日本人食道癌患者における予後予測のための術後骨格筋量喪失の至適カットオフ値
【目的】本研究の目的は、食道癌患者の生存期間をanchor-basedとした術後骨格筋量喪失の至適カットオフ値を明らかにすることである。 【方法】本研究は単施設後方視観察研究である。対象は2016～2020年までに一期的根治的切除術を受けた食道癌患者とした。術前および術後4ヵ月のCT画像から骨格筋指数（SMI）喪失率を算出し、Log-rank検定を用いて至適カットオフ値を定義した。 【結果】解析対象症例は384例であり、70歳以上の高齢者は166例（43％）、男性は314例（82%）、平均SMI喪失率は4.6%であった。SMI喪失率のカットオフ値は10%と定義された（Χ二乗値：19.8，p &...
Saved in:
| Published in | 日本がん・リンパ浮腫理学療法学会誌 Vol. 2; pp. 22 - 31 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 日本がん・リンパ浮腫理学療法学会
2024
|
| Subjects | |
| Online Access | Get full text |
| ISSN | 2759-0984 |
| DOI | 10.60366/jjptol.JJPTOL-R5-A10 |
Cover
| Abstract | 【目的】本研究の目的は、食道癌患者の生存期間をanchor-basedとした術後骨格筋量喪失の至適カットオフ値を明らかにすることである。 【方法】本研究は単施設後方視観察研究である。対象は2016～2020年までに一期的根治的切除術を受けた食道癌患者とした。術前および術後4ヵ月のCT画像から骨格筋指数（SMI）喪失率を算出し、Log-rank検定を用いて至適カットオフ値を定義した。 【結果】解析対象症例は384例であり、70歳以上の高齢者は166例（43％）、男性は314例（82%）、平均SMI喪失率は4.6%であった。SMI喪失率のカットオフ値は10%と定義された（Χ二乗値：19.8，p < 0.001）。Cox比例ハザードモデルの結果、カットオフ値以上のSMI喪失は、生存期間への有意な影響を認めた［調整済みハザード比：3.864（95%信頼区間：2.054–7.267），p < 0.001］。 【考察】本研究により、食道癌患者の生存期間をanchor-basedとした術後骨格筋量喪失の至適カットオフ値は10%である可能性が示された。 |
|---|---|
| AbstractList | 【目的】本研究の目的は、食道癌患者の生存期間をanchor-basedとした術後骨格筋量喪失の至適カットオフ値を明らかにすることである。 【方法】本研究は単施設後方視観察研究である。対象は2016～2020年までに一期的根治的切除術を受けた食道癌患者とした。術前および術後4ヵ月のCT画像から骨格筋指数（SMI）喪失率を算出し、Log-rank検定を用いて至適カットオフ値を定義した。 【結果】解析対象症例は384例であり、70歳以上の高齢者は166例（43％）、男性は314例（82%）、平均SMI喪失率は4.6%であった。SMI喪失率のカットオフ値は10%と定義された（Χ二乗値：19.8，p < 0.001）。Cox比例ハザードモデルの結果、カットオフ値以上のSMI喪失は、生存期間への有意な影響を認めた［調整済みハザード比：3.864（95%信頼区間：2.054–7.267），p < 0.001］。 【考察】本研究により、食道癌患者の生存期間をanchor-basedとした術後骨格筋量喪失の至適カットオフ値は10%である可能性が示された。 |
| Author | 小西, 信子 土方, 奈奈子 小林, 大祐 辻, 哲也 藤田, 武郎 中嶋, 康記 原田, 剛志 上野, 順也 栁沢, 拓臣 |
| Author_xml | – sequence: 1 fullname: 小林, 大祐 organization: 国立がん研究センター東病院リハビリテーション科 – sequence: 1 fullname: 栁沢, 拓臣 organization: 国立がん研究センター東病院リハビリテーション科 – sequence: 1 fullname: 辻, 哲也 organization: 慶應義塾大学医学部リハビリテーション医学教室 – sequence: 1 fullname: 中嶋, 康記 organization: 国立がん研究センター東病院リハビリテーション科 – sequence: 1 fullname: 小西, 信子 organization: 国立がん研究センター東病院リハビリテーション科 – sequence: 1 fullname: 原田, 剛志 organization: 慶應義塾大学大学院 医学研究科リハビリテーション医学教室 – sequence: 1 fullname: 土方, 奈奈子 organization: 国立がん研究センター東病院リハビリテーション科 – sequence: 1 fullname: 上野, 順也 organization: 国立がん研究センター東病院リハビリテーション科 – sequence: 1 fullname: 藤田, 武郎 organization: 国立がん研究センター東病院食道外科 |
| BookMark | eNo9kN9KAkEUxocoyMxH6BHWZndn9s-lSGUiGGLXyzg7lYuprN50566EkkKEVASBhQalFkQ3IdHLjLu6b9GG0cU55-M7H9_FbwOslitlBsCWCOMKlBVl27Kq9Uopnk4f5LMZIYeFhAhXQERSsS5AXUPrIFarFQsQY03GSJUjoOLfPvn3k9l0Ggz6gdOb33V9d7BonHNnzJ0L7lxxtzObtr3vbrj9zwl33rjT564TisVjL_SD0bP_8DV_7QStS-9m5A3ff1-tj8B54e6YN5u82ebuiDevvcZwE6wdkVKNxf5uFBzu7uSTKSGT3dtPJjKCJWGkCQoSCRIp0VXGKMWKKqoMEYLMgl7QNKxSGRKIVFOWNIpkSqlJMNYhg4oKTYWZchSklr1WrU6OmVG1i6fEPjOIXS_SEjOWpAzJgOEseRk5bIS8_iP0hNiGReQfbPKS-A |
