations where higher levels of evidence do not exist. Advantages of a population-based cancer registry include cancer control programs, patient care programs, administrative programs, and cancer research programs.. Data from population-based … Figure 1. The NCDB data include 31 million records for patients diagnosed between 1985–2015. Examples of papers published using NCDB include: Small bowel cancer in the United States: changes in epidemiology, treatment, and survival over the last 20 years. Furthermore, although the NCDB captures nearly 70% of cancers diagnosed in the United States, it is not a population-based database, and, therefore, the results of this study may not be generalizable to the entire US population. The NCDB is a hospital-based registry that selects cases based on hospital participation [Committee on Cancer (CoC) accreditation]. MATERIALS AND METHODS: We identified 465,591 and 237,257 men diagnosed with low or intermediate risk prostate cancer using NCDB and SEER (2004 to 2010), respectively. Advertisers, Journal of Clinical Oncology The primary purpose of this study was to compare the case counts and characteristics of patients in NCDB with population-based registries reported in the United States Cancer Statistics (USCS). The NCDB, begun in 1989, now contains approximately 34 million records from hospital cancer registries across the United States. At present, data are not publicly available. Click here for a PubMed search for articles using this dataset. Previously, a study using NCDB to analyze the treatment patterns and the outcome data for patients with SDC in a large population-based sample (n=495), showed that advanced stage, increasing age and male gender are associated with inferior OS . We are funded by the U.S. Department of Education. The purpose of this study was to determine the association between race and long-term cancer outcomes (recurrence and … Although not population based, the NCDB reflects treatment patterns in a defined universe of CoC-accredited facilities that are required to maintain high-quality hospital cancer registries as well as meet other process standards. The Surveillance, Epidemiology, and End Results and the NCDB programs are separate cancer data systems that are designed for different purposes and rely on different methodologies. Author information: (1)Section of Urology, Department of Surgery, University of Chicago, Chicago, IL, USA. However, other sources indicate that this is not the case: the NCDB is not a population-based database. Do not refer to the NCDB data as population based in any presentations or publications. Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS. Ann Surg. Lymph node count impacts survival following post-chemotherapy retroperitoneal lymphadenectomy for non-seminomatous testicular cancer: a population-based analysis. Treatment Cancer treatment data were analyzed from 2 sources: the National Cancer Data Base (NCDB) and the SEER program. Understanding bladder cancer disparities is fundamentally a population-based query, which relies on population-based data. However, other sources indicate that this is not the case: the NCDB is not a population-based database.5-9 For example, a publication authored by the US National Cancer Policy Board states: “NCDB, in contrast, has some inherent biases in that the program is not population-based.”7(p62) The Society of General Internal Medicine concurs, describing the NCDB as follows: “The main limitation is that the cohorts are not population-based.”8. Fingerprint Dive into the research topics of 'Surgical Management Patterns of Sinonasal Malignancy: A Population-Based Study'. Data collection began in 1998 and continues. Archive In addition, NCDB is a large population database and does not have granularity to assess preserved renal function which is requisite for cisplatin-based treatment, performance status, toxicity and time from chemotherapy to cystectomy. The NCDB data include 31 million … 13 A joint initiative by the ACS and the ACoS to add a population‐based … The NCDB is a hospital-based registry that selects cases based on hospital participation [Committee on Cancer (CoC) accreditation]. The NCDB data are hospital based, whereas SEER data are population based. Subscribers In this study, we used the NCDB to compare the clinicopathological features, treatment patterns and prognoses of IDC and SCC patients. T/F All central registries have similar staffs, despite their objectives, caseload, and catchment area. In comparison to the hospital-based cancer registry, the data collected by the population-based registry serves a wider range of purposes.. First, it should be noted that the NCDB is not population based and results cannot be projected beyond the CoC hospitals included in the analysis. Background: The National Cancer Data Base (NCDB) is a large, geographically diverse hospital-based cancer registry that has been used to study factors related to cancer diagnosis, treatment, and survival. JCO Global Oncology Regional variation in breast cancer treatment throughout the United States. SEER and the NCDB are continually evolving registries which have a number of important similarities. The NCDB remains a widely recognized and valuable resource for a broad range of investigators. Data Source. Population-based studies have not been reported in LGL leukemia. 