scholarly journals Trends in Overall Survival and Treatment Patterns in Two Large Population-Based Cohorts of Patients with Breast and Colorectal Cancer

Cancers ◽  
2019 ◽  
Vol 11 (9) ◽  
pp. 1239 ◽  
Author(s):  
Abbema ◽  
Vissers ◽  
Vos-Geelen ◽  
Lemmens ◽  
Janssen-Heijnen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Survival Rates ◽  
Relative Survival ◽  
Population Based ◽  
Treatment Patterns ◽  
Entire Study ◽  
Younger Patients ◽  
Risk Of Death ◽  
Over Time

Previous studies showed substantial improvement of survival rates in patients with cancer in the last two decades. However, lower survival rates have been reported for older patients compared to younger patients. In this population-based study, we analyzed treatment patterns and the survival of patients with breast cancer (BC) and colorectal cancer (CRC). Patients with stages I–III BC and CRC and diagnosed between 2003 and 2012 were selected from the Netherlands Cancer Registry (NCR). Trends in treatment modalities were evaluated with the Cochran-Armitage trend test. Trends in five-year overall survival were calculated with the Cox hazard regression model. The Ederer II method was used to calculate the five-year relative survival. The relative excess risk of death (RER) was estimated using a multivariate generalized linear model. During the study period, 98% of BC patients aged <75 years underwent surgery, whereas for patients ≥75 years, rates were 79.3% in 2003 and 66.7% in 2012 (p < 0.001). Most CRC patients underwent surgery irrespective of age or time period, although patients with rectal cancer aged ≥75 years received less surgery or radiotherapy over the entire study period than younger patients. The administration of adjuvant chemotherapy increased over time for CRC and BC patients, except for BC patients aged ≥75 years. The five-year relative survival improved only in younger BC patients (adjusted RER 0.95–0.96 per year), and was lower for older BC patients (adjusted RER 1.00, 95% Confidence Interval (CI) 0.98–1.02, and RER 1.00; 95% CI 0.98–1.01 per year for 65–74 years and ≥75 years, respectively). For CRC patients, the five-year relative survival improved over time for all ages (adjusted RER on average was 0.95 per year). In conclusion, the observed survival trends in BC and CRC patients suggest advances in cancer treatment, but with striking differences in survival between older and younger patients, particularly for BC patients.

Improved Survival for Patients with CLL in the Era of Combination Chemoimmunotherapy - a Danish Population Based Study

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1740-1740 ◽  
Author(s):  
Caspar da Cunha-Bang ◽  
Jacob Simonsen ◽  
Klaus Rostgaard ◽  
Christian H Geisler ◽  
Henrik Hjalgrim ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Probability ◽  
Population Based ◽  
Danish Population ◽  
Younger Patients ◽  
Risk Of Death ◽  
Improvement In Survival ◽  
The Impact ◽  
First Time ◽  
Over Time

