Long-term outcome of surgical resection in patients with gastroenteropancreatic neuroendocrine neoplasia: results from a German nation-wide multi-centric registry.

BACKGROUND: Neuroendocrine neoplasia (NEN) are rare and heterogenous tumours. Few data exist on the impact of surgical therapy. MATERIALS AND METHODS: This is a retrospective analysis of prospectively collected data of gastroenteropancreatic NEN in the German NET-Registry (1999-2012). It focuses on patients without distant metastases (limited disease, LD, stage I-IIIB). RESULTS: Data of 2239 patients with NEN were recorded. Median age was 59 years, the gender ratio was 1:1.3 (f:m). A total of 986 patients (44%) had LD, and the 5-year survival rate (5 years) was 77% for all and 90% for patients with LD. A total of 1635 patients (73%) received a surgical therapy (1st to 6th line); the 5 and 10 ysr were 83/65% after and 59/35% without surgery for all patients (p < .001). The resection margins in the LD patients were 76%, 16%, and 3% for R0, R1 and R2, respectively. The 10 ysr was 84%, 59% and 42% for R0, R1 and R2 resections, respectively (p = .021 R0/R1, p < .001 R0/R2). The R0 resection rate was 75% for G1/G2 NET and 67% for G3 NEC. CONCLUSION: The rate of complete tumour resection (R0) in LD is independent of tumour grading, and R0 resection is the key determinant of long-term survival, as demonstrated by the 10 ysr. of 84%. All NEN patients with limited disease should be considered for operation, if possible, as the best 10-year survival is shown after an R0 resection.

Attitude towards organ donation in German medical students.

PURPOSE: It is well known that personal decision making in respect to organ donation is highly dependent on the balance of knowledge, trust, and fear. We wanted to explore the attitude of German medical students towards organ donation and investigate the relationship between knowledge, trust, and fear in this special subgroup. METHODS: We conducted an online survey utilizing (1) the snowball effect of using Facebook groups and advertisement as well as (2) mailing lists of medical faculties in Germany for distribution. RESULTS: We surveyed 1370 medical students. 75.8 % (N = 988) of the participants stated to carry an organ donor card and allowed their organs to be donated. 1.8 % (N = 23) refused donation. 22.5 % (N = 293) did not carry an organ donor card. Analysis of the "decided" versus the "undecided" group revealed substantial differences regarding transplantation knowledge (mean knowledge score of 4.23 vs. 3.81; P < 0.001), trust in (mean trust score 4.11 vs. 3.39; P < 0.001), and fear of (mean fear score 1.63 vs. 2.22; P < 0.001) organ donation. 45.9 % of the undecided group (N = 134) opted for accessing additional information material. After reading the info material, 22.7 % (N = 29) stated their willingness to sign a donor card, whereas 76.6 % (N = 98) still could not reach a decision. CONCLUSIONS: The willingness to potentially act as organ donor was related to the pre-existent knowledge, trust, and fear. Access to information material did promote the decision towards organ donation in a group of previously undecided medical students. This advocates initiating information campaigns even in population groups with strong medical background.

What factors influence 10-year survival after curative resection of a colorectal carcinoma?

BACKGROUND: Ten-year survival rates are only rarely reported and frequently include a large proportion of censored data-that is, most of the patients have not survived the 10 years. We therefore selected patients in a prospectively maintained, hospital-based tumor register who had been operated on for colorectal carcinoma (CRC) more than 10 years earlier and who were classified as long-term survivors. METHODS: For 589 consecutive CRC patients who underwent R0 resection in the period 1990-1998, we compared prognosis-relevant characteristics and calculated the survival rate as a function of age, sex, location of the tumor, general state of health, urgency of the operation, and pT and pN class. All patients were observed until their death or until at least 10 years after resection. Patients who died of other causes were censored. Overall survival and relative survival (the latter based on tumor-related death) were assessed. RESULTS: The 10-year survivors were more often female (not significant), younger (p < 0.001), in good general health (p < 0.001), had undergone elective resection (p < 0.001), and had early-stage tumors (p < 0.001). In the univariate analysis emergency operation, impaired general health, invasion beyond the muscularis propria, and lymph-node metastasis were found to reduce relative survival. In the multivariate analysis, location, emergency resection, pT, and pN were found to be statistically independent risk factors. CONCLUSIONS: Long-term freedom from tumor recurrence, like-short-term, is influenced largely by factors that are beneficially influenced by early recognition. The patient's age at resection is immaterial.

