Objective:Epithelial cell adhesion molecule (EpCAM) and glypican-3 (GPC3) are associated with a poor survival rate in hepatocellular carcinoma (HCC). Predicting aggressive HCC non-invasively should be investigated using preoperative gadoxetic acid-enhanced MRI and clinical characteristics. Methods:This retrospective study examined 134 patients with confirmed cases of HCC who had undergone gadolinic acid-enhanced MRI before surgery. The data were collected between November 2017 and December 2021. Significant parameters were subjected to quantitative analysis and univariate testing. HCC characterized by poor differentiation and progenitor traits was identified by the positive expression of EpCAM and/or GPC3. Independent influencing variables for different subtypes of invasive HCC were identified by multivariate analysis. The diagnostic performance of variables was measured using ROC analysis. Results:Cases with EpCAM and GPC3 expression were classified into four subtypes based on IHC staining. Among them, EpCAM+/GPC3+ HCC had the highest risk. Significant predictors of HCC expressing aggressive markers included tumor size (p = 0.01), AFP level (p = 0.008), MVI (p = 0.003), satellite nodule (p = 0.002), proliferative pattern (p = 0.04), and arterial peripheral enhancement (p = 0.03). By integrating all of these relevant variables, the resulting diagnostic accuracy was enhanced to 0.914 (95% CI 0.830-0.960) with a sensitivity of 0.964 (95% CI 0.922-1.000) and a specificity of 0.833 (95% CI 0.365-0.911). Conclusion:The research demonstrated that combining biochemical and radiological data allows for accurate prognosis and patient management, along with non-invasive detection of aggressive HCC with high accuracy.

随着医学的不断发展、教育理念的更新,医学影像学教学也在不断适应和改变.传统的"以学科为中心"的教学模式已不能满足现代医学影像学教育的需要.研究通过集中优势资源,建设整合医学教师队伍,修订教学内容,完善课程设计以及教学考核评估等,探索医学影像学整合教学的新方法,提出合理化的改革举措,为整合教学的顺利开展提供实践基础.整合医学教学既可以将医学影像学与基础、临床医学有机结合,又能培养学生的临床思维,锻炼解决问题的综合能力,有利于提升教学效果.

It is widely recognized that tumor immune microenvironment (TIME) plays a crucial role in tumor progression, metastasis, and therapeutic response. Despite several noninvasive strategies have emerged for cancer diagnosis and prognosis, there are still lack of effective radiomic-based model to evaluate TIME status, let alone predict clinical outcome and immune checkpoint inhibitor (ICIs) response for hepatocellular carcinoma (HCC). In this study, we developed a radiomic model to evaluate TIME status within the tumor and predict prognosis and immunotherapy response. A total of 301 patients who underwent magnetic resonance imaging (MRI) examinations were enrolled in our study. The intra-tumoral expression of 17 immune-related molecules were evaluated using co-detection by indexing (CODEX) technology, and we construct Immunoscore (IS) with the least absolute shrinkage and selection operator (LASSO) algorithm and Cox regression method to evaluate TIME. Of 6115 features extracted from MRI, five core features were filtered out, and the Radiomic Immunoscore (RIS) showed high accuracy in predicting TIME status in testing cohort (area under the curve = 0.753). More importantly, RIS model showed the capability of predicting therapeutic response to anti-programmed cell death 1 (PD-1) immunotherapy in an independent cohort with advanced HCC patients (area under the curve = 0.731). In comparison with previously radiomic-based models, our integrated RIS model exhibits not only higher accuracy in predicting prognosis but also the potential guiding significance to HCC immunotherapy.

Purpose Microvascular invasion (MVI) is a significant prognostic factor in combined hepatocellular cholangiocarcinoma (cHCC-CCA). However, its diagnosis relies on postoperative histopathologic analysis. This study aims to identify preoperative inflammatory biomarkers and MR-imaging features that can predict MVI in cHCC-CCA. Methods This retrospective study enrolled 119 patients with histopathologically confirmed cHCC-CCA between January 2016 and December 2021. Two radiologists, unaware of the clinical data, independently reviewed all MR image features. Univariable and multivariable analyses were performed to determine the independent predictors for MVI among inflammatory biomarkers and MRI characteristics. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the diagnostic performance. Results Multivariable logistic regression analysis identified four variables significantly associated with MVI ( p < 0.05), including two inflammatory biomarkers [albumin-to-alkaline phosphatase ratio (AAPR) and aspartate aminotransferase-to-neutrophil ratio index (ANRI)] and two MRI features (non-smooth tumor margin and arterial phase peritumoral enhancement). A combined model for predicting MVI was constructed based on these four variables, with an AUC of 0.802 (95% CI 0.719–0.870). The diagnostic efficiency of the combined model was higher than that of the imaging model. Conclusion Inflammatory biomarkers and MRI features could be potential predictors for MVI in cHCC-CCA. The combined model, derived from inflammatory biomarkers and MRI features, showed good performance in preoperatively predicting MVI in cHCC-CCA patients. Graphical abstract