Abstract Background The treatment of chronic lymphocytic leukemia (CLL) is in rapid transition. As single agents, Fludarabine (F) was shown to be superior to chlorambucil (Rai, NEJM, 2000). Soon after F with Cyclophosphamide (C), showed superiority to F alone (Eichhorst, Blood, 2006; Flinn, JCO, 2007, Catovsky, Lancet, 2007). Subsequently, the addition of CD20 antibody rituximab (R) to FC for the first time showed a survival benefit for fit patients in a clinical trial (Hallek, Lancet, 2010). Likewise, in unfit patients the addition of CD20 antibodies to chlorambucil led to increased overall survival (Goede, NEJM, 2014). Eventually, BCR-targeted treatment for patients harboring TP53 aberrations demonstrated promising results (Farooqui, Lancet Onc, 2015). Here we assess the impact of these successive changes of therapy on the survival of patients with CLL in a Danish population-based cohort. Methods We studied the survival of a population-based cohort of CLL patients reported to the Danish Cancer Registry 1978-2013. Patients were categorized according to year of diagnosis from 1978-1994, 1995-2000, 2001-2005 and 2006-2013. For each CLL patient, we randomly selected 50 controls from the general population matched on age, gender and municipality. Kaplan MeierÕs survival curves and Hazard ratios (HR) and 95% confidence interval (95%CI) for death since time of diagnosis /matching date for controls were calculated. Change in survival probability relative to the controls with stratification on gender, age and calendar period of diagnosis was assessed. Results In total, 10500 patients were diagnosed with CLL in Denmark from 1978 to 2013 as follows: 1978-1994: 4651, 1995-2000: 1622, 2001-2005: 1664 and 2006-2013: 2563. Thus, the reported incidence of CLL increased slightly after year 2000. Overall, we observed a continuously decreasing risk of death for patients with CLL compared to matched controls, with HRs from 3.47 (3.37 - 3.58) to 2.09 (1.96 - 2.24) for patients diagnosed 1978-1994 and 2005-2013, respectively. In inter group analyses, a significant stepwise reduction in risk of death was observed for each period (Figure 1). In all age groups and calendar periods, male patients had an inferior survival compared to female patients and younger patients survived longer than older patients (p<0.0001). Discussion A significant improvement in survival probability for patients with CLL over time was found. This coincides with the introduction of FCR as standard therapy for younger patients with CLL (approval by EMA in 2009, affecting the cohort diagnosed 2006-2013). Significant survival improvement was also observed in the 2001-2005 cohort, possibly due to a shift to combination chemotherapy. Also for elderly patients, otherwise expected to get less intensive treatment in part due to co-morbidities, the survival improved over time. This may be accounted for by the introduction of semi-intensive chemotherapy like bendamustine, reduced intensity FC(R) and more recently chlorambucil combined with CD20-targeting antibodies. For the first time, we here present population-based data showing significant improvement in survival for patients with CLL in parallel with the introduction of new chemo-immunotherapeutic regimens into clinical practice. These data substantiate the reported increased survival for patients treated with chemo-immunotherapy in clinical studies. Further investigation and cross-reference with treatment databases are warranted in order to assess the impact of new targeted treatment options for CLL. Figure 1. Overall survival for patients (70-79 and 50-59 years), lower four curves; upper four curves represent matched controls. Figure 1. Overall survival for patients (70-79 and 50-59 years), lower four curves; upper four curves represent matched controls. Disclosures Geisler: GlaxoSmithKline: Consultancy; Novartis: Consultancy; Janssen: Consultancy; Celgene: Consultancy; Gilead: Consultancy; Roche: Consultancy. Niemann:Novartis: Other: Travel grant; Janssen: Consultancy; Roche: Consultancy; Gilead: Consultancy.

Salvage Surgery following Radiation Failure for Laryngeal Cancer in Elderly Patients

2011 ◽  
Vol 145 (5) ◽  
pp. 759-766 ◽  
Author(s):  
Jonathan J. Lusardi ◽  
Paula M. Buchanan ◽  
Kara M. Christopher ◽  
Mark A. Varvares
Keyword(s):  
Overall Survival ◽  
Laryngeal Cancer ◽  
Salvage Surgery ◽  
Survival Rates ◽  
Relative Survival ◽  
Population Based ◽  
Cancer Specific Survival ◽  
Age Cohorts ◽  
Data Registry ◽  
Registry Analysis

Objective. To find the survival rate of patients ≥80 years old who undergo salvage surgery for squamous cell carcinoma of the larynx. Study Design. National data registry analysis. Setting. Seventeen population-based registries comprising the National Cancer Institute’s Surveillance, Epidemiology, and End Results database. Subjects and Methods. Overall, cancer-specific, and relative survival rates were calculated from 1418 patients, stratified into 3 age cohorts, who underwent surgery following radiation therapy for treatment of laryngeal cancer. Results. The 1-year overall survival of patients ≥80 years old (n = 57) was 76.1%. The cancer-specific survival at 1 year was 86.4%. These survival rates were significantly less than those of patients <65 years old (n = 869), who had a 1-year overall survival of 88.1% ( P = .006) and cancer-specific survival of 90.5% ( P = .029). Patients aged between 65 and 79 years old (n = 492) displayed 1-year overall survival of 80.7% ( P = .426) and cancer-specific survival of 85.1% ( P = .711), which were not significantly different from the ≥80 year cohort. When comparing relative survival at 5 years, the ≥80-year-old cohort’s survival trended the highest (≥80 years, 62.8%; 65-79 years, 51.3%; 20-64 years, 56.2%). Conclusion. While patients ≥80 years old have a less favorable prognosis than patients <65 years old, the survival rates of patients ≥80 years old are not significantly different from the 65- to 79-year-old cohort. After controlling for non-cancer-related death, patients ≥80 years old appear to have similar 5-year survival outcomes compared with other patients.