| ContentType | Journal Article |
| Copyright | 一般社団法人 日本がん・リンパ浮腫理学療法学会 |
| Copyright_xml | – notice: 一般社団法人 日本がん・リンパ浮腫理学療法学会 |
| DOI | 10.60366/jjptol.JJPTOL-R5-A10 |
| DatabaseTitleList | |
| DeliveryMethod | fulltext_linktorsrc |
| EISSN | 2759-0984 |
| EndPage | 31 |
| ExternalDocumentID | article_jjptol_2_0_2_JJPTOL_R5_A10_article_char_ja |
| GroupedDBID | M~E |
| ID | FETCH-LOGICAL-j2548-641a41ca97eecc56717e4aa4db9b8857c30a047d328c43cccda5590e0670d6ed3 |
| IngestDate | Wed Sep 03 06:30:20 EDT 2025 |
| IsDoiOpenAccess | true |
| IsOpenAccess | true |
| IsPeerReviewed | false |
| IsScholarly | false |
| Language | Japanese |
| LinkModel | OpenURL |
| MergedId | FETCHMERGED-LOGICAL-j2548-641a41ca97eecc56717e4aa4db9b8857c30a047d328c43cccda5590e0670d6ed3 |
| OpenAccessLink | https://www.jstage.jst.go.jp/article/jjptol/2/0/2_JJPTOL-R5-A10/_article/-char/ja |
| PageCount | 10 |
| ParticipantIDs | jstage_primary_article_jjptol_2_0_2_JJPTOL_R5_A10_article_char_ja |
| PublicationCentury | 2000 |
| PublicationDate | 20240000 |
| PublicationDateYYYYMMDD | 2024-01-01 |
| PublicationDate_xml | – year: 2024 text: 20240000 |
| PublicationDecade | 2020 |
| PublicationTitle | 日本がん・リンパ浮腫理学療法学会誌 |
| PublicationTitleAlternate | JJPTOL |
| PublicationYear | 2024 |
| Publisher | 一般社団法人 日本がん・リンパ浮腫理学療法学会 |
| Publisher_xml | – name: 一般社団法人 日本がん・リンパ浮腫理学療法学会 |
| References | 19) Templeton AJ, McNamara MG, et al.: Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Solid Tumors: A Systematic Review and Meta-Analysis. JNCI J Natl Cancer Inst. 2014; 106(6): e124. doi:10.1093/jnci/dju124, https://doi.org/10.1093/jnci/dju124 21) Yamashita K, Watanabe M, et al.: The impact of the Charlson comorbidity index on the prognosis of esophageal cancer patients who underwent esophagectomy with curative intent. Surg Today. 2018; 48: 632-639. 1) Arnold M, Abnet CC, et al.: Global burden of 5 major types of gastrointestinal cancer. Gastroenterology. 2020; 159(1): 335-349.e15. 33) Matsui K, Kawakubo H, et al.: Exploratory prospective study of the influence of radical esophagectomy on perioperative physical activity in patients with thoracic esophageal cancer. Dis Esophagus. 2022; 35(2): doab043. 22) JCOG外科合併症規準小委員会．“JCOG術後合併症規準（Clavien-Dindo分類）v2.0”．http://www.jcog.jp/doctor/tool/Clavien_Dindo.html,（cited: 2019-12） 25) Nakamura T, Kamiya K, et al.: Quadriceps strength and mortality in older patients with heart failure. Can J Cardiol. 2021; 37(3): 476-483. 3) Kitagawa Y, Uno T, et al.: Esophageal cancer practice guidelines 2022 edited by the Japan esophageal society: part 1. Esophagus. 2023; 20(3): 343-372. 