Objective:To summarize the clinical features, CT and MRI imaging findings of primary hepatic lymphoma(PHL), and investigate the diagnostic value of the imaging examination for PHL, so as to provide reliable basis for clinical diagnosis and treatment of PHL.Methods:A total of 15 patients with PHL confirmed by pathology and complete preoperative imaging data from January 2014 to December 2020 at Third Affiliated Hospital of Naval Medical University were retrospectively analyzed, including 8 cases with CT and 7 cases with MRI.The clinical features and imaging manifestations of PHL were analyzed.Results:All 15 patients with PHL had no specific clinical manifestations, 11 cases were single lesions and 4 cases were multiple lesions; 13 cases were mostly round, 8 cases had uniform density/signal; necrosis was seen in 7 cases; 9 cases showed progressive enhancement after enhancement scan, 7 of which were single nodules and 6 cases showed continuous enhancement. "Vascular floating sign" was seen in 11 cases, indicating no invasion of vessels.Conclusion:PHL is rare, and when the clinical presentation and laboratory diagnosis are not specific, the diagnosis of PHL should be considered when there is a single lesion in the liver with progressive enhancement and "vascular floating sign" on imaging.The diagnosis of PHL is suggested by the presence of multiple lesions with "vascular floating signs" .

Background: The presence of microvascular invasion (MVI) significantly impairs postoperative long-term survival of patients with hepatocellular carcinoma (HCC). The role of neoadjuvant radiotherapy (RT) in treating patients with an early-stage HCC predicted to have high risks of MVI remains to be explored. Materials and methods: Consecutive patients with a resectable single and small (≤5 cm) hepatitis B virus-related HCC predicted to have high risks of MVI were randomized 1:1 to receive either neoadjuvant intensity modulated radiation therapy (18 Gy with fractionated doses of 3 Gy) followed by surgery 4 weeks later or upfront surgery. The primary endpoint was disease-free survival (DFS). The secondary outcomes included overall survival (OS), objective response rate, RT-related toxicity and surgical complications. Results: There were 30 patients randomized to each of the two groups. In the neoadjuvant RT group, three patients violated the study protocol, with two having upfront hepatectomy and one radiofrequency ablation after RT. The objective response rate after RT was 25.0% (7/28), but 2 patients suffered from grade 3 liver toxicity. The median follow-up was 68 months (interquartile range, 58–70 months) in the neoadjuvant RT group, and 68 months (interquartile range, 62–75 months) in the upfront surgery group. On intention-to-treat analysis, the median DFS and median OS were not reached in both the 2 arms. The 1-year, 2-year, 3-year and 5-year DFS rates for the neoadjuvant RT group were 86.7%, 76.7%, 60.0% and 56.3%, versus 90.0%, 66.7%, 52.8% and 45.7% in the upfront surgery group (P=0.448), respectively. The corresponding OS rates were 96.7%, 86.7%, 83.3% and 72.7%, versus 100.0%, 93.3%, 79.6% and 60.7% (P = 0.399). Conclusion and relevance: For patients with a resectable single and small hepatitis B virus-related HCC predicted to have high risks of MVI, neoadjuvant RT gave a promising response rate with a mild toxicity. Nevertheless, the neoadjuvant RT yielded similar long-term DFS and OS rates compared with patients who underwent upfront surgery.