scholarly journals Transformation and outcome of nodular lymphocyte predominant Hodgkin lymphoma: a Finnish Nationwide population-based study

2021 ◽  
Vol 11 (12) ◽  
Author(s):  
Ilja Kalashnikov ◽  
Tomas Tanskanen ◽  
Janne Pitkäniemi ◽  
Nea Malila ◽  
Sirkku Jyrkkiö ◽  
...  
Keyword(s):  
B Cell ◽  
Hodgkin Lymphoma ◽  
Relative Survival ◽  
B Cell Lymphoma ◽  
Population Based ◽  
Population Based Study ◽  
Entire Study ◽  
Risk Of Death ◽  
Increased Risk ◽  
Histological Transformation

AbstractNodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a rare B-cell malignancy associated with excellent survival. However, some patients experience histological transformation into aggressive large B-cell lymphoma. Population-based data on transformation in patients with NLPHL is limited. We conducted a nationwide population-based study to estimate the risk of transformation and relative survival in patients diagnosed with NLPHL in Finland between 1995 and 2018. We identified a total of 453 patients (median age, 48 years; 76% males) with the incident NLPHL from the Finnish Cancer Registry. The cumulative incidence of transformation was 6.3% (95% CI, 4.2-9.6) at 10 years. After adjusting for sex, age and year of diagnosis, transformation was associated with a substantially increased risk of death (HR 8.55, 95% CI 4.49−16.3). Ten-year relative survival was 94% (95% CI, 89%‒100%). The patients diagnosed at a later calendar year had lower excess risk of death (HR, 0.38 per 10-year increase; 95% CI, 0.15‒0.98). We conclude that while the 10-year relative survival for the patients with NLPHL was excellent in this large population-based cohort for the entire study period, transformation resulted in a substantially increased mortality compared with the patients without transformation. Our results also suggest a reduction in excess mortality over time.

Interpreting Survival Differences and Trends

1997 ◽  
Vol 83 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Franco Berrino ◽  
Andrea Micheli ◽  
Milena Sant ◽  
Riccardo Capocaccia
Keyword(s):  
Early Diagnosis ◽  
Survival Data ◽  
Survival Rates ◽  
Relative Survival ◽  
Cancer Registries ◽  
Population Based ◽  
Disease Stage ◽  
Definition Of ◽  
Survival Differences ◽  
Over Time

Since 1990 a concerted action between European population-based cancer registries (the EUROCARE project) has been carried out with the aims of establishing whether there are differences in cancer patient survival in Europe, and the reasons for such differences. Survival differences actually exist for cancer sites for which the stage of disease at diagnosis is the major prognostic factor (such as breast, stomach and colon cancer). However, for most cancer sites, survival increases over time and the survival rates of different countries tend to converge towards higher values. Interpreting survival differences and trends is not an easy task. Longer survival may be achieved by postponing death through better treatment or by anticipating diagnosis. However, an earlier diagnosis may or may not make a treatment more effective in postponing death. The computation of stage-specific or stage-adjusted survival is not sufficient for interpretation of survival differences, because staging procedures change over time and may vary in different hospitals and countries. In addition to an early diagnosis and more effective treatment, a number of factors may bias survival estimates. They may be classified into factors that can be controlled in the analysis (at least partially), such as mortality from other causes, demographic factors, epoch of diagnosis, different statistical methodology, and factors depending on the validity of cancer registry data, such as definition of the illness, exhaustiveness and quality of registration, completeness of follow-up, definition of the date of diagnosis, and definition of disease stage including the diagnostic procedure used to establish stage. To help disentangle the effects of early diagnosis and better treatment, several statistical approaches are being developed: multivariate analysis on relative survival data, new modeling analysis to separately estimate the proportion of cured patients and the length of survival for those patients destined to die, and the standardized collection of information on stage at diagnosis and staging procedures.

