Survivals of patients with pancreatic neuroendocrine carcinomas: An in-depth analysis by the American Joint Committee on Cancer 8th tumor-node-metastasis staging manual.

Recently, the American Joint Committee on Cancer (AJCC) 8th staging manual stipulated the World Health Organization (WHO) G3 pancreatic neuroendocrine carcinomas (p-NECs) should all be classified by the system for pancreatic exocrine adenocarcinomas, which had ignored the heterogeneity of G3 p-NECs. We focused on demonstrating whether the heterogeneous subgroups of G3 p-NECs would influence the accurate application of AJCC 8th staging systems.G3 p-NECs were divided into well-differentiated and poorly-differentiated subgroups, whose clinical features and overall survival (OS) were compared. Survival analysis by applying 2 new AJCC 8th staging systems to well-differentiated G3 p-NECs were performed to validate whether these subgroup patients should also be staged by the system proposed for all G3 p-NECs.We enrolled 172 patients who were histopathologically diagnosed as G3 p-NECs, including 64 well-differentiated G3 p-NECs and 108 poorly-differentiated ones, whose patient demographics and tumor characteristics present no notably differences (P > .05), except their Ki-67 index and mitotic rate (P = .031, P = .025; respectively). The estimated OS of well-differentiated G3 p-NECs was significantly better than those of poorly-differentiated tumors (P < .001). When applying the new AJCC system for all G3 p-NECs to well-differentiated G3 tumors, 18, 22, 12, and 12 patients were respectively distributed in the new AJCC Stage I, Stage II, Stage III, and Stage IV. Using the AJCC 8th staging system for WHO G1/G2 pancreatic neuroendocrine tumors (p-NETs) to well-differentiated G3 p-NECs, there were 5, 25, 22, and 12 patients classified from the new AJCC Stage I to Stage IV, respectively. The system for G1/G2 p-NETs could significantly differentiate the survival differences between each new stage of well-differentiated G3 p-NECs (P < .05), while comparisons of survivals between Stage II with Stage III or Stage III with Stage IV by the system for G3 p-NECs were not statistically different (P = .334, P = .073; respectively).G3 p-NECs were heterogeneous with well-differentiated and poorly-differentiated subgroups. Both AJCC 8th staging systems proposed for all G3 p-NECs and G1/G2 p-NETs were practical for well-differentiated G3 p-NECs, while the one originally applied to G1/G2 p-NETs appeared to be superior in performance due to its better prognostic stratification and more accurate predicting ability.

Fungal community associated with fermentation and storage of Fuzhuan brick-tea.

Chinese Fuzhuan brick-tea is a unique microbial fermented tea characterized by a period of fungal growth during its manufacturing process. The aim of the present study was to characterize, both physicochemically and microbiologically, traditional industrial production processes of Fuzhuan brick-tea. Fermenting tea samples were collected from the largest manufacturer. Physicochemical analyses showed that the low water content in the tea substrates provided optimal growth conditions for xerophilic fungi. The fungal communities existing in tea materials, fermenting tea, and stored teas were monitored by polymerase chain reaction (PCR)-denaturing gradient gel electrophoresis (DGGE) targeting the D1 region of the 26S rRNA genes, followed by sequencing of the amplicons. Results revealed that the microorganisms were from, or closely related to, the genera Eurotium, Debaryomyces, Aspergillus, Verticillium, Pichia, Pestalotiopsis, Rhizomucor and Beauveria. This is the first report of Debaryomyces participating in the processing of Fuzhuan brick-tea. We concluded that the dominant genera Eurotium, Debaryomyces and Aspergillus are beneficial fungi associated with the fermentation of Fuzhuan brick-tea. The genus Beauveria was present in the stored Fuzhuan brick-tea, which may help protect tea products from insect spoilage. The remaining four genera were of minor importance in the manufacturing of Fuzhuan brick-tea. The predominant Eurotium species, a strain named Eurotium sp. FZ, was phenotypically and genotypically identified as Eurotium cristatum. High performance thin layer chromatography analysis of anthraquinones showed that emodin existed in all the dark tea samples, but physcion was only detectable in the tea fermented by E. cristatum. The PCR-DGGE approach was an effective and convenient means for profiling the fungal communities in Fuzhuan brick-tea. These results may help promote the use of microbial consortia as starter cultures to stabilize and improve the quality of Fuzhuan brick-tea products.