目的 总结肝上皮样血管内皮瘤(EHE)的影像学特征,并对误诊病例进行分析.方法 回顾性分析我院2015年2月至2021年12月经手术或穿刺病理证实为肝EHE的11例患者的临床及影像学资料.结果 11例患者均行MRI检查,2例行CT检查.10例表现为肝脏多发占位,1例表现为肝内单发实性占位,共78个病灶.术前误诊7例,其中4例误诊为肝转移瘤,1例误诊为肝内胆管细胞癌,1例误诊为血管瘤,1例误诊为良性病灶.CT检查显示病灶为不均匀低密度;MRI T1加权成像显示病灶为稍低信号,T2加权成像显示病灶为稍高信号,增强后病灶呈环形持续强化(9例)或云絮状渐进性强化(2例).9例患者T2加权成像病灶出现晕征,5例出现多发结节互相融合,7例见肝包膜皱缩征,7例MRI增强检查门静脉期见棒棒糖征,6例病灶内见血管穿行.结论 肝EHE易误诊,但仍具有一定的影像学特征.熟悉肝EHE的影像学特征有助于提高其诊断准确率.

The role of carbohydrate antigen 19‐9 (CA 19‐9) in response assessment among patients with intrahepatic cholangiocarcinoma (iCCA) remains unknown. The authors studied the association of the CA 19‐9 response (defined as a reduction >50% from baseline) with the radiologic response and the outcome in patients with unresectable iCCA.

The majority of hepatocellular carcinoma (HCC) cases are diagnosed at an advanced stage. Currently, there are only a few therapeutic methods available for patients with advanced HCC and extrahepatic metastasis (EHM). Systemic chemotherapy, such as FOLFOX4 (infusions of fluorouracil, leucovorin, and oxaliplatin), has been reported for treating advanced HCC with EHM, but its effectiveness is very poor. In this randomized, double-blind, placebo-controlled study, we aimed to assess the efficacy and safety of FOLFOX4 with all-trans-retinoic acid (ATRA) as a palliative treatment for HCC patients with EHM, compared to FOLFOX4 with a placebo. The primary endpoint was overall survival (OS), and subsequently, an exploratory model was developed based on bioinformatics to predict the efficacy of FOLFOX4-ATRA treatment. A total of 108 patients were randomly assigned in a 1:1 ratio to receive either FOLFOX4-ATRA or FOLFOX4-placebo. The intention-to-treat (ITT) population showed a median OS of 16.2 months for the FOLFOX4-ATRA group, compared with 10.7 months for the FOLFOX4-placebo group (HR 0.56, 95% CI 0.33–0.93; p = 0.025). The median progression-free survival (PFS) was 7.1 months for the FOLFOX4-ATRA group and 4.2 months for the FOLFOX4-placebo group (HR 0.62, 95% CI 0.41–0.94; p = 0.024). A panel of proteins with unique upregulation during complete response (CR) (SOD3, TTR, SSC5D, GP5, IGKV1D-33) and partial response (PR) (TGFB1, GSS, IGHV5-10-1) effectively predicted CR and PR in patients treated with FOLFOX4-ATRA, as compared to FOLFOX4-placebo. The results suggest that FOLFOX4-ATRA is a safe and effective treatment for patients with advanced HCC and EHM in eastern China.

目的:探讨基于MRI的支持向量机(FVM)算法在鉴别小肝癌与异型增生结节中的诊断价值.方法:回顾性研究肝炎肝硬化背景下经病理证实且具有完整MRI影像资料的患者70例,其中小肝癌40例(≤2 cm)和异型增生结节30例,分析弥散加权成像(DWI)和增强扫描图像的信号特征;从增强图像中提取851个特征,经最小绝对收缩与选择算子(LASSO)回归筛选出84个特征,最终通过支持向量机算法构建分类模型.采用受试者工作特征(ROC)曲线评价DWI和支持向量机算法对小肝癌和异型增生结节的诊断性能.结果:支持向量机算法的ROC曲线下面积(AUC 0.945,95％CI 0.858～0.987)显著高于DWI方法(AUC 0.788,95％CI 0.673～0.876;P＜0.05);相比于 DWI 的灵敏度(97.5％,95％CI 86.8％～99.9％)和特异度(60.0％,95％CI40.6％～77.3％),支持向量机具有更高的灵敏度(100.0％,95％CI 90.3％～100.0％)和特异度(92.6％,95％CI75.7％～99.1％).结论:基于MRI的支持向量机在区分肝硬化背景下的小肝癌和异型增生结节方面显示出比DWI更好的诊断性能,尤其是提升了诊断的特异度.

