目的 观察中晚期肝细胞癌患者应用仑伐替尼联合卡瑞利珠单抗治疗后临床缓解情况,探讨未缓解的影响因素.方法 2021年1-12月河南省人民医院诊治无法行手术治疗的中晚期肝细胞癌患者41例,均采用仑伐替尼联合卡瑞利珠单抗方案治疗,至疾病进展或出现不可耐受的不良反应停药.治疗期间每4～6周评估疗效,随访至2022年12月记录肿瘤缓解情况和不良反应发生情况.根据末次随访结果将41例患者分为缓解组(完全缓解+部分缓解)和未缓解组(疾病进展+疾病稳定).比较2组入院时血管内皮生长因子、谷草转氨酶、谷丙转氨酶、血小板计数,糖类抗原125(CA125)、糖类抗原19-9(CA19-9)、甲胎蛋白等指标及肿瘤直径、肝硬化、肝外转移、门静脉癌栓、BCLC分期、肝功能Child-Pugh分级、联合肝动脉栓塞化疗情况等.多因素logistic回归分析中晚期肝细胞癌患者采用仑伐替尼联合卡瑞利珠单抗治疗未缓解的影响因素.结果 末次随访时41例患者中完全缓解4例,部分缓解6例,疾病稳定21例,疾病进展10例,总缓解率为24.39％.未缓解组血管内皮生长因子[176.00(103.00,318.80)ng/L]、谷草转氨酶[50.40(32.10,72.80)u/L]水平均高于缓解组[101.72(77.36,119.15)ng/L、30.20(23.43,37.45)u/L](U=-2.215,P=0.034;U=-2.338,P=0.019;),BCLC 分期 C 期(67.7％)、有门静脉癌栓(58.1％)、血小板计数＞350×109/L(45.2％)比率均高于缓解组(20.0％、20.0％、10.0％)(x2=6.998,P=0.008;x2=4.385.P=0.036;x2=4.029,P=0.045),肿瘤直径[78.00(31.00,115.00)mm]大于缓解组[30.82(27.50,40.71)mm](U=-2.672,P=0.009);2 组血清白蛋白、谷丙转氨酶、CA125、CA19-9、甲胎蛋白、总胆红素水平,乙型及丙型肝炎病毒感染、联合肝动脉栓塞化疗、肝硬化、肝外转移比率及肝功能Child-Pugh分级比较差异均无统计学意义(P＞0.05).肿瘤直径(OR=1.042,95％CI:1.015～1.069,P=0.022)、血小板计数(OR=1.413,95％CI:1.007～1.982,P=0.042)、BCLC 分期(OR=1.363,95％CI:1.123～1.664,P=0.016)、门静脉癌栓(OR=2.044,95％CI:1.518～4.973,P=0.014)是中晚期肝细胞癌患者采用仑伐替尼联合卡瑞利珠单抗治疗后未缓解的影响因素.结论 肿瘤直径大、血小板计数＞350× 109/L、有门脉癌栓、肿瘤分期晚的中晚期肝细胞癌患者采用仑伐替尼联合卡瑞丽珠单抗治疗效果差.

目的 探讨T1b期胆囊癌(GBC)患者采用腹腔镜胆囊切除(LC)联合肝组织楔形切除、区域淋巴结清扫术治疗的临床效果.方法 选取 2016 年 2 月至 2020 年 1 月在河南省人民医院接受治疗的T1b期GBC患者共计 86 例,以随机数字表法分为研究组(n=44,LC联合肝组织楔形切除、区域淋巴结清扫术治疗)与对照组(n=42,LC治疗),对两组围手术期指标、疼痛程度[痛觉模拟评分法(VAS)]、肿瘤标志物、生活质量[世界卫生组织生存质量测定量表简表(WHOQOL-BREF)]、并发症发生率、生存率进行比较.结果 研究组手术时间、胃肠功能恢复时间、住院时间长于对照组,且出血量多于对照组,差异有统计学意义(P＜0.05);研究组术后 24 h、72 h VAS评分与对照组比较,差异无统计学意义(P＞0.05);两组术后 72 h癌胚抗原(CEA)、血清糖类抗原 19-9(CA19-9)水平降低,差异有统计学意义(P＜0.05),但研究组与对照组比较,差异无统计学意义(P＞0.05);两组术后 1 个月WHOQOL-BREF评分提高,且研究组评分高于对照组,差异有统计学意义(P＜0.05);研究组并发症发生率(11.36%)与对照组(7.14%)比较,差异无统计学意义(P＞0.05);研究组术后3年生存率(36.36%)较对照组(16.67%)更高,差异有统计学意义(P＜0.05).结论 LC联合肝组织楔形切除、区域淋巴结清扫术应用于T1b期GBC患者治疗中,能够提高生活质量,提高远期生存率,不会增加术后并发症,但手术时间更长,术中出血量更多,恢复时间更长.

Gallbladder cancer (GBC) is a highly malignant tumor with extremely poor prognosis. Previous studies have suggested that the carcinogenesis and progression of GBC is a multi-stage and multi-step process, but most of them focused on the genome changes. And a few studies just compared the transcriptome differences between tumor tissues and adjacent noncancerous tissues. The transcriptome changes, relating to every stage of GBC evolution, have rarely been studied. We selected three cases of normal gallbladder, four cases of gallbladder with chronic inflammation induced by gallstones, five cases of early GBC, and five cases of advanced GBC, using next-generation RNA sequencing to reveal the changes in mRNAs and lncRNAs expression during the evolution of GBC. In-depth analysis of the sequencing data indicated that transcriptome changes from normal gallbladder to gallbladder with chronic inflammation were distinctly related to inflammation, lipid metabolism, and sex hormone metabolism; transcriptome changes from gallbladder with chronic inflammation to early GBC were distinctly related to immune activities and connection between cells; and the transcriptome changes from early GBC to advanced GBC were distinctly related to transmembrane transport of substances and migration of cells. Expression profiles of mRNAs and lncRNAs change significantly during the evolution of GBC, in which lipid-based metabolic abnormalities play an important promotive role, inflammation and immune activities play a key role, and membrane proteins are very highlighted molecular changes.

Objective:To analyze the different clinicopathological features of intrahepatic cholangiocarcinoma with and without viral hepatitis.Methods:The clinicopathological data of 79 intrahepatic cholangiocarcinoma cases from Mar 2012 to Sep 2018 at Henan Provincial People's Hospital were retrospectively analyzed.Results:Twenty-five of the 79 patients with intrahepatic cholangiocarcinoma were accompanied by viral hepatitis. Those with viral hepatitis had a lower mean age at onset than those without [(53±11) years vs. (60±11) years, P=0.011], higher proportion of male patients (80% vs. 52%, P=0.017), higher AFP positive rate (40% vs. 19%, P=0.041), lower CA19-9 positive rate (48% vs. 72%, P=0.036), tend to occur in the right liver lobe (76% vs. 44%, P=0.009), a lower rate of bile duct invasion (16% vs. 41%, P=0.03), and were more likely to be mass type (mass type proportion 96% vs. 72%, P=0.032). Conclusions:Viral hepatitis is common in intrahepatic cholangiocarcinoma. Intrahepatic cholangiocarcinoma with and without viral hepatitis differ in clinicopathology. Intrahepatic cholangiocarcinoma with viral hepatitis is more likely to have the characteristics of hepatocellular carcinoma, while intrahepatic cholangiocarcinoma without viral hepatitis is more likely to have the characteristics of cholangiocarcinoma.