With the emergence of new virus variants, limited data are available on the impact of SARS-CoV-2 Omicron infection on surgery outcomes in cancer patients who have been widely vaccinated. This study aimed to determine whether undergoing hepatectomy poses a higher risk of postoperative complications for liver cancer patients who have had mild Omicron infection before surgery. A propensity-matched cohort study was conducted at a tertiary liver center from 8 October 2022 to 13 January 2023. In total, 238 liver cancer patients who underwent hepatectomy were included, with 57 (23.9%) recovering from preoperative SARS-CoV-2 Omicron infection and 190 (79.8%) receiving COVID-19 vaccination. Pre- and post-matching, there was no significant difference in the occurrence of postoperative outcomes between preoperative COVID-19 recovered patients and COVID-19 negative patients. Multivariate logistic regression showed that the COVID-19 status was not associated with postoperative major pulmonary and cardiac complications. However, preexisting comorbidities (odds ratio [OR], 4.645; 95% confidence interval [CI], 1.295–16.667), laparotomy (OR, 10.572; 95% CI, 1.220–91.585), and COVID-19 unvaccinated (OR, 5.408; 95% CI, 1.489–19.633) had increased odds of major complications related to SARS-CoV-2 infection. In conclusion, liver cancer patients who have recovered from preoperative COVID-19 do not face an increased risk of postoperative complications.

Background Hepatitis B virus (HBV) reactivation impact negatively the prognosis of patients with HBV-related hepatocellular carcinoma (HCC). This study aimed to observe the effect of antiviral therapy (AVT) on viral reactivation and long-term outcomes after percutaneous radiofrequency ablation (PRFA) for HBV-related HCC. Methods Data on 538 patients between 2009 and 2013 were reviewed. Propensity score matching (PSM) analysis was used to adjust for differences in baseline features between patients who received AVT (AVT group) and did not receive it (non-AVT group). Logistic regression was used to identify the independent factors for viral reactivation. The tumor recurrence and overall survival (OS) rates were analyzed using the Kaplan–Meier method. Recurrence patterns were also investigated. Results HBV reactivation developed in 10.8% (58/538) of patients after PRFA. AVT was associated independently with decreased viral reactivation (odd ratio: 0.061, 95% confidence interval: 0.018–0.200). In 215 pairs of patients obtained after PSM, the AVT group had lower 1-, 3-, and 5-year recurrence rates (24%, 55%, and 67% vs 33%, 75%, and 85%, respectively) and higher 1-, 3-, and 5-year OS rates (100%, 67%, and 59% vs 100%, 52%, and 42%, respectively) than non-AVT group ( P < 0.001 for both). Additionally, the relapses in distant hepatic segments and the late recurrence after 2 years of PRFA were significantly reduced in the AVT group (78/215 vs 111/215 vs., P = 0.001; 39/109 vs. 61/91, P = 0.012, respectively). Conclusions AVT reduced late and distal intrahepatic recurrence and improved OS in patients undergoing PRFA for HBV-related HCC by inhibiting viral reactivation.

临床外科专业实习、教学在高标准要求下需要不断改进和提高,少量文献报道将Mini-CEX结合DOPS应用于临床能力双向评估,具有操作方便、观察直接、教学相长、测评信度较高、弥补Mini-CEX外科评估不足等特点.结合肝胆外科实际,带教对学生临床能力进行分项评估,相反学生也对带教在教学中的临床实践和教学技能等方面表现进行现场评估,并交流反馈.增加了学生在床旁教学中的实践机会,加强了相互学习;在评教的反馈中,强调了言传身教在医学教学中的应用,促进了教学水平的提高.Mini-CEX结合DOPS的双向评估取得较好的教学效果,教学相长.