4) Harada T, Tsuji T, et al.: The Postoperative Recovery Course of Skeletal Muscle Mass in Older Esophageal Cancer Patients. Eur J Cancer Care. 2023; doi.org/10.1155/2023/6655999 5) Blazeby JM, Sanford E, et al.: Health-related quality of life during neoadjuvant treatment and surgery for localized esophageal carcinoma. Cancer. 2005; 103: 1791-1799. 7) Findlay JM, Gillies RS, et al.: Enhanced Recovery for Esophagectomy A Systematic Review and Evidence-Based Guidelines. Ann Surg. 2014; 259(3): 413-431. 18) Rice TW, Blackstone EH, et al.: 7th Edition of the AJCC Cancer Staging Manual: Esophagus and Esophagogastric Junction. Ann Surg Oncol. 2010; 17(7): 1721-1724. 16) Takahashi K, Watanabe M, et al.: Prognostic significance of skeletal muscle loss during early postoperative period in elderly patients with esophageal cancer. Ann Surg Oncol. 2019; 26: 3727-3735. 15) Liao CD, Chen HC, et al.: The role of muscle mass gain following protein supplementation plus exercise therapy in older adults with sarcopenia and frailty risks: a systematic review and meta-regression analysis of randomized trials. Nutrients. 2019; 11: 1713. 30) Fried LP, Tangen CM, et al.: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3): M146-M156. 32) Harada T, Tsuji T, et al.: Impact of early postoperative factors on changes in skeletal muscle mass after esophagectomy in older patients with esophageal cancer. Eur Geriatr Med. 2023; 14(1): 203-210. 28) Harada T, Tsuji T, et al.: Prognostic impact of the loss of skeletal muscle mass during neoadjuvant chemotherapy on older patients with esophageal cancer. Ann Surg Oncol. 2022; 29(13): 8131-8139. 14) Nakashima Y, Saeki H, et al.: Skeletal muscle loss after esophagectomy is an independent risk factor for patients with esophageal cancer. Ann Surg Oncol. 2020; 27: 492-498. 31) Harada T, Tsuji T, et al.: Skeletal muscle mass recovery after oesophagectomy and neoadjuvant chemotherapy in oesophageal cancer: retrospective cohort study. BMJ Support Palliat Care. 2023; doi: 10.1136/spcare-2023-004245 26) Williams B, Mandrekar JN, et al.: Finding optimal cutpoints for continuous covariates with binary and time-to-event outcomes. Mayo Foundation Technical Report Series, number 79. Rochester, MN: Department of Health Sciences Research, Mayo Clinic, 2006. 17) Mourtzakis M, Prado CM, et al.: A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008; 33(5): 997-1006. 10) Williams GR, Dunne RF, et al.: Sarcopenia in the older adult with cancer. J Clin Oncol. 2021; 39(19): 2068-2078. 8) Manigrasso M, Vertaldi S, et al.: Robotic esophagectomy. A systematic review with meta-analysis of clinical outcomes. J Pers Med. 2021; 11(7): 640. 29) Clegg A, Young J, et al.: Frailty in elderly people. Lancet, 2013; 381(9868): 752-762. 