1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
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International Journal of Surgery xxx (2014) 1e9
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Original research
Prognostic significance of splenectomy for patients with gastric adenocarcinoma undergoing total gastrectomy: A retrospective cohort study Q1
Frank Wang a,1, Yu-Cheng Chang a,1, Tsung-Hsing Chen b, Jun-Te Hsu a, *, Chia-Jung Kuo b, Chun-Jung Lin b, Jen-Shi Chen c, Kun-Chun Chiang d, Ta-Sen Yeh a, Tsann-Long Hwang a, Yi-Yin Jan a a
Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, Taiwan, ROC Department of Gastroenterology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, Taiwan, ROC c Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, Taiwan, ROC d Department of Surgery, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Taoyuan 333, Taiwan, ROC b
a r t i c l e i n f o
a b s t r a c t
Article history: Received 14 November 2013 Received in revised form 24 November 2013 Accepted 25 April 2014 Available online xxx
Background: The addition of splenectomy to a D2 gastrectomy in patients with gastric adenocarcinoma (GA) has remained controversial. This study aimed to assess the impact of splenectomy on the overall survival of patients undergoing total gastrectomy for GA. Methods: This was a retrospective review of 463 GA patients (excluding positive resection margins and pathologic spleen invasion) undergoing curative total gastrectomy with (TS) and without splenectomy (T) between 1994 and 2008. Clinicopathologic factors affecting the prognosis of these patients were collected prospectively and analyzed. Results: Two hundred and ninety one patients had T and 172 patients underwent TS. Patient clinicopathological characteristics were comparable between the 2 groups except for tumor size. There were no significant differences in postoperative morbidity and mortality between T and TS groups. Patients in the T group had similar 3- and 5-year survival rates compared with those in the TS groups (p ¼ 0.181). The addition of splenectomy to a total gastrectomy did not impact on the overall survival rates in patients with GA in terms of depth of tumor invasion and nodal metastasis. Conclusions: The addition of splenectomy is not associated with survival advantage in GA patients undergoing total gastrectomy. Ó 2014 Published by Elsevier Ltd on behalf of Surgical Associates Ltd.
Keywords: Gastric cancer Total gastrectomy Splenectomy
1. Introduction Gastric adenocarcinoma (GA) is the second commonest cause of cancer-related deaths worldwide. [1] Currently, radical gastric resection with adequate lymphadenectomy in patients with GA provides the best chance of cure [2]. Lymph node metastasis is one
* Corresponding author. Department of General Surgery, Chang Gung Memorial Hospital, 5, Fushing Street, KweishanShiang, Taoyuan 333, Taiwan, ROC. E-mail addresses: [email protected] (F. Wang), [email protected] (Y.-C. Chang), [email protected] (T.-H. Chen), [email protected] (J.-T. Hsu), [email protected] (C.-J. Kuo), [email protected] (C.-J. Lin), [email protected] (J.-S. Chen), [email protected] (K.-C. Chiang), [email protected] (T.-S. Yeh), [email protected]. tw (T.-L. Hwang), [email protected] (Y.-Y. Jan). 1 Frank Wang and Yu-Chen Chang contributed equally to this work.
of the important factors influencing long-term survival after curative resection [3e5]. The rate of metastasis to the lymph nodes at the splenic hilum (no. 10) in patients with proximal gastric cancer ranges from 9% to 28% [6e8]. The 5-year survival rate was only 11% for patients with splenic hilar node involvement, which was significantly worse than the rate of 52% in those without splenic hilar node metastasis [6]. Splenic lymph node involvement has not been observed in early GA [6]. Given the fact that the survival benefit of splenectomy is uncertain and the associated morbidity and mortality rates are not insignificant, performing a splenectomy for the purpose of splenic hilar node clearance is only advocated in patients with high suspicion of metastasis near the splenic hilum or direct tumor invasion of the spleen [6,7,9,10]. Although there are prospective randomized and retrospective trials reporting no survival benefit on the impact of splenectomy on the long-term survival of GA patients, the sample sizes in these studies are small
http://dx.doi.org/10.1016/j.ijsu.2014.04.006 1743-9191/Ó 2014 Published by Elsevier Ltd on behalf of Surgical Associates Ltd.