AbstractBackgroundHepatectomy is an effective treatment for synchronous colorectal liver metastases (SCLM) patients. However, whether to choose simultaneous hepatectomy (SIH) or staged hepatectomy (STH) is still controversial, especially during major hepatectomy (≥3 liver segments).AimsCompare the difference between the SCLM patients underwent SIH and STH, especially during major hepatectomy (≥3 liver segments).Methods and ResultsA meta‐analysis was conducted by analyzing the published data on the outcomes of SCLM patients underwent SIH or STH from January 2010 to December 2020 from the electronic databases. A random‐effects model was used to derive pooled estimates of odds ratio (OR) with 95% confidence interval (CI) for the explored outcomes. Eventually, 18 studies, including 5101 patients, were included this study. The result of meta‐analysis showed that SIH did not increase postoperative complications (pooled OR: 1.037; 95% CI: 0.897–1.200), perioperative mortality (pooled OR: 0.942; 95% CI: 0.552–1.607), 3‐year mortality (pooled OR: 1.090; 95% CI: 0.903–1.316) or 5‐year mortality (pooled OR: 1.077; 95% CI: 0.926–1.253), as compared with STH. Subgroup analysis showed that, simultaneous major hepatectomy (SIMH) also did not increase postoperative complications (pooled OR: 0.863; 95% CI: 0.627–1.188) or perioperative mortality (pooled OR: 0.689; 95% CI: 0.290–1.637) as compared with staged major hepatectomy (STMH).ConclusionPostoperative complications, perioperative mortality and long‐term prognosis had no significant difference between SIH and STH for SCLM patients. Besides, postoperative complications and perioperative mortality also had no significant difference between SIMH and STMH.

Background Intrahepatic cholangiocarcinoma (iCCA) is the second most common malignant hepatic tumor and has a high postoperative recurrence rate and a poor prognosis. The key roles of most tumor recurrence-associated molecules in iCCA remain unclear. This study aimed to explore hub genes related to the postsurgical recurrence of iCCA. Method Differentially expressed genes (DEGs) between iCCA samples and normal liver samples were screened from The Cancer Genome Atlas (TCGA) database and used to construct a weighted gene coexpression network. Module-trait correlations were calculated to identify the key module related to recurrence in iCCA patients. Genes in the key module were subjected to functional enrichment analysis, and candidate hub genes were filtered through coexpression and protein–protein interaction (PPI) network analysis. Validation studies were conducted to detect the “real” hub gene. Furthermore, the biological functions and the underlying mechanism of the real hub gene in iCCA tumorigenesis and progression were determined via in vitro experiments. Results A total of 1019 DEGs were filtered and used to construct four coexpression modules. The red module, which showed the highest correlations with the recurrence status, family history, and day to death of patients, was identified as the key module. Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses demonstrated that genes in the red module were enriched in genes and pathways related to tumorigenesis and tumor progression. We performed validation studies and identified estrogen receptor 1 (ESR1), which significantly impacted the prognosis of iCCA patients, as the real hub gene related to the recurrence of iCCA. The in vitro experiments demonstrated that ESR1 overexpression significantly suppressed cell proliferation, migration, and invasion, whereas ESR1 knockdown elicited opposite effects. Further investigation into the mechanism demonstrated that ESR1 acts as a tumor suppressor by inhibiting the JAK/STAT3 signaling pathway. Conclusions ESR1 was identified as the real hub gene related to the recurrence of iCCA that plays a critical tumor suppressor role in iCCA progression. ESR1 significantly impacts the prognosis of iCCA patients and markedly suppresses cholangiocarcinoma cell proliferation, migration and invasion by inhibiting JAK/STAT3 signaling pathway.