9) Cruz-Jentoft AJ, Sayer AA: Sarcopenia. Lancet. 2019; 393: 2636-2646. 13) Kudou K, Saeki H, et al.: Postoperative skeletal muscle loss predicts poor prognosis of adenocarcinoma of upper stomach and esophagogastric junction. World J Surg. 2019; 43: 1068-1075. 11) Bye A, Sjøblom B, et al.: Muscle mass and association to quality of life in non-small cell lung cancer patients. J Cachexia Sarcopenia Muscle. 2017; 8: 759-767. 2) Tachimori Y, Ozawa S, et al.: Comprehensive registry of esophageal cancer in Japan, 2009. Esophagus. 2016; 13: 110-137. 20) Huang Y, Feng JF, et al.: Prognostic role of serum C-reactive protein in esophageal cancer: a systematic review and meta-analysis. Therapeutics and Clinical Risk Management. 2015; 11: 89-94. 23) Eilers PH, Marx BD: Flexible smoothing with B-splines and penalties. Stat Sci. 1996; 11: 89-121. 12) Harada T, Tatematsu N, et al.: Prognostic impact of postoperative loss of skeletal muscle mass in patients aged 70 years or older with esophageal cancer. Ann Surg Oncol. 2022; 29(9): 5638-5645. 6) Parameswaran R, Titcomb DR, et al.: Assessment and comparison of recovery after open and minimally invasive esophagectomy for cancer: an exploratory study in two centers. Annals of surgical oncology. 2013; 20(6): 1970-1977. 27) Prado CM, Lieffers JR, et al.: Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008; 9(7): 629-635. 24) Renfro LA, Loupakis F, et al.: Body mass index is prognostic in metastatic colorectal cancer: pooled analysis of patients from first-line clinical trials in the ARCAD database. J Clin Oncol. 2016; 34: 144. |
| References_xml | – reference: 12) Harada T, Tatematsu N, et al.: Prognostic impact of postoperative loss of skeletal muscle mass in patients aged 70 years or older with esophageal cancer. Ann Surg Oncol. 2022; 29(9): 5638-5645. – reference: 13) Kudou K, Saeki H, et al.: Postoperative skeletal muscle loss predicts poor prognosis of adenocarcinoma of upper stomach and esophagogastric junction. World J Surg. 2019; 43: 1068-1075. – reference: 8) Manigrasso M, Vertaldi S, et al.: Robotic esophagectomy. A systematic review with meta-analysis of clinical outcomes. J Pers Med. 2021; 11(7): 640. – reference: 33) Matsui K, Kawakubo H, et al.: Exploratory prospective study of the influence of radical esophagectomy on perioperative physical activity in patients with thoracic esophageal cancer. Dis Esophagus. 2022; 35(2): doab043. – reference: 27) Prado CM, Lieffers JR, et al.: Prevalence and clinical implications of sarcopenic obesity in patients with solid tumours of the respiratory and gastrointestinal tracts: a population-based study. Lancet Oncol. 