Please cite this article in press as: F. Wang, et al., Prognostic significance of splenectomy for patients with gastric adenocarcinoma undergoing total gastrectomy: A retrospective cohort study, International Journal of Surgery (2014), http://dx.doi.org/10.1016/j.ijsu.2014.04.006
55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65
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F. Wang et al. / International Journal of Surgery xxx (2014) 1e9
Table 1 Clinicopathological characteristics of patients with gastric adenocarcinoma undergoing total gastrectomy with or without splenectomy. Parameters Age (years) Median (range) Gender Male Female Tumor size (cm) Median (range) Differentiation Yes No Location Lesser curvature Greater curvature Whole Other T status T1 þ T2 T3 þ T4 N status N0 N1 N2 N3 LN ratioa Median (range) No. of examined lymph node 15 >15 No. of examined lymph node Median (range) No. of lymph node metastasis Median (range) Stage I II III Vascular invasion (yes) Lymphatic invasion (yes) Perineural invasion (yes) Comorbidity 0 1 2 3 Charlson comorbidity index score 2 3 4 5 Complications Surgical procedure-related Anastomotic leak Intra-abdominal abscess Wound infection Bleeding Ileus Surgical procedure-unrelated Pneumonia Atelectasis Cardiovascular disease Sepsis Others Hospital mortality Chemotherapyb(yes) a b
Non-splenectomy N ¼ 291
Splenectomy N ¼ 172
65 (53e73)
66 (56e73)
195 96
121 51
5.0 (3.3e7.0)
5.5 (3.5e8.0)
105 186
69 103
163 25 30 73
83 20 28 41
26 265
19 153
83 48 46 114
44 28 38 62
0.1 (0.0e0.4)
0.2 (0.0e0.4)
41 250
33 139
29.0 (21.0e40.0)
26.0 (18.0e36.0)
3.0 (0.0e11.0)
4.0 (0.0e10.8)
22 64 205 48 171 168
14 32 126 37 111 100
200 65 17 9
123 38 8 3
181 89 20 1 61
109 52 8 3 37
0.889
21 15 10 4 4
20 8 9 6 0
0.106 0.810 0.347 0.184 0.302
6 1 3 4 17 14 192
4 0 0 0 7 7 102
1.000 1.000 0.298 0.302 0.406 0.711 0.158
P 0.471 0.456
0.040 0.387
0.145
0.459
0.395
0.171 0.148
0.171 0.469 0.682
0.163 0.171 0.855 0.761
0.339
Ratio of metastatic to examined lymph nodes. Excluding T1-2N0 cases.
Please cite this article in press as: F. Wang, et al., Prognostic significance of splenectomy for patients with gastric adenocarcinoma undergoing total gastrectomy: A retrospective cohort study, International Journal of Surgery (2014), http://dx.doi.org/10.1016/j.ijsu.2014.04.006
66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65
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F. Wang et al. / International Journal of Surgery xxx (2014) 1e9
Fig. 1. Cumulative overall survival rates in T1e2 (A) and T3e4 (B) lesion with and without splenectomy.
Please cite this article in press as: F. Wang, et al., Prognostic significance of splenectomy for patients with gastric adenocarcinoma undergoing total gastrectomy: A retrospective cohort study, International Journal of Surgery (2014), http://dx.doi.org/10.1016/j.ijsu.2014.04.006
3
66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65
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F. Wang et al. / International Journal of Surgery xxx (2014) 1e9
Fig. 2. Cumulative overall survival rates in N0-2 (A) and N3 (B) lesion with and without splenectomy.