Background Effective adjuvant treatment after hepatectomy for hepatocellular carcinoma (HCC) is an important area of research. Radioactive iodine (I-131)-labelled metuximab is a radiolabelled monoclonal antibody against the CD147 (also known as basigin or HAb18G) antigen that is expressed in HCC. We aimed to examine the role of I-131-metuximab as an adjuvant therapy after HCC resection. Methods This randomised, controlled, multicentre, open-label, phase 2 trial was done at five medical centres in China. Patients aged 18-75 years who underwent curative-intent resection of histologically confirmed HCC expressing CD147 were randomly assigned (1:1) by a computer-generated random sequence, stratified by centre, to receive either adjuvant transarterial injection of one dose of 27.75 MBq/kg I-131-metuximab 4-6 weeks after the hepatectomy (treatment group) or no adjuvant treatment (control group). Patients and physicians were not masked to the study groups. The primary outcome was 5-year recurrence-free survival (RFS) in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, NCT00819650. Findings Between April 1, 2009, and Nov 30, 2012, 485 patients were screened for eligibility. 329 (68%) of these patients were excluded and 156 (32%) were randomly assigned to receive either I-131-metuximab (n=78) or no adjuvant treatment (n=78). The median follow-up was 55.9 months (IQR 18.6-79.4). In the intention-to-treat population, the 5-year RFS was 43.4% (95% CI 33.6-55.9) in the I-131-metuximab group and 21.7% (14.2-33.1) in the control group (hazard ratio 0.49 [95% CI 0.34-0.72]; Z=2.96, p=0.0031). I-131-metuximab-associated adverse events occurred within the first 4 weeks in 34 (45%) of 76 patients, seven (21%) of whom had grade 3 or 4 adverse events. These adverse events were all resolved with appropriate treatment within 2 weeks of being identified. Interpretation Adjuvant I-131-metuximab treatment significantly improved the 5-year RFS of patients after hepatectomy for HCC tumours expressing CD147. This treatment was well tolerated by patients. Copyright (C) 2020 Elsevier Ltd. All rights reserved.

目的 2019年12月以来,新型冠状病毒肺炎在武汉爆发,并迅速向全国蔓延.新型冠状病毒传染性强,人群普遍易感.如何在做好疫情防控的同时,又能确保肝癌患者得到有效的诊疗,是当前亟待解决的临床问题.笔者依据原发性肝癌诊疗规范,结合自身经验,概述了疫情当下的肝癌诊疗策略.包括门诊患者的严格筛查与诊断,肝癌患者不同分期的针对性临床实践方法,需紧急处理的情况如破裂出血和梗阻性黄疸等.有助于肝脏肿瘤专科医师在新型冠状病毒肺炎疫情下合理有效地开展肝癌的诊断与治疗工作.

Portal vein tumor thrombosis (PVTT) in hepatocellular carcinoma (HCC) is a sign of advanced stage disease, which is associated with poor prognosis. Liver resection (LR) may provide better prognosis in selected patients. In the present study, we aimed to assess information from HCC patients with PVTT who died within 3 months or 2 years after LR in order to identify preoperative factors correlated to short-term or long-term survival, by which inappropriate selection of patients for LR might be avoided in the future.

Background: Several studies have noted that the discriminatory ability and stratification performance of the AJCC 8th edition staging system is not entirely satisfactory. We aimed to improve the American Joint Committee on Cancer (AJCC) 8th edition staging system for intrahepatic cholangiocarcinoma (ICC). Methods: A multicentric database from three Chinese mainland centers (n = 1601 patients) was used to modify the 8th edition staging system. This modified TNM (mTNM) staging system was then validated using the SEER database (n = 761 patients). A new TNM staging system, by incorporating serum tumor markers (TNMIS) into the mTNM staging system was then proposed. Results: The 8th edition staging system did not provide an adequate stratification of prognosis in the Chinese multicentric cohort. The mTNM staging system offered a better discriminatory capacity in the multicentric cohort than the original 8th edition. External validation in the SEER cohort showed that the mTNM staging system also had a good stratification performance. After further incorporating a serum marker stage into the mTNM staging, the TNMIS staging system was able to stratify prognosis even better. Conclusion: The proposed mTNM staging system resulted in better stratification performance and the TNMIS staging system provided even more accurate prognostic classification than the conventional TNM system.

肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)约占原发性肝癌的10％ ～ 15％,近年来其发病率在全球范围内呈上升趋势[1].ICC的发病诱因及病因复杂,目前已确定的危险因素有年龄、肝内胆管结石、肝血吸虫病、胆管腺瘤、胆管乳头状瘤病、胆管囊肿和Caroli病[2].近年来,全基因组测序技术发展和ICC基因表达谱的深入研究为ICC的分子靶向治疗提供了新的线索,将有望成为ICC的突破性治疗方法.ICC恶性程度高,发病隐匿,许多病人就诊时已经达到疾病的中晚期,失去根治性手术治疗的机会,加之临床上缺乏有效的肿瘤筛查及诊断标志物,故导致ICC病人诊疗困难,预后极差.根治性手术切除是目前唯一有效的治疗方法,但因术后高复发率导致ICC病人术后5年的生存率在20％ ～40％[1].因此,如何有效地综合治疗ICC成为摆在临床医生面前的一个难题.

ImportanceRepeat hepatectomy and percutaneous radiofrequency ablation (PRFA) are most commonly used to treat early-stage recurrent hepatocellular carcinoma (RHCC) after initial resection, but previous studies comparing the effectiveness of the 2 treatments have reported conflicting results.ObjectiveTo compare the long-term survival outcomes after repeat hepatectomy with those after PRFA among patients with early-stage RHCC.Design, Setting, and ParticipantsThis open-label randomized clinical trial was conducted at the Eastern Hepatobiliary Surgery Hospital and the National Center for Liver Cancer of China. A total of 240 patients with RHCC (with a solitary nodule diameter of ≤5 cm; 3 or fewer nodules, each ≤3 cm in diameter; and no macroscopic vascular invasion or distant metastasis) were randomized 1:1 to receive repeat hepatectomy or PRFA between June 3, 2010, and January 15, 2013. The median (range) follow-up time was 44.3 (4.3-90.6) months (last follow-up, January 15, 2018). Data analysis was conducted from June 15, 2018, to September 28, 2018.InterventionsRepeat hepatectomy (n = 120) or PRFA (n = 120).Main Outcomes and MeasuresThe primary outcome was overall survival (OS). Secondary outcomes included repeat recurrence-free survival (rRFS), patterns of repeat recurrence, and therapeutic safety.ResultsAmong the 240 randomized patients (216 men [90.0%]; median [range] age, 53.0 [24.0-59.0] years), 217 completed the trial. In the intention-to-treat (ITT) population, the 1-year, 3-year, and 5-year OS rates were 92.5% (95% CI, 87.9%-97.3%), 65.8% (95% CI, 57.8%-74.8%), and 43.6% (95% CI, 35.5%-53.5%), respectively, for the repeat hepatectomy group and 87.5% (95% CI, 81.8%-93.6%), 52.5% (95% CI, 44.2%-62.2%), and 38.5% (95% CI, 30.6%-48.4%), respectively, for the PRFA group (P = .17). The corresponding 1-year, 3-year, and 5-year rRFS rates were 85.0% (95% CI, 78.8%-91.6%), 52.4% (95% CI, 44.2%-62.2%), and 36.2% (95% CI, 28.5%-46.0%), respectively, for the repeat hepatectomy group and 74.2% (95% CI, 66.7%-82.4%), 41.7% (95% CI, 33.7%-51.5%), and 30.2% (95% CI, 22.9%-39.8%), respectively, for the PRFA group (P = .09). Percutaneous radiofrequency ablation was associated with a higher incidence of local repeat recurrence (37.8% vs 21.7%, P = .04) and early repeat recurrence than repeat hepatectomy (40.3% vs 23.3%, P = .04). In subgroup analyses, PRFA was associated with worse OS vs repeat hepatectomy among patients with an RHCC nodule diameter greater than 3 cm (hazard ratio, 1.72; 95% CI, 1.05-2.84) or an α fetoprotein level greater than 200 ng/mL (hazard ratio, 1.85; 95% CI, 1.15-2.96). Surgery had a higher complication rate than did ablation (22.4% vs 7.3%, P = .001).Conclusions and RelevanceNo statistically significant difference was observed in survival outcomes after repeat hepatectomy vs PRFA for patients with early-stage RHCC. Repeat hepatectomy may be associated with better local disease control and long-term survival in patients with an RHCC diameter greater than 3 cm or an AFP level greater than 200 ng/mL.Trial RegistrationClinicalTrials.gov identifier: NCT00822562.

