scholarly journals Extensive Dissection at No. 12 Station During D2 Lymphadenectomy Improves Survival for Advanced Lower-Third Gastric Cancer: A Retrospective Study From a Single Center in Southern China

2022 ◽  
Vol 11 ◽  
Author(s):  
Weigang Dai ◽  
Er-Tao Zhai ◽  
Jianhui Chen ◽  
Zhihui Chen ◽  
Risheng Zhao ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cox Regression ◽  
Southern China ◽  
Progression Free Survival ◽  
Control Group ◽  
D2 Lymphadenectomy ◽  
Term Survival ◽  
Cox Regression Analysis ◽  
Group A

BackgroundD2 lymphadenectomy including No. 12a dissection has been accepted as a standard surgical management of advanced lower-third gastric cancer (GC). The necessity of extensive No. 12 nodes (No. 12a, 12b, and 12p) dissection remains controversial. This study aims to explore its impact on long-term survival for resectable GC.MethodsFrom 2009 to 2016, 353 advanced lower-third GC patients undergoing at least D2 lymphadenectomy during a radical surgery were included, with 179 patients receiving No. 12a, 12b, and 12p dissection as study group. A total of 174 patients with No. 12a dissection were employed as control group. Surgical and long-term outcomes including 90-day complications incidence, therapeutic value index (TVI), 3-year progression-free survival (PFS), and 5-year overall survival (OS) were compared between both groups.ResultsNo. 12 lymph node metastasis was observed in 20 (5.7%) patients, with 10 cases in each group (5.6% vs. 5.7%, p = 0.948). The metastatic rates at No. 12a, 12b, and 12p were 5.7%, 2.2%, and 1.7%, respectively. The incidence of 90-day complications was identical between both groups. Extensive No. 12 dissection was associated with increased TVI at No. 12 station (3.9 vs. 0.6), prolonged 3-year PFS rate (67.0% vs. 55.9%, p = 0.045) and 5-year OS rate (66.2% vs. 54.0%, p = 0.027). The further Cox-regression analysis showed that the 12abp dissection was an independent prognostic factor of improved survival (p = 0.026).ConclusionAdding No. 12b and 12p lymph nodes to D2 lymphadenectomy might be effective in surgical treatment of advanced lower-third GC and improve oncological outcomes compared with No. 12a-based D2 lymphadenectomy.

scholarly journals Application value of nomogram and prognostic factors of gastric cancer patients who underwent D2 radical lymphadenectomy

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Guang-Chuan Mu ◽  
Yuan Huang ◽  
Zhi-Ming Liu ◽  
Xiang-Hua Wu ◽  
Xin-Gan Qin ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Regression Analysis ◽  
Prognostic Factors ◽  
Cancer Patients ◽  
Cox Regression ◽  
Term Survival ◽  
Long Term Survival ◽  
Cox Regression Analysis ◽  
Gastric Cancer Patients

Abstract Background The aim of this study was to explore the prognostic factors and establish a nomogram to predict the long-term survival of gastric cancer patients. Methods The clinicopathological data of 421 gastric cancer patients, who were treated with radical D2 lymphadenectomy by the same surgical team between January 2009 and March 2017, were collected. The analysis of long-term survival was performed using Cox regression analysis. Based on the multivariate analysis results, a prognostic nomogram was formulated to predict the 5-year survival rate probability. Results In the present study, the total overall 3-year and 5-year survival rates were 58.7 and 45.8%, respectively. The results of the univariate Cox regression analysis revealed that tumor staging, tumor location, Borrmann type, the number of lymph nodes dissected, the number of lymph node metastases, positive lymph nodes ratio, lymphocyte count, serum albumin, CEA, CA153, CA199, BMI, tumor size, nerve invasion, and vascular invasion were prognostic factors for gastric cancer (all, P < 0.05). However, merely tumor staging, tumor location, positive lymph node ratio, CA199, BMI, tumor size, nerve invasion, and vascular invasion were independent risk factors, based on the results of the multivariate Cox regression analysis (all, P < 0.05). The nomogram based on eight independent prognostic factors revealed a well-degree of differentiation with a concordance index of 0.76 (95% CI: 0.72–0.79, P < 0.001), which was better than the AJCC-7 staging system (concordance index = 0.68). Conclusion The present study established a nomogram based on eight independent prognostic factors to predict long-term survival in gastric cancer patients. The nomogram would be beneficial for more accurately predicting the prognosis of gastric cancer, and provide important basis for making individualized treatment plans following surgery.