Please cite this article in press as: F. Wang, et al., Prognostic significance of splenectomy for patients with gastric adenocarcinoma undergoing total gastrectomy: A retrospective cohort study, International Journal of Surgery (2014), http://dx.doi.org/10.1016/j.ijsu.2014.04.006
66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65
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F. Wang et al. / International Journal of Surgery xxx (2014) 1e9
5
Table 2 Univariate and multivariate analyses of prognostic factors in patients with gastric adenocarcinoma undergoing total gastrectomy with or without splenectomy. Factors Age 65 (n ¼ 220) >65 (n ¼ 222) Gender Male (n ¼ 303) Female (n ¼ 139) Tumor size (cm)a 5 (n ¼ 223) >5 (n ¼ 210) Differentiation Yes (n ¼ 168) No (n ¼ 274) Location Lesser curvature (n ¼ 232) Greater curvature (n ¼ 43) Whole (n ¼ 56) Others (n ¼ 111) T status 1 þ 2 (n ¼ 44) 3 þ 4 (n ¼ 398) Nodal status N0 (n ¼ 126) N1 (n ¼ 69) N2 (n ¼ 80) N3 (n ¼ 167) LN ratiob 0.14 (n ¼ 217) >0.14 (n ¼ 225) Vascular invasiona No (n ¼ 349) Yes (n ¼ 82) Lymphatic invasiona No (n ¼ 164) Yes (n ¼ 267) Perineural invasiona No (n ¼ 174) Yes (n ¼ 254) Splenectomy No (n ¼ 277) Yes (n ¼ 165) Chemotherapyc No (n ¼ 113) Yes (n ¼ 294)
Hazard ratio
95% CI
P
Hazard ratio
95% CI
P
1 1.447
1.049e1.995
0.024
1 1.466
1.045e2.055
0.027
1 1.522 2.647 1.358
0.968e2.395 1.759e3.984 0.941e1.959
0.069
IJSU1334_proof ■ 30 April 2014 ■ 1/9
International Journal of Surgery xxx (2014) 1e9
Contents lists available at ScienceDirect
International Journal of Surgery journal homepage: www.journal-surgery.net
Original research
Prognostic significance of splenectomy for patients with gastric adenocarcinoma undergoing total gastrectomy: A retrospective cohort study Q1
Frank Wang a,1, Yu-Cheng Chang a,1, Tsung-Hsing Chen b, Jun-Te Hsu a, *, Chia-Jung Kuo b, Chun-Jung Lin b, Jen-Shi Chen c, Kun-Chun Chiang d, Ta-Sen Yeh a, Tsann-Long Hwang a, Yi-Yin Jan a a
Department of Surgery, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, Taiwan, ROC Department of Gastroenterology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, Taiwan, ROC c Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 333, Taiwan, ROC d Department of Surgery, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Taoyuan 333, Taiwan, ROC b
a r t i c l e i n f o
a b s t r a c t
Article history: Received 14 November 2013 Received in revised form 24 November 2013 Accepted 25 April 2014 Available online xxx
Background: The addition of splenectomy to a D2 gastrectomy in patients with gastric adenocarcinoma (GA) has remained controversial. This study aimed to assess the impact of splenectomy on the overall survival of patients undergoing total gastrectomy for GA. Methods: This was a retrospective review of 463 GA patients (excluding positive resection margins and pathologic spleen invasion) undergoing curative total gastrectomy with (TS) and without splenectomy (T) between 1994 and 2008. Clinicopathologic factors affecting the prognosis of these patients were collected prospectively and analyzed. Results: Two hundred and ninety one patients had T and 172 patients underwent TS. Patient clinicopathological characteristics were comparable between the 2 groups except for tumor size. There were no significant differences in postoperative morbidity and mortality between T and TS groups. Patients in the T group had similar 3- and 5-year survival rates compared with those in the TS groups (p ¼ 0.181). The addition of splenectomy to a total gastrectomy did not impact on the overall survival rates in patients with GA in terms of depth of tumor invasion and nodal metastasis. Conclusions: The addition of splenectomy is not associated with survival advantage in GA patients undergoing total gastrectomy. Ó 2014 Published by Elsevier Ltd on behalf of Surgical Associates Ltd.