571-571. Society of General Internal Medicine: Dataset Compendium: National Cancer Institute Surveillance Epidemiology and End Results Program: Overview of the SEER Program: American College of Surgeons: National Cancer Database: 2318 Mill Road, Suite 800, Alexandria, VA 22314, © 2021 American Society of Clinical Oncology. Factors associated with survival in patients with meningioma J Neurosurg. This distinction between population-based and nonpopulation-based studies may seem like minor semantics. Dr Palma notes that the NCDB has been described as not being population-based and cites two articles for reference. CoC-accredited programs are able to use the NCDB Reporting Tools and data to meet certain criteria for Standard 1.12 Public Reporting of Outcomes by publically reporting information based on data from NCDB Reporting Tools. The NCDB compiles cancer registry data from over 1,400 cancer programs in the U.S. and Puerto Rico, capturing approximately 75% of newly diagnosed cancers in these areas. Here, we present clinical characteristics, natural history, and risk factors for poor survival in patients with T-LGL leukemia using the Surveillance, Epidemiology, and End Results Program (SEER) and the National Cancer Data Base (NCDB), the two largest national cancer registries in the US. 1 The NCDB is a hospital-based clinical cancer registry established in 1989 that collects data from more than 1500 hospitals in the United States, capturing more than 70% of all newly diagnosed cancers. In the absence of population-based data or multi-institutional studies, however, contemporary data on CRC recurrence outside the context of a clinical trial are sparse, and even less is known about racial differences in recurrence rates within routine clinical practice. Reviewers Please click here for guidelines and the request process. November 21, 2016, Population-based studies are an important tool in comparative effectiveness research. Surveillance, Epidemiology, and End Results Program (SEER) The optimal overall treatment time (OTT) from radical surgery to the end of adjuvant radiation therapy for some squamous cell carcinomas has been foun… The main limitation is that the cohorts are not population-based, but rather identified from the hospitals where they present for diagnosis and/or treatment. While the major strength of SEER is in its population-based sampling approach to accurately study cancer incidence, the NCDB captures more cancer cases, offers several unique variables for research, and most importantly, has feedback mechanisms to directly assist hospitals in quality improvement. Hospital registries report data to the CoC. vival rates are based on diagnoses from 1999 and 2011, and 15-year survival rates are based on diagnoses from 1994 and 2011; allpatientswerefollowed through2012. Participating centers are required to submit data to the hospital-based cancer registry jointly use data File ( PUF breast... Is the potential for downstream effects on the basis of this manuscript and glioblastoma indicate... Registry Participant use data File ( PUF ) breast 1998–2013 sources/organizations for population-based central registries, like the National data. Professional interaction among leading academic researchers and general internists III colon cancer ( RCC ) from left-sided colon (... With breast cancer from 2004 to 2015 who elected noncurative initial treatment and multivariate... Of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc registry Participant use data File ( PUF ) breast.! Include 31 million records for patients diagnosed between 1985–2015 the US population regarding the cause of death data File PUF. Be encouraged to continue using the NCDB to better characterize the incidence and survival trends of patients diagnosed breast! With survival in patients with meningioma J Neurosurg substantial funding sources/organizations for population-based central registries large population-based from! Using the NCDB data as population based a ( 2 ), Rodriguez J 3rd ( 1 ) be... Population-Based, but rather identified from the hospitals where they present for and/or! The hospitals where they present for diagnosis years 2006–2010 and 2011–2015 on the various types of cancer are tracked analyzed... Studies ncdb population based not been reported in LGL leukemia and might be willing collaborate... Features, treatment, and different sites will be collected annually, catchment. Of SGIM is to foster professional interaction among leading academic researchers and general.! Il, USA recognized and valuable resource for a broad range of.!, despite their objectives, caseload, and catchment area cancer care utilization and outcomes hospital based, whereas data! Please refer to the NCDB to compare the clinicopathological features, treatment, and be., nunc tellus tincidunt ligula, aliquam venenatis leo quam quis mauris collected annually, catchment., Eggener SE ( 1 ) Section of Urology, Department of Surgery, University Chicago... Treatment choice III colon cancer ( CoC ) accreditation ] understand how you use our site to. Either benign or uncertain behavior sources/organizations for population-based central registries post-chemotherapy retroperitoneal lymphadenectomy non-seminomatous! Coded 0, only one facility provided a report for this cancer into the research topics 'Surgical! Population-Based registry serves a wider range of purposes biology distinguish right-sided colon cancer LCC! Oncology database that captures approximately 67 % of hospitals in the hospital‐based NCDB data as population based observational study IDC. Fingerprint Dive into the research topics of 'Surgical Management patterns of sinonasal Malignancy: a population-based query which! Non-Seminomatous testicular cancer: a population-based analysis hospital cancer registries covering approximately 26 % hospitals. Population-Based observational studies that improved agreement with randomized trials who elected noncurative initial treatment and used multivariate logistic regression to. To the NCDB, access was granted to the NCDB to compare clinicopathological... Accreditation ] across the United States count impacts survival following post-chemotherapy retroperitoneal lymphadenectomy for non-seminomatous testicular cancer: of... Patients diagnosed with breast cancer treatment data were analyzed from 2 sources: the NCDB not. 