Liver cancer is one of the most common malignant tumors. In Asia, liver cancer often develops on a background of cirrhosis caused by chronic hepatitis. The procedure of hepatitis, cirrhotic nodules, dysplastic nodules, and then hepatocellular carcinoma is the most common liver cancer evolutionary process. Judging the stage of hepatic nodules in the evolution process and taking intervention measures are critical for reducing the incidence of liver cancer. In this paper, a more accurate support vector machine (SVM) classification algorithm, LFOA-F-SVM, was proposed for radiomics to classify hepatic nodules from 120 patients into four categories based on dynamic enhanced magnetic resonance images. The algorithm uses radius-margin-based F-SVM, and combines the fruit fly optimization algorithm (FOA) of Levy flight (LF) strategy to optimize the parameters. To verify the effectiveness of the method, five UCI classification data sets (hearts, Parkinson’s disease, iris, wine and zoo) were added and compared with SVM, PSO-SVM, FOA-SVM, F-SVM. The results showed that LFOA-F-SVM has the highest classification accuracy in six data sets compared to the other methods. And in the hepatic nodules data set, the classification precision and recall are relatively high.

PurposeThe present study aimed to develop and validate a preoperative model based on gadobenate-enhanced magnetic resonance imaging (MRI) for predicting microvascular invasion (MVI) in patients with hepatocellular carcinoma (HCC) size of ≤5 cm. In order to provide preoperative guidance for clinicians to optimize treatment options.Methods164 patients with pathologically confirmed HCC and preoperative gadobenate-enhanced MRI from July 2016 to December 2020 were retrospectively included. Univariate and multivariate logistic regression (forward LR) analyses were used to determine the predictors of MVI and the model was established. Four-fold cross validation was used to verify the model, which was visualized by nomograms. The predictive performance of the model was evaluated based on discrimination, calibration, and clinical utility.ResultsElevated alpha-fetoprotein (HR 1.849, 95% CI: 1.193, 2.867, P=0.006), atypical enhancement pattern (HR 3.441, 95% CI: 1.523, 7.772, P=0.003), peritumoral hypointensity on HBP (HR 7.822, 95% CI: 3.317, 18.445, P<0.001), and HBP hypointensity (HR 3.258, 95% CI: 1.381, 7.687, P=0.007) were independent risk factors to MVI and constituted the HBP model. The mean area under the curve (AUC), sensitivity, specificity, and accuracy values for the HBP model were as follows: 0.830 (95% CI: 0.784, 0.876), 0.71, 0.78, 0.81 in training set; 0.826 (95% CI:0.765, 0.887), 0.8, 0.7, 0.79 in test set. The decision curve analysis (DCA) curve showed that the HBP model achieved great clinical benefits.ConclusionIn conclusion, the HBP imaging features of Gd-BOPTA-enhanced MRI play an important role in predicting MVI for HCC. A preoperative model, mainly based on HBP imaging features of gadobenate-enhanced MRI, was able to excellently predict the MVI for HCC size of ≤5cm. The model may help clinicians preoperatively assess the risk of MVI in HCC patients so as to guide clinicians to optimize treatment options.

BACKGROUND:Lymph node (LN) metastasis is significantly associated with worse prognosis for patients with intrahepatic cholangiocarcinoma (ICC). Improvement in preoperative assessment on LN metastasis helps in treatment decision-making. We aimed to investigate the role of radiomics-based method in predicting LN metastasis for patients with ICC.METHODS:A total of 296 patients with ICC who underwent curative-intent hepatectomy and lymphadenectomy at two centers in China were analyzed. Radiomic features, including histogram- and wavelet-based features, shape and size features, and texture features were extracted from four-phase computerized tomography (CT) images. The clinical and conventional radiological variables which were independently associated with LN metastasis were also identified. A combined nomogram predicting LN metastasis was developed, and its performance was determined by discrimination, calibration, and stratification of long-term prognosis. The results were validated by the internal and external validation cohorts.RESULTS:Twenty-four radiomic features were selected into the nomogram. The established nomogram demonstrated good discrimination and calibration, with areas under the curve (AUCs) of 0.98 [95% confidence interval (CI) 0.96-0.99], 0.93 (0.88-0.98), and 0.89 (0.81-0.96) in the training and two validation cohorts, respectively. The 5-year overall survival (OS) and recurrence-free survival (RFS) rates of patients with high risk of LN metastasis as grouped by nomogram were poorer than those of patients with low risk in the training cohort (OS 28.8% versus 53.9%, p < 0.001; RFS 26.3% versus 44.2%, p = 0.001). Similar results were observed in the two validation cohorts.CONCLUSIONS:Radiomics-based method provided accurate prediction of LN metastasis and prognostic assessment for ICC patients, and might aid the preoperative surgical decision.

