Clinical Analysis of 65 Multiple Primary Cancer Cases

BACKGROUND: Multiple primary cancer (MPC), which is defined as the multiple occurrence of malignant neoplasms in the same individual, has been reported as gradually increasing among patients treated for initial cancers. Therefore, there have been many reports about multiple primary cancers, but there is in sufficient information on the incidence or the relative risk. Furthermore, diagnostic access to the early detection of MPC has not been established. The purpose of this report is to present an overview of a clinical analysis of MPC, with attention to above aspects. METHODS: During the 7.6 years from 1990 until August 1997, 6,346 cancer patients were registered at Kang-dong Sacred Heart Hospital, among which were 91 cases (1.43%) of MPC compatible with Warren & Gates' criteria. Among these 91 cases, 65 cases (1.02%) which received surgical treatment are analysed in this report. Medical records were reviewed retrospectively, and data were analyzed for annual incidence, sex, age, the site of the cancer, the time interval between cancers, etiology, etc. RESULTS: The mean age was 60.1 years old. The sex ratio was 1.32:1 (male 37, female 28). Synchronous cancers were present in 28 cases and metachronous cancers in 37 cases. Among index cancers, stomach cancer was the most common (16 cases, 24.6%). In metachronous cancers, the average time duration between the discovery of the index and the additional cancer was 6.6 years. In the 28 synchronous cancers, only 10 cases (35.7%) received a curative resection, but in the 37 metachronous cancers, 18 cases (50%) received a curative resection. CONCLUSIONS: Among the 65 MPCs, multiple primary cancers associated with stomach cancer were most common. The curability of metachronous cancer was higher than that of synchronous cancer. We may carefully infer that synchronous MPCs have a poorer prognosis than metachronous MPCs. Therefore, only knowledge of MPC and efforts for early diagnosis may increase the survival rate for MPC patients. Thus, further prospective study is needed.

Relationship of Renal Implantation Biopsies and Acute Rejection during Immediate Posttransplantation Period / 대한이식학회지

Many factors can be recognized for the acute rejection such as: degree of HLA mismatching, cytokine gene expression, ischemic time, etc. Some authors have suggested the importance of early routine biopsy of renal allograft to predict acute rejection. This prospective study on renal implantation biopsies was performed to evaluate the relationship between the implantation biopsies and the acute rejection during the immediate post-transplantation period. From December 1996 to February 1998 implantation biopsies were performed on 46 renal allografts within 40~60 minutes after vascular anastomosis using tru-cut needle (18G). Two samples were obtained from transplanted kidney in each patient. Serial sections were stained for the light microscopic examination. The slides were evaluated for histologic features such as interstitial cellular infiltration, nephrosclerosis, tubular damage, glomerular neutrophil count (GL-PMN), and peritubular neutrophil count (PTC-PMN). Forty six biopsies were grouped into acute rejection group (R group, n=10) and non-rejection group (N group, n=36) during immediate posttransplantation period (1 month). Acute rejections were confirmed by ultrasonography guided biopsy. Histologic findings were classified according to Banff schema. The statistical analysis was performed by using Chi-Square Test and Spearman Rank Sum Test. During the immediate post-transplantation period, acute rejection developed in 10 cases (21.7%) of which 9 cases were the biopsy-proven rejection. The male to female ratio was 21:25. Recipients were ranged from 22 to 54 years old with a mean age of 38.2+/- 9.1. Original disease of recipient were chronic glomerulonephritis in 15 cases (32.6%), hypertension in 8 cases, diabetes mellitus in 3 cases, RPGN in 2 cases. Fifteen cases (32.6%) were of unknown etiology. The mean number of HLA mismatches was 4.6+/- 0.9 in R group, 4.7+/- 1.2 in N group, and the mean number of HLA-B & DR mismatches was 2.2+/- 0.4 in R group, 2.3+/- 0.7 in N group. The ratio of the living vs. cadaveric donors was 34:12. No statistical difference was observed between two groups in interstitial cellular infiltration, nephrosclerosis and tubular damage. The GL-PMN was 0.6 0.9 in R group, while 0.1 +/- 0.4 in N group. The PTC-PMN was 5.3+/- 3.3 in R group and 0.3+/- 1.1 in N group (p<0.05). The presence of more than five PTC-PMN count was related with the occurrence of acute rejection (p<0.01). In conclusion, the PTC-PMN of renal implantation biopsies is a possible predicting factor for acute rejection in this preliminary report.