Keywords: Gastric cancer Total gastrectomy Splenectomy
1. Introduction Gastric adenocarcinoma (GA) is the second commonest cause of cancer-related deaths worldwide. [1] Currently, radical gastric resection with adequate lymphadenectomy in patients with GA provides the best chance of cure [2]. Lymph node metastasis is one
* Corresponding author. Department of General Surgery, Chang Gung Memorial Hospital, 5, Fushing Street, KweishanShiang, Taoyuan 333, Taiwan, ROC. E-mail addresses: [email protected] (F. Wang), [email protected] (Y.-C. Chang), [email protected] (T.-H. Chen), [email protected] (J.-T. Hsu), [email protected] (C.-J. Kuo), [email protected] (C.-J. Lin), [email protected] (J.-S. Chen), [email protected] (K.-C. Chiang), [email protected] (T.-S. Yeh), [email protected]. tw (T.-L. Hwang), [email protected] (Y.-Y. Jan). 1 Frank Wang and Yu-Chen Chang contributed equally to this work.
of the important factors influencing long-term survival after curative resection [3e5]. The rate of metastasis to the lymph nodes at the splenic hilum (no. 10) in patients with proximal gastric cancer ranges from 9% to 28% [6e8]. The 5-year survival rate was only 11% for patients with splenic hilar node involvement, which was significantly worse than the rate of 52% in those without splenic hilar node metastasis [6]. Splenic lymph node involvement has not been observed in early GA [6]. Given the fact that the survival benefit of splenectomy is uncertain and the associated morbidity and mortality rates are not insignificant, performing a splenectomy for the purpose of splenic hilar node clearance is only advocated in patients with high suspicion of metastasis near the splenic hilum or direct tumor invasion of the spleen [6,7,9,10]. Although there are prospective randomized and retrospective trials reporting no survival benefit on the impact of splenectomy on the long-term survival of GA patients, the sample sizes in these studies are small
http://dx.doi.org/10.1016/j.ijsu.2014.04.006 1743-9191/Ó 2014 Published by Elsevier Ltd on behalf of Surgical Associates Ltd.
Please cite this article in press as: F. Wang, et al., Prognostic significance of splenectomy for patients with gastric adenocarcinoma undergoing total gastrectomy: A retrospective cohort study, International Journal of Surgery (2014), http://dx.doi.org/10.1016/j.ijsu.2014.04.006
55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65
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F. Wang et al. / International Journal of Surgery xxx (2014) 1e9
Table 1 Clinicopathological characteristics of patients with gastric adenocarcinoma undergoing total gastrectomy with or without splenectomy. Parameters Age (years) Median (range) Gender Male Female Tumor size (cm) Median (range) Differentiation Yes No Location Lesser curvature Greater curvature Whole Other T status T1 þ T2 T3 þ T4 N status N0 N1 N2 N3 LN ratioa Median (range) No. of examined lymph node 15 >15 No. of examined lymph node Median (range) No. of lymph node metastasis Median (range) Stage I II III Vascular invasion (yes) Lymphatic invasion (yes) Perineural invasion (yes) Comorbidity 0 1 2 3 Charlson comorbidity index score 2 3 4 5 Complications Surgical procedure-related Anastomotic leak Intra-abdominal abscess Wound infection Bleeding Ileus Surgical procedure-unrelated Pneumonia Atelectasis Cardiovascular disease Sepsis Others Hospital mortality Chemotherapyb(yes) a b
Non-splenectomy N ¼ 291
Splenectomy N ¼ 172
65 (53e73)
66 (56e73)
195 96
121 51
5.0 (3.3e7.0)
5.5 (3.5e8.0)
105 186
69 103
163 25 30 73
83 20 28 41
26 265
19 153
83 48 46 114
44 28 38 62
0.1 (0.0e0.4)
0.2 (0.0e0.4)
41 250
33 139
29.0 (21.0e40.0)
26.0 (18.0e36.0)
3.0 (0.0e11.0)
4.0 (0.0e10.8)
22 64 205 48 171 168
14 32 126 37 111 100
200 65 17 9
123 38 8 3
181 89 20 1 61
109 52 8 3 37
0.889
21 15 10 4 4
20 8 9 6 0
0.106 0.810 0.347 0.184 0.302
6 1 3 4 17 14 192
4 0 0 0 7 7 102
1.000 1.000 0.298 0.302 0.406 0.711 0.158
P 0.471 0.456
0.040 0.387
0.145
0.459
0.395
0.171 0.148
0.171 0.469 0.682
0.163 0.171 0.855 0.761
0.339
Ratio of metastatic to examined lymph nodes. Excluding T1-2N0 cases.