肝细胞癌(HCC)往往伴有肝炎和肝硬化,根据其疾病分期、肿瘤部位及肝功能等情况进行精准治疗的要求很高.临床上多种诊疗方法均对HCC具有一定的疗效,故如何有效地对患者进行预后分析,从而选择合适的个体化治疗方案,成为亟需解决的问题.针对HCC的预后,有多种预测系统,其中列线图因能够较好地针对HCC患者进行个体化分析而备受关注.目前,根据不同类型的HCC已建立了多种列线图预测模型,这些模型纳入了一些临床和病理指标,如肿瘤标志物、肝功能、HBV指标、微血管癌栓等,其对不同患者计算出不同的风险评分,能够较好地预测预后.同时,可以根据不同的风险等级指导患者选择合适的治疗方式和术后抗复发治疗,从而达到个体化治疗的目的.

Background: There is no universally accepted adjuvant therapy after hepatectomy for hepatocellular carcinoma (HCC). 131I-metuximab is a radiolabeled monoclonal antibody specifically against HAb18G/CD147 expressed in HCC. This study aimed to examine the adjuvant role of 131I-metuximab on recurrence-free survival (RFS) following HCC resection. Methods: This multicenter, open-label, phase 2, randomised, controlled trial was carried out in 5 centers in China. Patients who underwent curative resection for HCC with positive HAb18G/CD147 expressions were enrolled and randomly assigned (1:1) to the 131I-metuximab and control groups. Central block randomisation with stratification by the participation centers was done. In addition to similar surgical and postoperative managements among the two groups, patients in the treatment group received one hepatic intra-arterial injection of 27·75 MBq/kg of 131I-metuximab within postoperative 4-6 weeks. The patients and clinicians were unmasked to the group assignment. The primary endpoint was 3-year RFS rate. Intention-to-treat analysis was used to compare survival outcomes. Adverse effects (AEs) following 131I-metuximab were recorded. Findings: Between February 2009 and September 2012, 156 patients were enrolled with 78 in each group. The median follow-up was 43·6 (IQR 35·7- 53·9) months. AEs were identified in 34 (44·7%) patients after adjuvant ¹³¹I-metuximab. Seven of these patients had grade 3/4 events. The 1-, 3- and 5-year RFS rates for the treatment and control groups were 79·5% (95% CI 71·0-89·0), 62·8% (53·0-74·5) and 39·7% (28·3-55·7) vs. 56·4% (46·4- 68·6), 30·8% (22·1-42·9) and 26·5% (18·3-38·6), respectively (p<0·001). On multivariate analysis, adjuvant ¹³¹I-metuximab was a protective factor of RFS (hazard ratio 0·44 [95% CI 0·29-0·69]), and it was associated with decreased recurrence rates in the first two years after surgery. Interpretation: Adjuvant 131I-metuximab after hepatectomy was effective and safe in patients with HCC with positive HAb18G/CD147 expression. Clinical Trial Number: The trial was registered in ClinicalTrials.gov, number NCT00819650. Funding Statement: This study was supported by the State Key Project on Infectious Diseases of China (2012ZX10002-016 to FS), and the Creative Research Groups of the National Natural Science Foundation of China (81521091 to HYW). Declaration of Interests: All authors declare no competing interests.Ethics Approval Statement: The study was done in compliance with the guidelines of the Declaration of Helsinki and Good Clinical Practice. Appropriate approvals from the Institutional Ethics Committees at each participating center were obtained. All patients provided written informed consent before randomisation