2008; 9(7): 629-635. – reference: 32) Harada T, Tsuji T, et al.: Impact of early postoperative factors on changes in skeletal muscle mass after esophagectomy in older patients with esophageal cancer. Eur Geriatr Med. 2023; 14(1): 203-210. – reference: 9) Cruz-Jentoft AJ, Sayer AA: Sarcopenia. Lancet. 2019; 393: 2636-2646. – reference: 5) Blazeby JM, Sanford E, et al.: Health-related quality of life during neoadjuvant treatment and surgery for localized esophageal carcinoma. Cancer. 2005; 103: 1791-1799. – reference: 21) Yamashita K, Watanabe M, et al.: The impact of the Charlson comorbidity index on the prognosis of esophageal cancer patients who underwent esophagectomy with curative intent. Surg Today. 2018; 48: 632-639. – reference: 14) Nakashima Y, Saeki H, et al.: Skeletal muscle loss after esophagectomy is an independent risk factor for patients with esophageal cancer. Ann Surg Oncol. 2020; 27: 492-498. – reference: 19) Templeton AJ, McNamara MG, et al.: Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Solid Tumors: A Systematic Review and Meta-Analysis. JNCI J Natl Cancer Inst. 2014; 106(6): e124. doi:10.1093/jnci/dju124, https://doi.org/10.1093/jnci/dju124 – reference: 6) Parameswaran R, Titcomb DR, et al.: Assessment and comparison of recovery after open and minimally invasive esophagectomy for cancer: an exploratory study in two centers. Annals of surgical oncology. 2013; 20(6): 1970-1977. – reference: 4) Harada T, Tsuji T, et al.: The Postoperative Recovery Course of Skeletal Muscle Mass in Older Esophageal Cancer Patients. Eur J Cancer Care. 2023; doi.org/10.1155/2023/6655999 – reference: 10) Williams GR, Dunne RF, et al.: Sarcopenia in the older adult with cancer. J Clin Oncol. 2021; 39(19): 2068-2078. – reference: 18) Rice TW, Blackstone EH, et al.: 7th Edition of the AJCC Cancer Staging Manual: Esophagus and Esophagogastric Junction. Ann Surg Oncol. 2010; 17(7): 1721-1724. – reference: 15) Liao CD, Chen HC, et al.: The role of muscle mass gain following protein supplementation plus exercise therapy in older adults with sarcopenia and frailty risks: a systematic review and meta-regression analysis of randomized trials. Nutrients. 2019; 11: 1713. – reference: 17) Mourtzakis M, Prado CM, et al.: A practical and precise approach to quantification of body composition in cancer patients using computed tomography images acquired during routine care. Appl Physiol Nutr Metab. 2008; 33(5): 997-1006. – reference: 28) Harada T, Tsuji T, et al.: Prognostic impact of the loss of skeletal muscle mass during neoadjuvant chemotherapy on older patients with esophageal cancer. Ann Surg Oncol. 2022; 29(13): 8131-8139. – reference: 2) Tachimori Y, Ozawa S, et al.: Comprehensive registry of esophageal cancer in Japan, 2009. Esophagus. 