Classification of gastric neuroendocrine tumors and its clinicopathologic significance

AIMS To study the pathologic classification of gastric neuroendocrine tumors and its clinicopathologic significance. METHODS Paraffin embedded sections of 52 gastric neuroendocrine tumors including 42 carcinoid tumors, and 10 cases of neuroendocrine carcinoma from 326 patients who underwent resection of stomach carcinomas were studied by immunohistochemical methods including 10 endocrine markers or hormones antibodies and endocrine cells in gastric neuroendocrine tumors and extratumoral mucosa were observed under electromicroscope. RESULTS The 52 gastric neuroendocrine tumors were divided into three types: ① Gastrin dependent type of carcinoid (26 cases) accompanied by chronic atrophic gastritis (CAG) and tumor extension limited to the mucosa or submucosa complicated with hypergastrinemia and G cell hyperplasia. This type was consistently preceded by and associated with generalized proliferation of endocrine cells in the extratomoral fundic mucosa. ② Non gastrin dependent type of carcinoids (16 cases) associated with neither CAG nor hypergastrinemia. This type was more aggressive; and ③ Neuroendocrie carcinomas (10 cases), which are highly aggressive tumors. CONCLUSIONS A correct identification of different types of gastric endocrine tumors has major implications for the treatment and prognosis of the patients.

Evaluation of efficacy and safety of sunitinib regimen in 22 patients with metastatic renal cell carcinoma： at least 12-month follow-up

Background Sunitinib has been proved an effective new option for treatment of metastatic renal cell carcinoma （mRCC）. Analysis of clinical data of 22 patients, who were exposed to sunitinib for at least 1 year, was conducted to evaluate the long-term efficacy and safety of sunitinib for the treatment of mRCC. Methods A total of 54 patients with mRCC were treated with sunitinib malate, 50 mg/d orally, on a 4-weeks-on and 2-weeks-off dosing schedule in Peking University First Hospital. Treatment continued until disease progression, unacceptable adverse events （AEs）, or death. Among them, 22 patients continued treatment for at least I year. The clinical data of these 22 patients were prospectively collected for analysis. AEs were assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events, Version 3.0. Tumor response was evaluated in accordance with the Response Evaluation Criteria in Solid Tumors. Results Median progression-free survival was 19.5 months until last follow-up. The best efficacy results achieved were complete response, partial response, and stable disease for 2, 9, and 11 patients, respectively. Objective response rate was 50%. The most common AEs were hand-foot syndrome （95%） and hypertension （91%）. Other common AEs were thyroid-stimulating hormone elevation （82%）, platelet decrease （77%）, and loss of appetite （77%）. Only one patient withdrew from treatment for cardiac infarction. Another nine patients experienced dose modifications or short-term suspensions. Conclusion Long-term exposure to sunitinib malate showed encouraging efficacy in the treatment of mRCC. At the same time, the tolerability was good.

Marginal living donor in kidney transplantation： experience in a Chinese single center

Background Living donor kidney transplantation is becoming popular in China, whereas, in clinical situations, some kidney donors may be sub-optimal, namely marginal living donor. The present study aimed to evaluate the safety and efficacy of marginal living donor kidney transplantation in a Chinese single center. Methods Between January 2001 and December 2009, 888 kidney transplantations were performed in our center; 149 were living donor kidney transplantations. The living donors and recipients were followed up regularly after the operation. Of the living donors, 30 donors were marginal, who were older than 60 years or suffered from kidney anomaly or some benign diseases. Among the non-marginal living kidney transplantations, 58 donors and recipients had complete peri- operative and follow-up data. We compared the marginal and non-marginal living donor kidney transplantations with regard to donor age, follow-up period, donor＇s serum creatinine at the last follow-up, recipient＇s serum creatinine at the last follow-up, and graft survival at the last follow-up. Results The mean age of donors in the marginal and non-marginal living donors were （55＋9） （37-66） and （43＋12） （30- 59） years. The mean follow-up times of the marginal and non-marginal groups were （26.4＋13.4） months and （28.8＋14.8） months. The donor and recipient serum creatinine levels at the last follow-up were （1.16＋0.20） mg/dl and （1.30＋0.24） mg/dl in the marginal group, and （1.12＋0.32） mg/dl and （1.34＋0.32） mg/dl in the non-marginal group. Three recipients in the marginal group and five recipients in the non-marginal group had acute rejection episodes during the first year. Actuarial 3-year graft survival was 96.7% in the marginal group and 100% in the non-marginal group. No significant differences were detected between the two groups with regard to these data. Conclusion Utilization of highly selective marginal living donors can be a safe, feasible, and effective way for the treatment of patients with end stage renal disease.