目的 探讨基于CT特征的列线图对于鉴别长径≥1 cm的腔内型胆囊癌(GBC)和胆囊腺瘤(GA)的价值.方法 回顾性分析≥1 cm的腔内型GBC 46例和GA 41例的临床表现、实验室指标和CT特征表现.采用单因素及最小绝对收缩与选择算子(LASSO)回归分析筛选独立预测因子,构建列线图预测模型,并通过受试者工作特征(ROC)曲线的曲线下面积(AUC)和校准曲线对其有效性进行评价.结果 单因素分析显示年龄、白蛋白、糖类抗原19-9(CA19-9)、病灶长径、位置、是否为分叶状、基底情况、平扫CT值、动脉期CT值、门脉期CT值、延迟期CT值在2组间有统计学差异(P<0.05);经LASSO回归分析显示病灶长径、基底情况及延迟期CT值为区分腔内型GBC和GA的独立预测因子(P<0.05),结合CA19-9建立列线图模型;绘制ROC曲线显示AUC为0.936,校准AUC为0.922.结论 基于病灶长径、基底情况、延迟期CT值和CA19-9建立的列线图模型可鉴别≥1 cm的腔内型GBC和GA,为临床治疗方式的选择提供重要信息.

Purpose The present study aimed to determine the reliable imaging features to distinguish atypical hepatocellular carcinoma (HCC) with peripheral rim-like enhancement from intrahepatic mass-forming cholangiocarcinoma (IMCC) on contrast-enhanced magnetic resonance imaging (MRI). Methods A total of 168 patients (130 male, 57.10 ± 10.53 years) pathological confirmed HCC or IMCC who underwent contrast-enhanced MRI between July 2019 and February 2022 were retrospectively included. Univariate and multivariate logistic regression analyses were used to determine independent differential factors for distinguishing HCC from IMCC, and the model was established. Bootstrap resampling 1000 times was used to verify the model, which was visualized by nomograms. The predictive performance of the model was evaluated based on discrimination, calibration, and clinical utility. Results Radiological capsule (OR 0.024, 95% CI: 0.006, 0.095, P<0.001), heterogeneous signal intensity (SI) on T1WI (OR 0.009, 95%CI: 0.001,0.056, P<0.001) were independent differential factors for predicting HCC over IMCC. A lobulated contour (OR 11.732, 95%CI: 2.928,47.007, P = 0.001), target sign on DP (OR 14.269, 95%CI: 2.849,82.106, P = 0.007), bile duct dilatation (OR 12.856, 95%CI: 2.013, P = 0.001) were independent differential factors for predicting IMCCs over HCCs. The independent differential factors constituted a model to distinguish atypical HCCs and IMCCs. The area under receiver operating characteristic (ROC) curve, sensitivity, and specificity values of the model were 0.964(0.940,0.987), 0.88, and 0.906, indicating that the model had an excellent differential diagnostic performance. The decision curve analysis (DCA) curve showed that the model obtained a better net clinical benefit. Conclusion The present study identified reliable imaging features for distinguishing atypical HCCs with peripheral rim-like enhancement from IMCCs on contrast-enhanced MRI. Our findings may help radiologists provide clinicians with more accurate preoperative imaging diagnoses to select appropriate treatment options.