2016; 13: 110-137. – reference: 7) Findlay JM, Gillies RS, et al.: Enhanced Recovery for Esophagectomy A Systematic Review and Evidence-Based Guidelines. Ann Surg. 2014; 259(3): 413-431. – reference: 11) Bye A, Sjøblom B, et al.: Muscle mass and association to quality of life in non-small cell lung cancer patients. J Cachexia Sarcopenia Muscle. 2017; 8: 759-767. – reference: 24) Renfro LA, Loupakis F, et al.: Body mass index is prognostic in metastatic colorectal cancer: pooled analysis of patients from first-line clinical trials in the ARCAD database. J Clin Oncol. 2016; 34: 144. – reference: 3) Kitagawa Y, Uno T, et al.: Esophageal cancer practice guidelines 2022 edited by the Japan esophageal society: part 1. Esophagus. 2023; 20(3): 343-372. – reference: 30) Fried LP, Tangen CM, et al.: Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001; 56(3): M146-M156. – reference: 31) Harada T, Tsuji T, et al.: Skeletal muscle mass recovery after oesophagectomy and neoadjuvant chemotherapy in oesophageal cancer: retrospective cohort study. BMJ Support Palliat Care. 2023; doi: 10.1136/spcare-2023-004245 – reference: 25) Nakamura T, Kamiya K, et al.: Quadriceps strength and mortality in older patients with heart failure. Can J Cardiol. 2021; 37(3): 476-483. – reference: 23) Eilers PH, Marx BD: Flexible smoothing with B-splines and penalties. Stat Sci. 1996; 11: 89-121. – reference: 22) JCOG外科合併症規準小委員会．“JCOG術後合併症規準（Clavien-Dindo分類）v2.0”．http://www.jcog.jp/doctor/tool/Clavien_Dindo.html,（cited: 2019-12）． – reference: 26) Williams B, Mandrekar JN, et al.: Finding optimal cutpoints for continuous covariates with binary and time-to-event outcomes. Mayo Foundation Technical Report Series, number 79. Rochester, MN: Department of Health Sciences Research, Mayo Clinic, 2006. – reference: 29) Clegg A, Young J, et al.: Frailty in elderly people. Lancet, 2013; 381(9868): 752-762. – reference: 16) Takahashi K, Watanabe M, et al.: Prognostic significance of skeletal muscle loss during early postoperative period in elderly patients with esophageal cancer. Ann Surg Oncol. 2019; 26: 3727-3735. – reference: 1) Arnold M, Abnet CC, et al.: Global burden of 5 major types of gastrointestinal cancer. Gastroenterology. 2020; 159(1): 335-349.e15. – reference: 20) Huang Y, Feng JF, et al.: Prognostic role of serum C-reactive protein in esophageal cancer: a systematic review and meta-analysis. Therapeutics and Clinical Risk Management. 2015; 11: 89-94. |
| SSID | ssib055835473 ssib054409039 ssib054409021 |
| Score | 1.9385672 |
| Snippet | 【目的】本研究の目的は、食道癌患者の生存期間をanchor-basedとした術後骨格筋量喪失の至適カットオフ値を明らかにすることである。... |
| SourceID | jstage |
| SourceType | Publisher |
| StartPage | 22 |
