BACKGROUND:Current tumour-node-metastasis (TNM) staging for hepatocellular carcinoma (HCC) relies primarily on anatomical factors without incorporating tumour biological characteristics, limiting prognostic precision. This study aimed to develop and validate a novel staging system integrating serum biomarkers alpha-fetoprotein (AFP) and protein induced by vitamin K absence or antagonist-II (PIVKA-II) with conventional TNM classification to enhance prognostic stratification following hepatectomy. METHODS:This multicentre cohort study included patients undergoing curative hepatectomy for HCC at six hospitals in China. The APTNM staging system was constructed by combining preoperative AFP (≥200 μg/L = 1 point), PIVKA-II (≥400 mAU/mL = 1 point), and AJCC 8th edition TNM stage (stages I-III = 1-3 points). Patients were classified as APTNM stage I (1 point), stage II (2-3 points), or stage III (4-5 points). Prognostic performance was evaluated using Kaplan-Meier analysis, multivariate Cox-regression, net reclassification improvement (NRI), and time-dependent receiver operating characteristic (ROC) curves. RESULTS:Among 660 HCC patients, the APTNM staging system demonstrated clear stratification for 5-year overall survival (OS) [stage I (n = 195), 47.7 %; stage II (n = 316), 28.1 %; stage III (n = 149), 15.3 %; P < 0.001] and recurrence-free survival (RFS) (stage I, 29.4 %; stage II, 12.7 %; stage III, 0.0 %; P < 0.001). Multivariate analysis confirmed APTNM staging as an independent predictor of both OS (stage II: HR 1.592, 95 % CI 1.209-2.096; stage III: HR 2.314, 1.668-3.211; both P < 0.001) and RFS (stage II: 1.556, 1.230-1.969; stage III: 2.159, 1.623-2.872; both P < 0.001). Time-dependent NRI values ranged from 0.20 to 0.26 for OS and 0.18-0.31 for RFS across 5-year follow-up, demonstrating substantial improvement over conventional TNM staging. Time-dependent ROC analysis consistently showed superior performance for the APTNM staging. CONCLUSIONS:The APTNM staging system successfully integrates tumour biomarkers with anatomical factors, providing significantly enhanced prognostic stratification compared with conventional TNM staging. This biologically informed approach may facilitate more precise risk stratification and guide individualised postoperative surveillance and adjuvant therapy decisions for patients with HCC.

Neuroendocrine neoplasms (NENs) are biologically heterogeneous tumors in which differentiation/grade and hormonal functionality are intersecting but non-equivalent axes. This review focuses on functional and non-functional well-differentiated neuroendocrine tumors (NETs), principally gastroenteropancreatic and pancreatic NETs, and critically evaluates how site, lineage, stage, tumor burden, genomic and epigenetic alterations, immune-stromal remodeling, metabolic adaptation, microbiome-associated signals, and treatment pressure converge on metastasis and recurrence. Apparent outcome differences by functionality are inconsistent after clinicopathological adjustment: non-functional presentation is often enriched for delayed diagnosis and adverse features, whereas functional subtypes range from typically indolent insulinomas to clinically aggressive hormone-producing tumors. We reconcile these observations through a layered model in which lineage-defining alterations and chromatin/telomere programs establish cellular state; signaling and metabolic plasticity enable stress adaptation; and hypoxia, angiogenesis, immune cells, fibroblasts, extracellular matrix, and therapy create selective niches for dissemination and relapse. We also define computational strategies for heterogeneous multi-omics integration and a staged biomarker-validation pathway. Evidence remains dominated by pancreatic NETs, and causal support is weakest for microbiome-functionality relationships and several proposed cross-omic links. A spectrum-based framework is therefore most useful when it generates testable, site- and grade-specific hypotheses rather than treating functionality as an isolated prognostic variable.

Malignant distal biliary obstruction (MDBO) is commonly managed by internal drainage with ERCP-guided self-expandable metal stents (ERCP-SEMS) or surgical hepaticojejunostomy (HJ), yet contemporary SEMS-only, patient-centered comparisons focusing on time to recurrent jaundice are scarce. To compare HJ versus ERCP-SEMS in MDBO, with a primary focus on time to recurrent jaundice. We conducted a single-center retrospective cohort of consecutive MDBO patients undergoing palliative biliary decompression (February 2013–August 2021). Groups were defined by the first modality achieving effective internal drainage. The primary endpoint was time to recurrent jaundice (interval to repeat biliary intervention). Secondary endpoints were length of stay (LOS), 30-day complications, and overall survival (OS). Among 171 patients (HJ, n = 107; ERCP-SEMS, n = 64) with broadly comparable baselines, ERCP-SEMS yielded a shorter LOS (6.67 ± 4.02 vs. 9.56 ± 5.38 days; P < 0.001). Thirty-day complication rates were similar (21.9