Background: The current study aimed to examine the long-term survival after partial hepatectomy for patients with BCLC intermediate stage hepatocellular carcinoma (HCC) stratified by the Bolondi's sub-staging model. Materials and Methods: This cohort consisted of 360 patients with BCLC intermediate stage HCC who underwent partial hepatectomy between January 2008 and February 2010. Patients were stratified into 3 subgroups (B1-B3) based on the Bolondi's sub-staging model. The last follow-up was conducted at February 2014. Results: Of these patients, 166, 171 and 23 patients had Bl, B2, and B3 sub-stage HCC, respectively. The postoperative 5-year Overall survival (OS) rate for patients with these three sub-stages was 49.5%, 33.7% and 12.9%, respectively (P < 0.001). Compared with the reported survival outcomes from previous studies which used transarterial chemoembolization (TACE) as first-line treatment, hepatectomy had a better median survival than TACE in B1 and B2 patients. On multivariable analysis, presence of esophageal and gastric varices, higher NDR score, presence of microvascular invasion, differentiation grade III-IV, and patterns of AFP decreases after surgery were the independent risk factors of OS in the sub-stages B1 and B2 patients. A nomogram which integrated all these independent risk factors was developed, with a C-index of 0.71 for OS prediction. The calibration curve showed an optimal agreement between prediction by the nomogram and actual observation. Conclusions: The patients with intermediate stage HCC clarified as sub-stages B1 and B2 according to Bolondi's model had an optimal long-term survival following partial hepatectomy than TACE. Their postoperative prognosis could be accurately predicted by our proposed nomogram.

[摘要] 目的 探讨术前糖类抗原 19-9(CA19-9)水平对不同甲胎蛋白(AFP)水平肝细胞癌患者术后预后的 影响。方法 前瞻性收集 2008 年 1 月 4 日至 2010 年 12 月 31 日在我院因肝细胞癌首次接受肝切除术治疗的 3 791 例患者的临床及随访资料。以 400 ng/mL 为术前 AFP 水平的截断值,32 U/mL 为术前 CA19-9 水平的截断值,将患 者分为双阳性组(DP 组)、CA19-9 单阳性组 [SP(CA19-9)组]、AFP 单阳性组 [SP(AFP)组] 和双阴性组(DN 组),比较各组患者的肿瘤学特征。采用 Kaplan-Meier 法和 log-rank 检验分析各组患者的总生存(OS)和无瘤生存 (DFS)情况。采用 Cox 回归模型进行单因素和多因素分析,筛选影响肝细胞癌患者预后的危险因素。结果 4 组 患者有不同的肿瘤学特征。与 DN 组相比,SP(AFP)组、DP 组患者的肿瘤最大径更大、病理 EdmondsonSteiner 分级为 III~IV 级的比例和微血管侵犯(MVI)发生率更高(P<0.01),且 DP 组患者的多发肿瘤比例更高 (P<0.05);而 SP(CA19-9)组患者的肿瘤最大径更小(P<0.05),多发肿瘤的比例更高(P<0.01)。按 DN 组、SP(CA19-9)组、SP(AFP)组与 DP 组的顺序,患者的 1 年、3 年和 5 年 OS 率均依次降低(P 均<0.01); DN 组患者的 1 年、3 年和 5 年 DFS 率最高(P<0.01),DP 组最低(P<0.01),SP(CA19-9)组与 SP(AFP)组 差异无统计学意义。术前 AFP 水平分层分析结果表明,CA19-9<32 U/mL 组患者的 1 年、3 年和 5 年 OS 率及 DFS 率均高于 CA19-9≥32 U/mL 组患者(P<0.05)。多因素分析结果显示,AFP≥400 ng/mL、CA19-9≥32 U/mL、术 中出血≥600 mL、肿瘤最大径≥5 cm、肿瘤多发、肿瘤包膜缺如、MVI、Edmondson-Steiner 分级为 III~IV 级是影 响患者 OS 的独立危险因素(P<0.05);乙型肝炎病毒表面抗原(+)、AFP≥400 ng/mL、CA19-9≥32 U/mL、肿 瘤最大径≥5 cm、肿瘤多发、肿瘤包膜缺如、MVI 是影响患者 DFS 的独立危险因素(P<0.05)。结论 术前血清 AFP≥400 ng/mL 和 CA19-9≥32 U/mL 均是影响肝细胞癌患者 OS 和 DFS 的独立危险因素。对于不同术前 AFP 水平 的肝细胞癌患者,术前 CA19-9 水平是进一步评估预后的重要指标。 [关键词] 肝肿瘤;甲胎蛋白;糖类抗原 19-9;肝细胞癌;预后;肝切除术 [中图分类号] R 735.7 [文献标志码] A [文章编号] 0258-879X(2018)06-0603-07