scholarly journals Laparoscopic Gastrectomy Plus D2 Lymphadenectomy is as Effective as Open Surgery in Terms of Long-Term Survival: A Single-Institution Study on Gastric Cancer.

2020 ◽  
Author(s):  
Yawei Wang ◽  
Tailai An ◽  
Yan Wang ◽  
Wang Wu ◽  
Xiaofang Lu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Laparoscopic Gastrectomy ◽  
Open Surgery ◽  
Locally Advanced ◽  
Open Gastrectomy ◽  
D2 Lymphadenectomy ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Cox Regression Analysis

Abstract Background: Laparoscopic surgery has been widely accepted to treat early-stage gastric cancer. However, it is still controversial to perform laparoscopic gastrectomy plus D2 lymphadenectomy for locally advanced gastric cancer. We performed the present study to compare the long-term outcomes of patients after laparoscopic or open gastrectomy plus D2 lymphadenectomy . Methods: The clinicopathological data of 182 gastric cancer patients receiving gastrectomy plus D2 lymphadenectomy between January 2011 and December 2015 at Shenzhen Traditional Chinese Medicine Hospital were retrospectively retrieved. The overall survival (OS) and disease-free survival (DFS) of these 182 patients were compared.Results: On the whole, OS (P=0.789) and DFS (P=0.672) of patients receiving laparoscopic gastrectomy plus D2 lymphadenectomy were not significantly different from those of patients receiving open surgery. For stage I patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P=0.573) and DFS (P=0.157). Similarly, for stage II patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P=0.567) and DFS (P=0.830). For stage III patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P=0.773) and DFS (P=0.404). Laparoscopic or open gastrectomy plus D2 lymphadenectomy was not proven by Cox regression analysis to be an independent prognostic factor for OS and DFS.Conclusions: For patients with gastric cancer, laparoscopic gastrectomy plus D2 lymphadenectomy was not inferior to open surgery in terms of long-term outcomes.

Full Dose of Lenalidomide for 12 Months Followed by a Lower Maintenance Dose Improves Progression-Free Survival in Patients with Relapsed/Refractory Multiple Myeloma.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2874-2874 ◽  
Author(s):  
Meletios A Dimopoulos ◽  
Mohamad Hussein ◽  
Arlene S. Swern ◽  
Donna Weber
Keyword(s):  
Dose Reduction ◽  
Cox Regression ◽  
Progression Free Survival ◽  
Duration Of Treatment ◽  
Cox Regression Analysis ◽  
Full Dose ◽  
Group A ◽  
Group B ◽  
Dose Reductions