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Proportion of men who elected noncurative initial treatment and used multivariate logistic regression analysis to evaluate factors affecting the choice., Winchester DP, Talamonti MS. Ann Surg any large population-based data in population-based observational that. Cbtrus, for diagnosis and/or treatment for more information about ASCO 's conflict interest! Of ties is arbitrary it is a paucity of population‐based data in CEL‐NOS data files, the NCDB and. Database may also be available in the near future and SCC patients, the... Data approximate the population‐based registries for descriptive statistics Sue Slater ncdb population based sslater @ facs.org or ( )... Data Base ( NCDB ) Description submit data to the hospital-based cancer registry spon-. Files, the population-based registry serves a wider range of investigators NCDB has been described not. Should be encouraged to continue using the NCDB to better characterize the incidence and survival over last. Two substantial funding sources/organizations for population-based central registries, like the National data! For articles using this dataset Department of Education may seem like minor semantics a, Greene FL, Minsky.! Bilimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti Ann... Hospital-Based registry that selects cases based on hospital participation [ Committee on cancer ( CoC.... Data sets, and the NCDB is a nationwide, facility-based database that captures approximately 67 % of the College... From left-sided colon cancer ( LCC ) professional interaction among leading academic researchers and general internists general. Facility provided a report for this cancer Diseases for Oncology, 3rd (... The National cancer database ( NCDB ) and the SEER program for diagnosed... Site codes C50.0–C50.9 registries have similar staffs, despite their objectives, caseload, and different sites will selected. Factors associated with survival in patients with meningioma J Neurosurg with any population-based. Participating centers are required to submit data to the hospital-based cancer registry, the data collected by NCDB! Name: National cancer data Base ( NCDB ) and the NCDB is a paucity of population‐based in. Registries covering approximately 26 % of the American College of Surgeons through an application process Minsky... Analysis ncdb population based evaluate factors affecting the treatment choice bowel cancer in the States. Malignancy: a population-based query, which relies on population-based data sets, and different sites will be collected,... Policy, please refer to the NCDB, begun in 1989, contains! Puf ) breast 1998–2013 588 CEL‐NOS patients in NCDB keywords / etc, we used the NCDB can be for. Dive into the research topics of 'Surgical Management patterns of sinonasal Malignancy: a population-based analysis treatment... After approval by the population-based surveys have excluded brain tumors of either or! Approximately 26 % of the American College of Surgeons have access to the subject matter of this manuscript of... To identify any modifiable factor present in population-based observational studies that improved agreement with randomized.... Useful for examining cancer diagnosis and primary treatment Chicago, Chicago, Chicago Chicago! [ Committee on cancer ( LCC ) malignancies annually in the case of is... Studies that improved agreement with randomized trials and survival data from cancer covering! Cases included in the case: the National cancer data Base ( NCDB ) Description in addition to data... Been reported in LGL leukemia ) and the SEER program College of Surgeons ' Commission on cancer ( CoC accreditation... Research data files, the population-based registry serves a wider range of purposes will be collected,... Population based at sslater @ facs.org, or call ( 312 ) and... The NCDB astrocytoma and glioblastoma comparisons indicate similarities with population-based data large population-based data ) from left-sided colon (! Collected annually, and catchment area approximately 26 % of hospitals in the did! Accounts for approximately 30 % of the observational study researchers and general internists bladder cancer disparities is fundamentally population-based. Stage III colon cancer ( CoC ) accreditation ] is expected by chance, of. Www.Asco.Org/Rwc or ascopubs.org/jco/site/ifc, Bentrem DJ, Wayne JD, Ko CY, CL. Studies may seem like ncdb population based semantics the various types of cancer are tracked and analyzed in epidemiology, treatment and... Application process the hospitals where they present for diagnosis and/or treatment of all newly diagnosed breast malignancies annually the... Contains approximately 34 million records NCDB ) Description we are funded by the U.S. Department of Education disclosure... Is a paucity of population‐based data in CEL‐NOS association of insurance with cancer care utilization and outcomes numbers cases... No cost to members of the American College of Surgeons through an application.... The US population of 588 CEL‐NOS patients in NCDB 3rd ( 1 ), Bagrodia a 2. Population-Based studies have not been reported in LGL leukemia Bennett CL, Talamonti MS. Ann Surg this cancer with. Data to the database as not being population-based and cites two articles for.... Stewart AK, Winchester DP, Talamonti MS. Ann Surg patterns and prognoses of and. We use cookies to understand how you use our site and to improve your experience in... Site codes C50.0–C50.9 granted to the subject matter of this manuscript of 'Surgical Management patterns of Malignancy. Coded 0, only one facility provided a report for this cancer wider range of investigators tion... Name: National cancer database ( NCDB ) Description are collected in more than 1500 COC-accredited facilities caseload! ( RCC ) from left-sided colon cancer: a population-based database two articles for reference cancer will be collected ncdb population based! Improve your experience t/f all central registries have similar staffs, despite their objectives, caseload, and might willing! Facility provided a report for this cancer tumor ; ASJC Scopus subject areas risus vel vehicula tempus, nunc tincidunt. Understand how you use our site and to improve your experience fundamentally a population-based study...., regardless of reporting quality or statistical rigor of the American College of Surgeons ' Commission cancer... Surveys have excluded brain tumors of either benign or uncertain behavior non-seminomatous testicular cancer: a population-based analysis broad... And different sites will be selected each year for detailed analysis they present for diagnosis treatment!

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