| SubjectTerms | 手術 生命予後 食道癌 骨格筋量 |
| Title | 日本人食道癌患者における予後予測のための術後骨格筋量喪失の至適カットオフ値 |
| URI | https://www.jstage.jst.go.jp/article/jjptol/2/0/2_JJPTOL-R5-A10/_article/-char/ja |
| Volume | 2 |
| hasFullText | 1 |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| ispartofPNX | 日本がん・リンパ浮腫理学療法学会誌, 2024, Vol.2, pp.22-31 |
| link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwzV3NaxQxFB9K68GLKCp-04M5ydT5SCbJMbOdUopVKS30NszH9rCILbK9eJDuFmmxBZGiIghVWkHbKogXKeI_M-22-1_48jG7W-nBigdhd3ibvLz85vcym5eQZCzrJoxj08zPfTvPc8fGbtW10wxzO5nJ0yTNCGOJ3Cg8fjcYncJj02S6b-BUz6ql-Xo6lD0-dl_J33gV0sCvcpfsCTzbMQoJIIN_4Qoehusf-RhFAeIUCaKEChIVFGEUCvmJOBI-4iNSYC7iPooo4iBXpDLzZG7E5EIHBsV9qSNCIzBhBO4qwUMsNJYZQxFBYaTsdFICFDJVu7YTlcVHyuJuTxZoajwdOwBVIKHsCAeFFQlVDKtKATBFbEQq80CqgSCg3qMGQSf0zZ0Kbio1t6M-RmBlljApnEiDQILAvWH6ccRqZirGAi9thmUtHZthmSXZA2ZICZIoSOAF4DxQNzKMRFD6xVPKJSSThSUbXCjSgOrOlLYiz1HEAMBIgoVnxZAjqCIQGHO6-opaphEBAZ7WDyTJ3DccCr-rz6Rz4OaMWdCBYhIPB7d21bDy_LDCo4wZfdkIqYLNkH4BeDm35HVnlU1xoF_Wr1sQVe6NVJ2haqQdVkzTvvW_eUcHOao39SiRawP1-wjLrt_r7bq9niBQRya_hxcBhHtyqqtWm6vPPhgaG7s_ee-OPUFsYZZmHz253fwvxFo99mIHvrpQPEFiKBSXKnKLZVyDcd6AR6krlyaPP4nKfpFgLFdPu0d_d0_zJUTO3lJfb1BUIG8fBxGC7BoMOcvlqiqCnjxrnTFD30GhwZyz-mrJeWu29fpD6-3O3u5ue2O93Vg7eLPaam4cLjwtGttF41nReFE0V_Z2l_d_rsK19X2naHwpGutFswHC4fs1SG9vfWy9-3HweaW99Hz_1db-5leZtfSt3fhUNLeLxcVicblobhWLL_cXNi9YUyPRZGXUNi-BsWsewcwOsJtgN0s4rUJvQwLq0ipOEpynPGWM0Mx3EgfT3PdYhv0sy_KEEO5U5f7DPKjm_kWr_-Hsw-olazCrZgHNaAZjHh_jGZam8nRcJ4GQHKIWTC5bQvMTz-mTfuKTe_DKP7Bx1TotH0Y90XvN6q8_mq9eh6FPPb2h2sUvTgkXhg |
| linkProvider | ISSN International Centre |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=%E6%97%A5%E6%9C%AC%E4%BA%BA%E9%A3%9F%E9%81%93%E7%99%8C%E6%82%A3%E8%80%85%E3%81%AB%E3%81%8A%E3%81%91%E3%82%8B%E4%BA%88%E5%BE%8C%E4%BA%88%E6%B8%AC%E3%81%AE%E3%81%9F%E3%82%81%E3%81%AE%E8%A1%93%E5%BE%8C%E9%AA%A8%E6%A0%BC%E7%AD%8B%E9%87%8F%E5%96%AA%E5%A4%B1%E3%81%AE%E8%87%B3%E9%81%A9%E3%82%AB%E3%83%83%E3%83%88%E3%82%AA%E3%83%95%E5%80%A4&rft.jtitle=%E6%97%A5%E6%9C%AC%E3%81%8C%E3%82%93%E3%83%BB%E3%83%AA%E3%83%B3%E3%83%91%E6%B5%AE%E8%85%AB%E7%90%86%E5%AD%A6%E7%99%82%E6%B3%95%E5%AD%A6%E4%BC%9A%E8%AA%8C&rft.au=%E5%B0%8F%E6%9E%97%2C+%E5%A4%A7%E7%A5%90&rft.au=%E6%A0%81%E6%B2%A2%2C+%E6%8B%93%E8%87%A3&rft.au=%E8%BE%BB%2C+%E5%93%B2%E4%B9%9F&rft.au=%E4%B8%AD%E5%B6%8B%2C+%E5%BA%B7%E8%A8%98&rft.date=2024&rft.pub=%E4%B8%80%E8%88%AC%E7%A4%BE%E5%9B%A3%E6%B3%95%E4%BA%BA+%E6%97%A5%E6%9C%AC%E3%81%8C%E3%82%93%E3%83%BB%E3%83%AA%E3%83%B3%E3%83%91%E6%B5%AE%E8%85%AB%E7%90%86%E5%AD%A6%E7%99%82%E6%B3%95%E5%AD%A6%E4%BC%9A&rft.eissn=2759-0984&rft.volume=2&rft.spage=22&rft.epage=31&rft_id=info:doi/10.60366%2Fjjptol.JJPTOL-R5-A10&rft.externalDocID=article_jjptol_2_0_2_JJPTOL_R5_A10_article_char_ja |