Background: We intended to explore hepatitis B virus (HBV) reactivation after percutaneous radiofrequency ablation (PRFA) for HBV-related hepatocellular carcinoma (HCC) and the impact of antiviral therapy (AVT) on post-PRFA outcomes. Methods: Data on 538 consecutive patients who underwent PRFA for HBV-related early HCC at the Eastern Hepatobiliary Surgery Hospital between 2007 and 2011 were studied. Propensity score matching (PSM) analysis was used to compare the outcomes between the study groups. Recurrence free survival (RFS) and tumor recurrence were endpoints. Post-PRFA viral reactivation, hepatitis, and patterns of tumor recurrence were also observed. Logistic regression, Kaplan-Meier method and Cox proportional regression were used during the analysis. Results: Viral reactivation developed in 10.8% of patients who underwent PRFA. Patients with HBV reactivation had higher 1-, 3-, and 5-year tumor recurrence rates than patients without viral reactivation after PRFA (46.9%, 81.6% and 81.6% vs 36.0%, 63.5% and 65.4%, P = 0.004). AVT reduced viral reactivation rate (P < 0.001) and decreased 1-,3-,5-year tumor recurrence rate when compared with the no-AVT (30.2%, 58.6% and 61.4% vs 44.1%, 72.6% and 73.0%, P = 0.001). The local recurrence of tumor after PRFA was only associated with tumor diameter (P = 0.010), however, viral reactivation (P = 0.015) and AVT (P < 0.001) were independent risk factors of intrahepatic distant recurrence. Conclusions: HBV could be reactivated after PRFA. Viral reactivation and AVT had opposite impact on intrahepatic distant recurrence but not local tumor progression of HCC patients after PRFA. Legal entity responsible for the study: Feng Shen MD. Funding: State Key Project on Infectious Diseases of China (2012ZX10002-011,016 to FS). Disclosure: All authors have declared no conflicts of interest.

Partial hepatectomy is a potentially curative therapy for intrahepatic cholangiocarcinoma (ICC). Unfortunately, the overall surgical prognosis remains dismal and the actual 10-year survival has not been reported. This study aimed to document 10-year actual survival rates, identify the prognostic factors associated with 10-year survival rate, and analyze the characteristics of patients who survived ≥ 10 years. Among 251 patients who underwent curative liver resection for ICC between 2003 and 2006 at the Eastern Hepatobiliary Surgery Hospital, 21 patients (8.4%) survived ≥ 10 years. The 5-, 7-, and 10-year overall survival rates were 32.3%, 22.3% and 8.4%, respectively. The 10-year cumulative incidence of ICC-related death and recurrence were 80.9% and 85.7%, respectively. Multivariate analysis based on competing risk survival analysis identified that tumor > 5 cm was independently associated with ICC-related death and recurrence (hazard ratios: 1.369 and 1.445, respectively), in addition to carcinoembryonic antigen (CEA) >10 U/mL, carbohydrate antigen 19-9 (CA19-9) >39 U/mL, multiple nodules, vascular invasion, nodal metastasis and local extrahepatic invasion. Patients who survived ≥ 10 years had a longer time to first recurrence, lower levels of CEA, CA19-9 and alkaline phosphatase, less perioperative blood loss, solitary tumor, smaller tumor size, and absence of nodal metastasis or local extrahepatic invasion. In conclusion, a 10-year survival after liver resection for ICC is possible and can be expected in approximately 8.4% of patients.

Objective To explore the association between preoperative serum inflammatory markers and prognosis in intrahepatic cholangiocarcinoma (ICC) patients underwent liver resection.Methods Data of 382 consecutive ICC patients who underwent hepatectomy were retrospectively reviewed.The cut-off values of inflammation marker were calculated by using the minimum P value method.The curves of overall survival and tumor recurrence were depicted using the Kaplan-Meier method and compared using the logrank test.Independent risk factors of OS and tumor recurrence were analyzed with the Cox hazard regression model.Results NLR (neutrophil count divided by lymphocyte count) ≥ 2.30 was an independent risk factor of overall survival and tumor recurrence (Hazard Ratio [HR]:1.326,95％ Confidence Interval [CI]:1.105-1.593;1.270,1.071-1.506).Patients with a NLR ≥ 2.30 had higher CEA levels,larger tumor size,more tumor nodes,more lymph node metastasis and vascular invasion.Conclusions Inflammatory markers NLR ≥ 2.30 is an independent risk factor of prognosis,which predicted a worse prognosis of ICC patients who underwent resection.