Please cite this article in press as: F. Wang, et al., Prognostic significance of splenectomy for patients with gastric adenocarcinoma undergoing total gastrectomy: A retrospective cohort study, International Journal of Surgery (2014), http://dx.doi.org/10.1016/j.ijsu.2014.04.006
66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65
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F. Wang et al. / International Journal of Surgery xxx (2014) 1e9
Fig. 1. Cumulative overall survival rates in T1e2 (A) and T3e4 (B) lesion with and without splenectomy.
Please cite this article in press as: F. Wang, et al., Prognostic significance of splenectomy for patients with gastric adenocarcinoma undergoing total gastrectomy: A retrospective cohort study, International Journal of Surgery (2014), http://dx.doi.org/10.1016/j.ijsu.2014.04.006
3
66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65
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4
F. Wang et al. / International Journal of Surgery xxx (2014) 1e9
Fig. 2. Cumulative overall survival rates in N0-2 (A) and N3 (B) lesion with and without splenectomy.
Please cite this article in press as: F. Wang, et al., Prognostic significance of splenectomy for patients with gastric adenocarcinoma undergoing total gastrectomy: A retrospective cohort study, International Journal of Surgery (2014), http://dx.doi.org/10.1016/j.ijsu.2014.04.006
66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65
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F. Wang et al. / International Journal of Surgery xxx (2014) 1e9
5
Table 2 Univariate and multivariate analyses of prognostic factors in patients with gastric adenocarcinoma undergoing total gastrectomy with or without splenectomy. Factors Age 65 (n ¼ 220) >65 (n ¼ 222) Gender Male (n ¼ 303) Female (n ¼ 139) Tumor size (cm)a 5 (n ¼ 223) >5 (n ¼ 210) Differentiation Yes (n ¼ 168) No (n ¼ 274) Location Lesser curvature (n ¼ 232) Greater curvature (n ¼ 43) Whole (n ¼ 56) Others (n ¼ 111) T status 1 þ 2 (n ¼ 44) 3 þ 4 (n ¼ 398) Nodal status N0 (n ¼ 126) N1 (n ¼ 69) N2 (n ¼ 80) N3 (n ¼ 167) LN ratiob 0.14 (n ¼ 217) >0.14 (n ¼ 225) Vascular invasiona No (n ¼ 349) Yes (n ¼ 82) Lymphatic invasiona No (n ¼ 164) Yes (n ¼ 267) Perineural invasiona No (n ¼ 174) Yes (n ¼ 254) Splenectomy No (n ¼ 277) Yes (n ¼ 165) Chemotherapyc No (n ¼ 113) Yes (n ¼ 294)
Hazard ratio
95% CI
P
Hazard ratio
95% CI
P
1 1.447
1.049e1.995
0.024
1 1.466
1.045e2.055
0.027
1 1.522 2.647 1.358
0.968e2.395 1.759e3.984 0.941e1.959
0.069