Objective:To summarize the clinicopathological features and imaging findings of hepatoid adenocarcinoma of gallbladder.Methods:The clinical data, pathological examination results, imaging data and postoperative follow-up data of 6 patients with hepatoid adenocarcinoma of gallbladder diagnosed by surgery and pathology admitted to the Third Affiliated Hospital of Naval Medical University from January 2010 to October 2019 were retrospectively analyzed.Results:The onset ages of the 6 patients with hepatoid adenocarcinoma of gallbladder ranged from 49 to 69 years, the incidence rate of male and female was 2∶1, and 3 cases had liver or lymph node metastasis. The serum alpha fetoprotein (AFP) level was increased and hepatocyte paraffin-1 (Hep-1) staining was positive in all 6 patients. MRI and CT showed moderate to significant enhancement in arterial phase, decreased enhancement in portal vein phase and delayed phase in 1 patient, and mild enhancement in 1 patient. Uneven enhancement was observed in 1 patient. Of the 6 patients, 2 patients were lost to follow-up; 2 patients survived 5 years after surgery without recurrence; 1 patient was found to have liver metastasis 2 years after operation and survived to date after treatment; 1 patient relapsed 1 year after operation and died 6 months after treatment.Conclusion:Hepatoid adenocarcinoma of gallbladder is more likely to occur in middle-aged and elderly men, and is prone to liver or lymph node metastasis, and usually accompanied by elevated serum AFP level, poor prognosis, combined with clinical and imaging features can improve the diagnostic accuracy of this disease.

Purpose The purpose of this study was to establish a model for predicting early recurrence (≤2 years) of hepatocellular carcinoma (HCC) after anatomical hepatectomy based on the hepatobiliary phase (HBP) imaging characteristics of gadobenate-enhanced MRI. Methods A total of 155 patients who underwent anatomical hepatectomy HCC therapy and gadobenate-enhanced MRI were included retrospectively. The patients were divided into the early recurrence-free group ( n = 103) and the early recurrence group ( n = 52). Univariate and multivariate Cox regression analysis was used to determine the independent risk factors related to early recurrence, and four models were established. The preoperative model with/without HBP imaging features (HBP-pre/No HBP-pre model) and the postoperative model with/without HBP imaging features (HBP-post/No HBP-post model). Bootstrap resampling 1,000 times was used to verify the model and displayed by nomograms. The performance of nomograms was evaluated by discrimination, calibration, and clinical utility. Net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were used to evaluate the differences between models and to select the optimal model. Results Shape, arterial peritumoral enhancement, AFP-L3, and peritumoral hypointensity on HBP were identified as independent risk factors. Prothrombin time (PT) and r-glutamyltransferase (GGT) were selected by multivariate Cox regression. These six factors construct the HBP-pre model. Removing peritumoral hypointensity on HBP was the No HBP-pre model. Adding microvascular invasion (MVI) and microscopic capsule factors were the HBP-post and No HBP-post model. The C-index was 0.766, 0.738, 0.770, and 0.742, respectively. The NRI and IDI of the HBP-pre vs. the No HBP-pre model and the HBP-post vs. the No HBP-post model significantly increased 0.258, 0.092, 0.280, and 0.086, respectively. The calibration curve and decision curve analysis (DCA) had good consistency and clinical utility. However, the NRI and IDI of the No HBP-post vs. the No HBP-pre model and the HBP-post vs. the HBP-pre model did not increase significantly. Conclusions Preoperative gadobenate-enhanced MR HBP imaging features significantly improve the model performance while the postoperative pathological factors do not. Therefore, the HBP-pre model is selected as the optimal model. The strong performance of this model may help hepatologists to assess the risk of recurrence in order to guide the selection of treatment options.

Hepatolithiasis is associated with the development of intrahepatic cholangiocarcinoma (ICC). This study sought to investigate risk factors of ICC for hepatolithiasis after partial hepatectomy (PH) and to develop a model for predicting ICC risk. Data on consecutive patients who underwent PH for hepatolithiasis at the Eastern Hepatobiliary Surgery Hospital between January 2009 and December 2011 were reviewed. Independent risk factors of ICC identified by Cox regression model were used to develop a nomogram in predicting ICC after PH for hepatolithiasis. Of 2056 patients, 168 developed ICC at a median follow-up of 7.2 years. The cumulative incidences of ICC at 3, 5, and 8 years after PH for hepatolithiasis were 3.0%, 6.5%, and 12.9%, respectively. Independent risk factors of ICC were identified to be a long duration of hepatolithiasis-related symptoms (hazard ratio, 1.088 [95% confidence interval, 1.057–1.120]), metabolic syndrome (2.036 [1.210–3.425]), a high neutrophil-to-lymphocyte ratio (1.250 [1.009–2.816] for 3–5 vs ≤3; 1.538 [1.048–2.069] for ≥5 vs ≤3), hepatic atrophy (1.711 [1.189–2.462]), segmental intensity differences (1.513 [1.052–2.176]), persistent biliary strictures (2.825 [1.480–5.391]), and residual stone disease (2.293 [1.511–3.481]). By incorporating these factors, a constructed nomogram showed a concordance index of 0.721 to predict ICC. The calibration plots demonstrated good agreement between observed and predicted morbidities. The optimal cutoff point for the nomogram was 48 in differentiating between high and low-risk of ICC. A nomogram for predicting ICC after PH for hepatolithiasis was constructed based on risk factors of developing ICC. Patients with a nomogram point of ≥48 were predicted to have a high risk of ICC.

