Evaluation of diagnostic and prognostic significance of Ki-67 index in pulmonary carcinoid tumours.

BACKGROUND: Pulmonary carcinoid (PC) tumours are classified as either typical (TC) or atypical (AC) according to mitotic index (MI) and presence of necrosis. The aim of this study was to analyse the diagnostic and prognostic values of the Ki-67 index in PC. METHODS/PATIENTS: Between January 2001 and March 2015, we evaluated 94 consecutive patients with a confirmed diagnosis of TC (n = 75) or AC (n = 19) at our institution. Diagnostic histology was centrally reviewed by a local expert neuroendocrine pathologist, with assessment of Ki-67, MI, and necrosis. RESULTS: Median patient follow-up was 35 months. Eighty-four patients who underwent curative surgical resection were included in the survival analysis for identification of prognostic factors. Ki-67 index showed high diagnostic accuracy to predict histological subtype when assessed by receiver operator characteristic curves with an area under the curve of 0.923 (95% CI 0.852-0.995, p < 0.001). Multivariate analysis showed that MI, Ki-67 index, and the presence or absence of necrosis were independent prognostic factors for relapse-free survival. Combination of MI, Ki-67, and necrosis led to the classification of patients into four different prognostic groups (very low, low, intermediate, and high risks of relapse). CONCLUSIONS: The current study proposes the incorporation of Ki-67 index in the prognostic classification of PC tumours. Due to the limited number of patients and length of follow-up, the current model needs validation by larger cohort studies. Nevertheless, our results suggest that Ki-67 index and MI have continuous effect on prognosis. Prognostic models incorporating multiple cutoffs of Ki-67 and MI might better predict outcome and inform clinical decisions.

Drinking patterns of black and white men in the west Midlands.

The limited amount of evidence available from mortality statistics, mental hospital in-patient admission rates and community surveys appears to indicate that people of African-Caribbean origin resident in Britain have fewer alcohol-related problems than the white population. However, there are no systematic data on the normal drinking habits of random and representative samples of the black population of Britain, or the true extent of alcohol-related problems in the whole population. A survey of the drinking habits and alcohol-related problems of random samples of 200 black men and 170 white men from the Birmingham and Wolverhampton areas is reported. Black men were much less likely to report regular drinking and to report drinking large amounts of alcohol. They were far less likely to have got drunk in the past year, and scored lower on most items of an Alcohol Problems Scale. Age was the only demographic variable associated with drinking levels in both groups, and the link was more tenuous in the black than the white group. There were no generational differences found. Religious observance and belonging to a Pentecostal Church were found to be major differences between the black and white groups, and strongly associated with moderation in relation to alcohol.