Effectiveness of Organ Donation Information Campaigns in Germany: A Facebook Based Online Survey.

BACKGROUND: The German transplantation system is in a crisis due to a lack of donor organs. Information campaigns are one of the main approaches to increase organ donation rates. Since 2012, German health insurance funds are obliged by law to inform their members about organ donation. We raised the hypothesis: The willingness to sign a donor card rises due to the subsequent increase of specific knowledge by receiving the information material of the health insurance funds. OBJECTIVE: The objective of the study was to assess the influence of information campaigns on the specific knowledge and the willingness to donate organs. METHODS: We conducted an online survey based on recruitment via Facebook groups, advertisements using the snowball effect, and on mailing lists of medical faculties in Germany. Besides the demographic data, the willingness to hold an organ donor card was investigated. Specific knowledge regarding transplantation was explored using five factual questions resulting in a specific knowledge score. RESULTS: We recruited a total of 2484 participants, of which 32.7% (300/917) had received information material. Mean age was 29.9 (SD 11.0, median 26.0). There were 65.81% (1594/2422) of the participants that were female. The mean knowledge score was 3.28 of a possible 5.00 (SD 1.1, median 3.0). Holding a donor card was associated with specific knowledge (P<.001), but not with the general education level (P=.155). Receiving information material was related to holding a donor card (P<.001), but not to a relevant increase in specific knowledge (difference in mean knowledge score 3.20 to 3.48, P=.006). The specific knowledge score and the percentage of organ donor card holders showed a linear association (P<.001). CONCLUSIONS: The information campaign was not associated with a relevant increase in specific knowledge, but with an increased rate in organ donor card holders. This effect is most likely related to the feeling of being informed, together with an easy access to the organ donor card.

High KIT and PDGFRA are associated with shorter patients survival in gastroenteropancreatic neuroendocrine tumors, but mutations are a rare event.

PURPOSE: (1) To test whether in genomewide expression profiling differentially expressed genes were also distinct on the protein level including KIT and PDGFRA (2) to correlate the expression with clinicopathological parameters (3) to identify activating mutations that might be eligible for tyrosine kinase inhibitor therapy by mutational analysis of tumors with high expression. METHODS: Gastroenteropancreatic neuroendocrine tumors (GEP NETs) from 119 patients were analyzed for protein expression of ten biomarkers. Mutational analysis of KIT (exon 9, 13, 11 and 17) and PDGFRA (exons 12 and 18) was performed on those samples that showed high protein expression. RESULTS: High KIT expression was observed in 13% of all specimens, PDGFRA in 33%, CK19 in 26%, CK7 in 2%, CK20 in 5%, S100 in 6%, CD56 in 25%, Chromogranin in 55%, and Synapthophysin in 80%. High expression of KIT and PDGFRA was significantly correlated with shorter disease-specific survival (P = 0.003, P = 0.018, respectively). In multivariate analysis expression of PDGFRA, radicality of surgical treatment and WHO grading influenced disease-specific 10-year survival independently (P = 0.032, P = 0.001 and P = 0.008, respectively). Mutational analysis of highly expressed specimens (n = 51) reveals a novel mutation of KIT in exon 11 (K558N_V559insP) in a well-differentiated metastatic pancreatic neuroendocrine tumor. CONCLUSIONS: High expression of KIT and PDGFRA was significantly correlated with shorter patients survival and could serve as prognostic marker. Mutations of the KIT gene might open new avenues for tyrosine kinase inhibitor therapy in a subset of patients with advanced pancreatic neuroendocrine tumors.