BACKGROUND:Statins can reduce the malignancies through stimulating apoptosis. We aimed to elucidate the role of lovastatin in HepG-2 cells.METHODS:HepG-2 and non-tumor L-O2 cells were used as the cell models. CCK-8, flow cytometric analysis and carboxy fluorescein diacetate succinimidyl ester (CFDA-SE) labeling were performed to monitor the viability, apoptosis and proliferation.RESULTS:We found that lovastatin exerted the most tumor suppressing effects on liver cancer cells among the three tested statins. Lovastatin treatment significantly reduced cell viability and proliferation, and induced apoptosis in HepG-2. However, drug resistance effects were observed in the non-tumor L-O2 cells. The apoptosis triggered by lovastatin was accompanied by high intracellular levels of ROS. Pretreatment with the ROS blocker N-acetyl-cysteine (NAC) could mitigate the lovastatin-induced cytotoxicity in HepG-2 cells. Mechanistically, lovastatin increased HepG-2 cell apoptosis by triggering mitochondrial and endoplasmic reticulum (ER) stress pathways through ROS accumulation.CONCLUSIONS:Lovastatin significantly induced cell apoptosis by activating ROS-dependent mitochondrial and ER stress pathways in HepG-2 cells.

Objective To investigate the application value of hepatic portal reocclusion for the prevention of bile leakage after hepatectomy. Methods In this prospective study, 197 patients who underwent hepatectomy alone in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University between March 2014 and November 2014 were recruited. According to the random number talbe method, the patients were divided into the hepatic portal reocclusion group (n=99) and traditional surgery group (n=98). In the hepatic portal reocclusion group, 81 cases were males and 18 females, aged (54±11) years old on average. Among them, 89 cases were diagnosed with primary liver cancer and 10 with benign liver lesions. After the liver resection with Pringle maneuver, the first porta hepatis was reoccluded to elevate the pressure of intrahepatic blie duct, and the bile duct was examined and tightly sutured. In the traditional surgery group, 82 cases were males and 16 females, aged (52±10) years old on average. Among them, 91 cases were diagnosed with primary liver cancer and 7 with benign liver lesions. The liver resection was performed using Pringle maneuver. The informed consents of all patients were obtained and the local ethical committee approval was received. The perioperative status and prognosis were observed and compared between two groups. The hepatic portal occlusion time and operation time between two groups were compared using t test or Kruskal-Wallis rank test. The rates were compared using Chi-square test or Fisher's exact probability test. Results The frequency of hepatic portal occlusion in the hepatic portal reocclusion group was 2(1-4), significantly higher than 1(1-3) in the traditional surgery group (Z=0.000, P<0.05). The hepatic portal occlusion time in the hepatic portal reocclusion group was (21±10) min, significantly longer than (17±9) min in the traditional surgery group (t=0.001, P<0.05). The postoperative length of hospital stay in the hepatic portal reocclusion group was (8±3) d, significantly shorter than (9±3) d in the traditional surgery group (t=-0.040, P<0.05). The incidence of postoperative bile leakage in the hepatic portal reocclusion group was 1%(1/99), significantly lower than 9%(9/98) in the traditional surgery group (χ2=6.830, P<0.05). The symptoms of bile leakage were effectively controlled after short-term drainage. Conclusions Application of hepatic portal reocclusion can effectively reduce the incidence of bile leakage after hepatectomy, and provides a simple and efficacious approach to prevent the incidence of bile leakage for the surgeons. Key words: Hepatectomy; Biliary fistula; Hepatic portal reocclusion