Abstract Abstract 2874 Poster Board II-850 Background: Lenalidomide (len) is an oral immunomodulatory agent which is active in patients (pts) with multiple myeloma (MM). Two pivotal phase III studies in pts with relapsed/refractory MM (MM-009 and MM-010) demonstrated significant improvements in time to progression (TTP) and overall survival (OS) in those receiving len + dexamethasone (dex) compared to pts receiving placebo + dexamethasone. The aim of this analysis is to evaluate the effect of lenalidomide dose adjustments on patient outcomes from the MM-009/010 studies in order to determine an optimal long-term treatment strategy. Methods: Data up to the cut-off date of July 2008 were included in this analysis. All pts began lenalidomide at 25 mg daily for 21 days of each 28-day cycle. As previously described a protocol sanctioned dose reduction was only for an adverse event (AE). All pts received the same dose of dex. The impact of lenalidomide dose reduction, either before or after 12 months of therapy vs no dose reduction, on response and progression-free survival (PFS) was evaluated by performing a landmark analysis including only pts who had not progressed and were still on lenalidomide at 12 months . Pts were categorized based on their lenalidomide dose as follows: Group A (dose reduced from 25 mg daily therapy prior to 12 months. Group B (dose reduced from 25 mg daily therapy after 12 months), and Group C (no dose reduction during the study period). To control for possible biases in the comparison of these groups, only pts who were progression free and still receiving lenalidomide treatment at 12 months were included in the analysis. To determine if underlying factors, in addition to the reduction in dose, influenced PFS in these patient cohorts, baseline patient characteristics and laboratory values at baseline and 12 months were assessed with Cox regression analysis using PFS. Each covariate was evaluated by itself and all covariates with a p-value <0.25 were included in a multivariate model and all possible regression models were analyzed to select the best subset of covariates Results: Of the 116 pts who were still receiving lenalidomide and that had not progressed after 12 months, 39 (34%) had a dose reduction prior to 12 months (Group A), 25 (22%) had a dose reduction after 12 months (Group B), and 52 (45%) had no dose reduction at any time (Group C). Pts who were treated with lenalidomide 25 mg daily for at least 12 months and subsequently had dose reductions (Group B) demonstrated significantly longer PFS (median PFS not yet reached at median follow-up of 48 months) compared to pts who experienced a dose reduction prior to completing 12 months of therapy at 25 mg daily (Group A, median PFS 28.0 months, p= 0.007) or pts who never had a dose reduction (Group C, median PFS 36.8 months, p=0.039). Similarly, pts in Group B had longer median duration of treatment (44.4 months) compared to Group A (23.5 months) or Group C (29.7 months). Among pts who experienced a dose reduction, there was a similar rate of dose reductions due to AEs in each group (Group A – 92.3%, Group B – 88.0%). However, among all pts a higher rate of neutropenia (Group A – 71.8%, Group B – 76.0% Group C – 44.2%) and thrombocytopenia (Group A – 38.5%, Group B – 24.0%, Group C – 13.5%) was observed in pts with a dose reduction before or after 12 months. In the Cox regression analysis using PFS as an endpoint, pts reducing their dose after 12 months (Group B), had a 53% lower risk of progression or death compared to Groups A and C. A significantly higher proportion of pts in Group B exhibited a poorer ECOG performance status (PS) (79.2%, PS ≥ 1) vs 48.8%, PS ≥ 1) for Group A and C p < 0.01) Despite this difference, the significant improvement in PFS in Group B pts compared to other patient groups was maintained. Conclusions: This analysis suggests that pts responding and maintained on a full dose of lenalidomide (25 mg daily for 21 days of a 28-day cycle) for the first 12 months of therapy benefit from subsequent dose reductions. This was demonstrated by a statistically significant improvement in PFS in pts receiving dose reduction only after completing 12 months of full dose therapy. These data support the hypothesis that a lower maintenance dose of lenalidomide after 12 months of full dose therapy improves long-term patient tolerability and extends the duration of treatment, thereby improving long-term outcomes. Further studies to define the role of immunologic modulation and maintenance therapy are in progress. Disclosures: Dimopoulos: Celgene Corporation: Honoraria. Hussein:Celgene Corporation: Employment. Swern:Celgene: Employment. Weber:Celgene Corporation: Honoraria, Research Funding.

scholarly journals Laparoscopic gastrectomy plus D2 lymphadenectomy is as effective as open surgery in terms of long-term survival: a single-institution study on gastric cancer

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yawei Wang ◽  
Yan Wang ◽  
Wang Wu ◽  
Xiaofang Lu ◽  
Tailai An ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Laparoscopic Gastrectomy ◽  
Open Surgery ◽  
Locally Advanced ◽  
Open Gastrectomy ◽  
D2 Lymphadenectomy ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Cox Regression Analysis