Survival among colorectal cancer patients with a history of previous cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16146-e16146
Author(s):  
Sandi Pruitt ◽  
David E. Gerber ◽  
Hong Zhu ◽  
Daniel Heitjan ◽  
Bhumika Maddineni ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Cox Regression ◽  
Population Based ◽  
Competing Risk ◽  
Cancer Specific Survival ◽  
Risk Of Death ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

e16146 Background: A growing number of patients with colorectal cancer (CRC) have survived a previous cancer. Although little is known about their prognosis, this population is frequently excluded from clinical trials. We examined the impact of previous cancer on overall and cancer-specific survival in a population-based cohort of patients diagnosed with incident CRC. Methods: We identified patients aged ≥66 years and diagnosed with CRC between 2005-2015 in linked SEER-Medicare data. For patients with and without previous cancer, we estimated overall survival using Cox regression and cause-specific survival using competing risk regression, separately by CRC stage, while adjusting for numerous covariates and competing risk of death from previous cancer, other causes, or the incident CRC. Results: Of 112,769 CRC patients diagnosed with incident CRC, 15,935 (14.1%) had a previous cancer – most commonly prostate (32.9%) or breast (19.4%) cancer, with many 7505 (47.1%) diagnosed ≤5 years of CRC. For all CRC stages except IV in which there was no significant difference in survival, patients with previous cancer had modestly worse overall survival (hazard ratios from fully adjusted models range from 1.11-1.28 across stages; see Table). This survival disadvantage was driven by deaths due to previous cancer and other causes. Notably, most patients with previous cancer had improved CRC-specific survival. Conclusions: CRC patients who have survived a previous cancer have generally worse overall survival but superior CRC-specific survival. This evidence should be considered concurrently with concerns about trial generalizability, low accrual, and heterogeneity of participants when determining exclusion criteria. [Table: see text]

scholarly journals Improvement of Survival over Time for Colorectal Cancer Patients: A Population-Based Study

2020 ◽  
Vol 9 (12) ◽  
pp. 4038
Author(s):  
Audrius Dulskas ◽  
Vytautas Gaizauskas ◽  
Inga Kildusiene ◽  
Narimantas Evaldas Samalavicius ◽  
Giedre Smailyte
Keyword(s):  
Colorectal Cancer ◽  
Survival Rate ◽  
Cancer Patients ◽  
Survival Rates ◽  
Relative Survival ◽  
Population Based ◽  
Colorectal Cancers ◽  
Advanced Cancer Patients ◽  
Regional Metastases ◽  
Colorectal Cancer Patients

Purpose: In this study, we analyzed the mortality and survival of colorectal cancer patients in Lithuania. Methods: This was a national cohort study. Population-based data from the Lithuanian Cancer Registry and period analyses were collected. Overall, 20,980 colorectal cancer patients were included. We examined the changes in colorectal cancer mortality and survival rates between 1998 and 2012 according to cancer anatomical sub-sites and stages. We calculated the 5-year relative survival estimates using period analysis. Results: Overall, 20,980 colorectal cancer cases reported from 1998 to 2012 were included in the study. The total number of newly diagnosed colorectal cancers increased from 1998–2002 to 2008–2012 by 12.1%. The highest number of colorectal cancers was localized and increased from 33.9% to 42.0%. The number of cancers with regional metastases and advanced cancers decreased by 11.1% and 15.5%, respectively. An increased number of new cases was observed for almost all colon cancer sub-sites. The overall 5-year relative survival rate increased from 37.9% in 1998–2002 to 51.5% in 2008–2012. We showed an increase in survival rates for all stages and all sub-sites. In the most recent period, patients with a localized disease had a 5-year survival rate of 78.6%, while survival estimates for advanced cancer patients remained low at 6.6%. Conclusion: Although survival rates variated in colorectal cancer patients according to disease stages and sub-sites, we showed increased survival rates for all patients.

scholarly journals Racial disparities in incidence and outcome in multiple myeloma: a population-based study