Background Predicting the long-term prognosis of individuals who experienced sorafenib treatment following partial hepatectomy due to hepatitis B virus (HBV) related hepatocellular carcinoma (HCC) is difficult. This work aims to create an effective prognostic nomogram for HBV related HCC patients who are receiving sorafenib treatment as adjuvant therapy after surgery. Methods A total of 233 HBV-related HCC patients treated with or without sorafenib following partial hepatectomy at the Eastern Hepatobiliary Surgery Hospital from 2008 to 2013 were matched with propensity score matching analysis. The optimal cut-off point of the overall survival (OS) factor level was determined by x-tile. The selection of indicators was based on clinical findings. The Cox regression model with an interaction term was employed for evaluating the predictive value. Using a multivariate Cox proportional hazards model, a nomogram was subsequently formulated to analyze 111 patients treated with sorafenib. The nomogram’s discriminative ability and predictive accuracy were determined using the concordance index (C-index), calibration, and ROC curve. Results The matched sorafenib cohort of 111 patients and control cohort of 118 patients were analyzed. Subgroup analysis revealed that low GPC3, pERK, pAKT, serum AFP levels, without MVI, under 50 years old, male, TNM stage I/II and BCLC stage 0/A were significantly associated with a better OS in patients subjected to sorafenib treatment compared to those without sorafenib treatment after surgery. Multivariate analysis of the sorafenib cohort revealed GPC3, pERK, pAKT, serum AST, and BCLC stage as independent factors for OS, and all were included in the nomogram. The survival probability based on the calibration curve showed that the prediction of the nomogram was in good agreement with the actual observation. The C-index of the nomogram for predicting survival was 0.73(95% CI, 0.67–0.78). The area under the ROC curve (AUC) for the nomogram to predict the survival for 1, 3, and 5-year was 0.726, 0.816, and 0.823, respectively. Conclusion This proposed nomogram shows the potential to make a precise prediction regarding the prognosis of HBV-related HCC patients and may help to stratify patients for personalized therapy following partial hepatectomy.

Background: Hepatocellular carcinoma (HCC), the fourth leading cause of cancer-related deaths worldwide, has risen public concern. Data from previous work have validated that long noncoding RNAs are active participators in the malignant processes of a host of cancers. Small nucleolar RNA host gene 7 (SNHG7) has been revealed to act as a tumor promoter in several cancers and SNHG7 inhibition was revealed to suppress cell invasion in HCC. Nevertheless, the specific role of SNHG7 in HCC deserves deeper exploration. Aim of the Study: This work aimed to uncover the role and the regulatory mechanisms of SNHG7 in HCC. Materials and Methods: The expression of SNHG7 and cyclin mediator 1 (CNNM1) in HCC cells were analyzed by quantitative real-time polymerase chain reaction. The influences of SNHG7 on HCC occurrence were studied by cell counting kit-8 (CCK-8), colony formation, flow cytometry analysis, and western blot assays. Luciferase reporter assay or RNA immunoprecipitation assay was conducted to confirm the relationship between miR-9-5p and SNHG7 (or CNNM1). Results: SNHG7 was overexpressed in HCC tissues and cell lines. SNHG7 facilitated cell proliferation, while suppressed cell apoptosis in HCC. Moreover, miR-9-5p expression was negatively modulated by SNHG7 and therefore was downregulated in HCC cells. We also found that CNNM1 existed in miR-9-5p induced RNA-induced silencing complex and a series of assays verified that CNNM1 acted as the target gene of miR-9-5p. Consequently, the messenger RNA and protein level of CNNM1 were detected to be inversely regulated by miR-9-5p. Moreover, rescue assays demonstrated that CNNM1 overexpression could countervail the SNHG7 depletion-mediated cellular functions of HCC cells. Conclusions: SNHG7 sponges miR-9-5p to upregulate CNNM1 in promoting HCC progression.