Abstract Background Laparoscopic surgery has been widely accepted to treat early-stage gastric cancer. However, it is still controversial to perform laparoscopic gastrectomy plus D2 lymphadenectomy for locally advanced gastric cancer. We performed the present study to compare the long-term outcomes of patients after laparoscopic or open gastrectomy plus D2 lymphadenectomy. Methods The clinicopathological data of 182 gastric cancer patients receiving gastrectomy plus D2 lymphadenectomy between January 2011 and December 2015 at Shenzhen Traditional Chinese Medicine Hospital were retrospectively retrieved. The overall survival (OS) and disease-free survival (DFS) of these 182 patients were compared. Then, the prognostic significance of positive lymph node ratio (LNR) was assessed. Results As a whole, OS (P = 0.789) and DFS (P = 0.672) of patients receiving laparoscopic gastrectomy plus D2 lymphadenectomy were not significantly different from those of patients receiving open surgery. For stage I patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P = 0.573) and DFS (P = 0.157). Similarly, for stage II patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P = 0.567) and DFS (P = 0.830). For stage III patients, laparoscopic gastrectomy plus D2 lymphadenectomy was not significantly different from open surgery in terms of OS (P = 0.773) and DFS (P = 0.404). Laparoscopic or open gastrectomy plus D2 lymphadenectomy was not proven by Cox regression analysis to be an independent prognostic factor for OS and DFS. High LNR was significantly associated with worse OS (P < 0.001) and DFS (P < 0.001). Surgical type did not significantly affect prognosis of patients with low LNR or survival of patients with high LNR. Conclusions For patients with gastric cancer, laparoscopic gastrectomy plus D2 lymphadenectomy was not inferior to open surgery in terms of long-term outcomes. LNR is a useful prognostic marker for GC patients.

scholarly journals Impact of the introduction of formal D2 lymphadenectomy for gastric cancer in a Western setting

2021 ◽  
Vol 64 (2) ◽  
Author(s):  
Alexandre Brind’Amour ◽  
Jean-Pierre Gagné ◽  
Jean-Charles Hogue ◽  
Éric Poirier
Keyword(s):  
Gastric Cancer ◽  
Lymph Nodes ◽  
Gastric Resection ◽  
Training Group ◽  
Technical Training ◽  
Perioperative Outcomes ◽  
D2 Lymphadenectomy ◽  
Term Survival ◽  
Long Term Survival

Background: Two members from an academic tertiary hospital went to the National Cancer Institute in Tokyo, Japan, to learn how to perform an adequate D2 lymphadenectomy and to then introduce this technique in the surgical care of patients undergoing surgery for gastric cancer at a Western hospital. We aimed to compare the perioperative outcomes and long-term survival of Western patients who underwent gastric resection, performed by these 2 surgeons, before and after the surgeons’ shortcourse technical training in Japan. Methods: We conducted a retrospective comparative study of all patients (n = 27 before training and n = 79 after training) who underwent gastric resection for cancer by the same 2 surgeons between September 2007 and December 2017 at the Centre Hospitalier Universitaire de Québec — Université Laval (Québec, Canada). We collected data on patient demographic, clinical, surgical, pathological and treatment characteristics, as well as long-term survival and complications. Results: In the post-training group, the number of sampled lymph nodes was higher (median 33 v. 14, p < 0.0001), but this increase did not result in a higher number of histologically positive lymph nodes (p = 0.35). The rate of complications was lower in the post-training group (15.2% v. 48.2%, p = 0.002). The hospital stay was shorter in the post-training group (11 [standard deviation (SD) 7] v. 23 [SD 45] d, p = 0.03). The median survival was higher in the post-training group (47 v. 29 mo, p = 0.03). Conclusion: These results suggest that a short-course technical training in D2 lymphadenectomy, completed in Japan, improved lymph node sampling, decreased postoperative complications and improved survival of patients undergoing surgery for gastric cancer in a Western setting.

scholarly journals Association of masseter area and radiodensity with three-month survival after proximal anterior circulation occlusion

2020 ◽  
Vol 13 (1) ◽  
pp. 25-29 ◽  
Author(s):  
Iisa Lindström ◽  
Sara Protto ◽  
Niina Khan ◽  
Jussi Hernesniemi ◽  
Niko Sillanpää ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cox Regression ◽  
Multivariable Logistic Regression Analysis ◽  
Anterior Circulation ◽  
Term Survival ◽  
Cox Regression Analysis ◽  
Kaplan Meier