Blood ◽  
2010 ◽  
Vol 116 (25) ◽  
pp. 5501-5506 ◽  
Author(s):  
Adam J. Waxman ◽  
Pamela J. Mink ◽  
Susan S. Devesa ◽  
William F. Anderson ◽  
Brendan M. Weiss ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Large Scale ◽  
Age Of Onset ◽  
Hematologic Malignancy ◽  
Survival Rates ◽  
Relative Survival ◽  
Population Based ◽  
Population Based Study ◽  
Entire Study ◽  
Disease Specific

Abstract Multiple myeloma (MM) is the most common hematologic malignancy in blacks. Some prior studies suggest inferior survival in blacks; others suggest similar survival. Using the original 9 Surveillance, Epidemiology, and End Results registries, we conducted a large-scale population-based study including 5798 black and 28 939 white MM patients diagnosed 1973-2005, followed through 2006. Age-adjusted incidence rates, disease-specific survival, and relative survival rates were calculated by race, age, and time period of diagnosis. Mean age at diagnosis was 65.8 and 69.8 years for blacks and whites, respectively (P < .001). Incidence among blacks was m twice that among whites; this disparity was greater among patients < 50 years (P = .002). Over the entire study period, disease-specific and relative survival rates were higher in blacks than whites (P < .001). For whites, 5-year relative survival rates increased significantly 1973-1993 to 1994-1998 (26.3% to 30.8%; P < .001) and 1994-1998 to 1999-2005 (30.8% to 35.0%; P = .004). Survival improvements among blacks were smaller and nonsignificant (1973-1993 to 1999-2005: 31.0% to 34.1%; P = .07). We found (1) a younger age of onset among blacks; (2) better survival in blacks 1973-2005; and (3) significant survival improvement among whites over time, with smaller, nonsignificant change seen among blacks, possibly due to unequal access to and/or disparate responsiveness to novel therapies.

scholarly journals Impact of Age and Comorbidity on Multimodal Management and Survival from Colorectal Cancer: A Population-Based Study

2021 ◽  
Vol 10 (8) ◽  
pp. 1751
Author(s):  
Ilmo Kellokumpu ◽  
Matti Kairaluoma ◽  
Jukka-Pekka Mecklin ◽  
Henrik Kellokumpu ◽  
Ville Väyrynen ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Rectal Carcinoma ◽  
Population Based ◽  
Population Based Study ◽  
Comorbidity Burden ◽  
Multimodal Management ◽  
The Impact ◽  
Over Time

This retrospective population-based study examined the impact of age and comorbidity burden on multimodal management and survival from colorectal cancer (CRC). From 2000 to 2015, 1479 consecutive patients, who underwent surgical resection for CRC, were reviewed for age-adjusted Charlson comorbidity index (ACCI) including 19 well-defined weighted comorbidities. The impact of ACCI on multimodal management and survival was compared between low (score 0–2), intermediate (score 3) and high ACCI (score ≥ 4) groups. Changes in treatment from 2000 to 2015 were seen next to a major increase of laparoscopic surgery, increased use of adjuvant chemotherapy and an intensified treatment of metastatic disease. Patients with a high ACCI score were, by definition, older and had higher comorbidity. Major elective and emergency resections for colon carcinoma were evenly performed between the ACCI groups, as were laparoscopic and open resections. (Chemo)radiotherapy for rectal carcinoma was less frequently used, and a higher rate of local excisions, and consequently lower rate of major elective resections, was performed in the high ACCI group. Adjuvant chemotherapy and metastasectomy were less frequently used in the ACCI high group. Overall and cancer-specific survival from stage I-III CRC remained stable over time, but survival from stage IV improved. However, the 5-year overall survival from stage I–IV colon and rectal carcinoma was worse in the high ACCI group compared to the low ACCI group. Five-year cancer-specific and disease-free survival rates did not differ significantly by the ACCI. Cox proportional hazard analysis showed that high ACCI was an independent predictor of poor overall survival (p < 0.001). Our results show that despite improvements in multimodal management over time, old age and high comorbidity burden affect the use of adjuvant chemotherapy, preoperative (chemo)radiotherapy and management of metastatic disease, and worsen overall survival from CRC.