BackgroundMasseter area (MA), a surrogate for sarcopenia, appears to be useful when estimating postoperative survival, but there is lack of consensus regarding the potential predictive value of sarcopenia in acute ischemic stroke (AIS) patients. We hypothesized that MA and density (MD) evaluated from pre-interventional CT angiography scans predict postinterventional survival in patients undergoing mechanical thrombectomy (MT).Materials and methods312 patients treated with MT for acute occlusions of the internal carotid artery (ICA) or the M1 segment of the middle cerebral artery (M1-MCA) between 2013 and 2018. Median follow-up was 27.4 months (range 0–70.4). Binary logistic (alive at 3 months, OR <1) and Cox regression analyses were used to study the effect of MA and MD averages (MAavg and MDavg) on survival.ResultsIn Kaplan–Meier analysis, there was a significant inverse relationship with both MDavg and MAavg and mortality (MDavg P<0.001, MAavg P=0.002). Long-term mortality was 19.6% (n=61) and 3-month mortality 12.2% (n=38). In multivariable logistic regression analysis at 3 months, per 1-SD increase MDavg (OR 0.61, 95% CI 0.41 to 0.92, P=0.018:) and MAavg (OR 0.57, 95% CI 0.35 to 0.91, P=0.019) were the independent predictors associated with lower mortality. In Cox regression analysis, MDavg and MAavg were not associated with long-term survival.ConclusionsIn acute ischemic stroke patients, MDavg and MAavg are independent predictors of 3-month survival after MT of the ICA or M1-MCA. A 1-SD increase in MDavg and MAavg was associated with a 39%–43% decrease in the probability of death during the first 3 months after MT.

Safety and Feasibility of Thoracoscopic Lung Resection for Non-Small-Cell Lung Cancer in Octogenarians

2020 ◽  
pp. 155698452097162
Author(s):  
Xiaoying Lou ◽  
Andrew Sanders ◽  
Kaustubh Wagh ◽  
Jose N. Binongo ◽  
Manu Sancheti ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Cox Regression ◽  
Lung Resection ◽  
Small Cell ◽  
Small Cell Lung ◽  
Preoperative Risk ◽  
Term Survival ◽  
Long Term Survival ◽  
Cox Regression Analysis

Objective Octogenarians comprise an increasing proportion of patients presenting with non-small-cell lung cancer (NSCLC). This study examines postoperative morbidity and mortality, and long-term survival in octogenarians undergoing thoracoscopic anatomic lung resection for NSCLC, compared with younger cohorts. Methods We conducted a retrospective review of our institutional Society of Thoracic Surgeons General Thoracic Surgery Database of all patients ≥60 years old undergoing elective lobectomy or segmentectomy for pathologic stage I, II, and IIIA NSCLC between 2009 and 2018. Results were compared between octogenarians ( n = 71) to 2 younger cohorts of 60- to 69-year-olds ( n = 359) and 70- to 79-year-olds ( n = 308). Long-term survival among octogenarians was graphically summarized using the Kaplan–Meier method. Cox regression analysis was used to identify preoperative risk factors for mortality. Results A greater proportion of octogenarians required intensive care unit admission and discharge to extended-care facilities; however, postoperative length of stay was similar between groups. Among postoperative complications, arrhythmia and renal failure were more likely in the older cohort. Compared to the youngest cohort, in-hospital and 30-day mortality were highest among octogenarians. Overall survival among octogenarians at 1, 3, and 5 years was 87.3%, 61.8%, and 50.5%, respectively. On multivariable Cox regression analysis of baseline demographic variables, presence of stroke (hazard ratio [HR] = 28.5, 95% confidence interval [CI]: 6.1 to 132.7, P < 0.001) and coronary artery disease (HR = 2.5, 95% CI: 1.2 to 5.3, P = 0.02) were significant predictors of overall mortality among octogenarians. Conclusions Thoracoscopic resection can be performed with favorable early postoperative outcomes among octogenarians. Long-term survival, although comparable to their healthy peers, is worse than those of younger cohorts. Further study into preoperative risk stratification and alternative therapies among octogenarians is needed.

scholarly journals Human Nuclear Receptors (NRs) Genes have Prognostic Significance in Hepatocellular Carcinoma Patients

2020 ◽  
Author(s):  
Guangtao Sun ◽  
Kejian Sun ◽  
Chao Shen
Keyword(s):  
Hepatocellular Carcinoma ◽  
Nuclear Receptors ◽  
Risk Score ◽  
Prognostic Model ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Prognostic Signature ◽  
Term Survival ◽  
Cox Regression Analysis

Abstract Background: Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related mortality in the world. Human nuclear receptors (NRs) have been identified to closely related to various cancer. However, the prognostic significance of NRs on HCC patients has not been studied in detail.Method: We downloaded the mRNA profiles and clinical information of 371 HCC patients from TCGA database and analyzed the expression of 48 NRs. The consensus clustering analysis with the mRNA levels of 48 NRs was performed by the "ConsensusClusterPlus". The Univariate cox regression analysis was performed to predict the prognostic significance of NRs on HCC. The risk score was calculated by the prognostic model constructed based on eight optimal NRs which were selected. Then Multivariate Cox regression analysis was performed to determine whether the risk score is an independent prognostic signature. Finally, the nomogram based on multiple independent prognostic factors including risk score and TNM Stage was used to predict the long-term survival of HCC patients.Results: NRs could effectively separate HCC samples with different prognosis. The prognostic model constructed based on the eight optimal NRs (NR1H3, ESR1, NR1I2, NR2C1, NR6A1, PPARD, PPARG and VDR) could effectively predict the prognosis of HCC patients as an independent prognostic signature. Moreover, the nomogram was constructed based on multiple independent prognostic factors including risk score and TNM Stage and could better predict the long-term survival for 3- and 5-year of HCC patients.Conclusion: Our results provided novel evidences that NRs could act as the potential prognostic signatures for HCC patients.

Histology, not Lymph Node Involvement, Predicts Long-Term Survival in Bronchopulmonary Carcinoids

2011 ◽  
Vol 77 (12) ◽  
pp. 1669-1674 ◽  
Author(s):  
Rebecca Johnson ◽  
Steven Trocha ◽  
Marc Mclawhorn ◽  
Mitchell Worley ◽  
Grace Wheeler ◽  
...  
Keyword(s):  
Lymph Node ◽  
Cox Regression ◽  
Lymph Node Involvement ◽  
Term Survival ◽  
Pulmonary Carcinoid ◽  
Long Term Survival ◽  
Cox Regression Analysis ◽  
Node Involvement ◽  
Bronchopulmonary Carcinoid

Recently, the incidence of bronchopulmonary carcinoid has increased substantially, whereas survival associated with both subtypes has declined. We reviewed our experience with bronchopulmonary carcinoid to identify factors associated with long-term survival. We reviewed our cancer registry from 1985 to 2009 for all patients undergoing surgical resection for bronchopulmonary carcinoid. Cox regression analysis was used to evaluate prognostic factors. Fifty-two patients met criteria for inclusion. Forty-three patients (82%) presented with typical histology. The likelihood of lymph node metastasis was similar for patients with typical histology and patients with atypical histology. For patients with typical histology, the 5-year survival rates with and without lymph node metastases were 100 per cent and 97 per cent, respectively ( P = 0.420). The overall survival rate for patients with typical histology (97% at 5 years; 72% at 10 years) was significantly better than for patients with atypical histology (35% at 5 years, 0% at 10 years) ( P < 0.001). Univariate and multivariate analyses demonstrated that long-term survival was associated with histology but not lymph node involvement (hazards ratio = 14.6, 95% confidence interval: 1.7, 125.2). Our data suggests that long-term survival is associated with histology, not lymph node involvement. We found tumor histology to be the strongest predictor of long-term survival in patients with pulmonary carcinoid tumors.

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