scholarly journals Improved Survival in AL Amyloidosis: A Population-Based Study on 1,430 Patients Diagnosed in Sweden 1995-2013

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4448-4448 ◽  
Author(s):  
Brendan M. Weiss ◽  
Sigrun H Lund ◽  
Magnus Bjorkholm ◽  
Adam D. Cohen ◽  
Laura Dember ◽  
...  
Keyword(s):  
Overall Survival ◽  
Plasma Cell ◽  
Research Funding ◽  
Survival Rates ◽  
Population Based ◽  
Al Amyloidosis ◽  
Population Based Study ◽  
Cell Therapies ◽  
Entire Cohort ◽  
Over Time

Abstract Introduction: AL amyloidosis (AL) is a plasma cell disorder characterized by life-threatening vital organ dysfunction resulting in nearly a third of patients dying within the first year of diagnosis. The only available therapies are anti-plasma cell chemotherapy agents, which reduce the toxic and amyloidogenic immunoglobulin light chains. We have previously shown improved survival in multiple myeloma (MM) due to novel anti-plasma cell therapies. Studies from specialty amyloid centers have also shown improved survival in AL, but this has never been studied in a population-based setting. Methods: By using the nationwide Swedish Patient Registry we identified all individuals registered with AL amyloidosis (defined as more than one occurrence of the ICD-code E85.8 and E85.9) in Sweden 1995-2013. By using the Total Population Registry we identified four matched controls for each case of amyloidosis, matched by gender and year of birth, and the controls had to be alive at the time of diagnosis for the corresponding AL-amyloidosis case. By using the Cause of Death Registry we obtained information on date of death, with follow-up through 2013. Overall survival (OS) was analyzed using Kaplan-Meier method and Cox proportional model, adjusting for age, gender, and calendar period of diagnosis. The cohort was divided into 4 calendar periods to evaluate changes in overall survival (OS) over time. Results: We identified 1,430 AL patients; mean age at diagnosis of 66.3 years; male gender 58.5%. A diagnosis of MM was made in 10.7% of patients, 3.6% after the AL diagnosis (AL-MM) and 7.1% before the AL diagnosis (MM-AL). Compared to matched controls, AL patients in the entire cohort had a median OS of 1.72 years, median OS was not reached for controls (p<0.001). The median OS of MM-AL was 0.51 years, AL-MM 0.88 years and AL 1.87 years (p<0.001). Median OS for AL patients improved significantly over time: 0.77 years for 1995-99, 1.37 years for 2000-04, 1.85 years for 2005-09, and 3.48 years for 2010-2013 (p for trend <0.001). Survival improvements over time were observed in both those younger and older than age 65. The 1-year survival for AL patients was: 43% for 1995-1999, 58% for 2000-2004, 59% for 2005-2009 and 70% 2010-2013 (p<0.001). The 2-year survival rates: 30% for 1995-1999, 42% for 2000-2004, 49% for 2005-2009 and 61% 2010-2013 (p<0.05). Conclusions: In the first population-based study of outcomes in AL, based on almost 1,500 patients diagnosed during almost 20 years, we found that OS has improved over time. The most probable explanation is the availability of highly-effective anti-plasma cell agents and possibly improvement in supportive care. We have also demonstrated an improvement in early mortality in AL amyloidosis possibly due to earlier recognition of disease and prompt anti-plasma cell chemotherapy. This novel finding deserves further investigation. Figure 1 Figure 1. Disclosures Weiss: Prothena: Other: Travel, accommodations, Research Funding; GlaxoSmithKline: Consultancy; Millennium: Consultancy, Other: Travel, accommodations; Janssen: Consultancy, Other: Travel, accommodations, Research Funding; Novartis: Consultancy. Cohen:Bristol-Meyers Squibb: Consultancy, Research Funding; Janssen: Consultancy. Landgren:Amgen: Honoraria, Research Funding; BMS: Honoraria; Celgene: Honoraria, Research Funding; Takeda: Honoraria; Merck: Honoraria; Medscape Myeloma Program: Honoraria.

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