Lysosomes are essential for intracellular degradation and recycling, and changes in their function significantly contribute to tumor growth. Nonetheless, the exact role of lysosome-related genes (LRGs) in the pathogenesis of acute myeloid leukemia (AML) is still inadequately comprehended. Differentially expressed LRGs (DE-LRGs) between AML and control groups were identified using AML-related data extracted from the Gene Expression Omnibus (GEO). The LRGs-related prognostic genes were identified and the risk model was established using univariate COX regression analysis and machine learning algorithms, based on the data obtained from The Cancer Genome Atlas (TCGA). Subsequently, we performed comprehensive analyses regarding clinical features, functional pathways, immune microenvironment, and chemotherapeutic drugs sensitivity between the high- and low-risk groups. Reverse transcription Quantitative polymerase chain reaction (RT-qPCR) and western blot were adopted to validate the expression of prognostic genes in human bone marrow-derived cell line HS-27 A and human AML cell line MOLM-13. Through comprehensive analysis, a risk model was developed utilizing ten LRGs (ATP6V0E2, CALCRL, TMEM165, GZMB, HCK, TCIRG1, CD1D, GPRASP1, ABCA1, and NAGA), and this model was further validated using GEO datasets. Significant differences in clinical characteristics, functional pathways, immune microenvironment characteristics, and chemotherapeutic drug sensitivity were observed between the two risk groups In vitro validation experiment illustrated that the expression trends of ATP6V0E2, TMEM165, and ABCA1 were consistent with our bioinformatics analysis. Our study demonstrates that lysosome-associated signature might forecast the prognosis of AML patients and offer guidance for subsequent immunotherapy and chemotherapy strategies.

Objective:To investigate the clinicopathological characteristics, treatment strategies, and prognostic outcomes of biliary neuroendocrine carcinoma (Biliary NEC), and to review the relevant literature to provide further evidence for the clinical management of this rare malignancy. Methods:We retrospectively analyzed the clinical data of nine patients who underwent surgical resection and were pathologically diagnosed with biliary NEC at Shandong Provincial Hospital between May 2012 and October 2025. Clinical manifestations, imaging findings, surgical procedures, histopathological and immunohistochemical results (Syn, CgA, CD56, Ki-67), and follow-up outcomes were collected. Overall survival (OS) was estimated using the Kaplan-Meier method. Additionally, published case reports and case series from 2020 onward were reviewed for comparison. Results:Among the nine patients (3 males and 6 females; median age, 65 years; range, 57-77 years), the primary tumor sites included the gallbladder (n = 4), hilar bile duct (n = 3), and distal bile duct (n = 2). The main presenting symptoms were abdominal discomfort (n = 6) and jaundice (n = 3). All tumors were poorly differentiated NECs, comprising six small-cell and two large-cell types, with Ki-67 indices ranging from 30% to 80% (median, 70%). Immunohistochemistry showed Syn (+), CgA (±), and CD56 (±), with partial expression of SSTR2. All patients underwent curative-intent resection (R0 in 8 and R1 in 1), and four received systemic chemotherapy initiated after documented tumor recurrence. The median follow-up duration was 649 days (range, 67-953 days), and the median OS was 649 days (95% CI: 85-1213 days). A review of the literature revealed that systemic chemotherapy, particularly platinum-based regimens, was associated with longer median survival (18 vs. 9 months). Conclusions:Biliary NEC is a rare and highly aggressive malignancy with nonspecific clinical manifestations, and its diagnosis relies primarily on histopathological and immunohistochemical evaluation. Surgical resection remains the cornerstone of treatment, while systemic chemotherapy may provide additional survival benefit in selected patients. A high Ki-67 index and lymph node metastasis have been consistently reported as adverse prognostic indicators in biliary neuroendocrine carcinoma, primarily based on evidence from previously published studies. Given the limited sample size of the present case series, our observations should be interpreted as descriptive rather than statistically conclusive. Future multicenter studies incorporating molecular and immunologic profiling are warranted to clarify the biological behavior of biliary NEC and to optimize individualized therapeutic strategies.

Background: Hepatectomy remains the mainstay of curative treatment for hepatocellular carcinoma (HCC), although its high recurrence rates have limited long-term outcomes. This study aimed to compare long-term oncological outcomes following hepatectomy for HCC across two distinct periods to evaluate the impact of evolving systemic therapies and surgical approaches on patient survival. Methods: This multicentre study analysed patients who underwent curative hepatectomy for HCC from 2011-2022 at 12 hepatobiliary centres in China. Outcomes were compared between two 6-year periods: 2011-2016 (n=1,736) and 2017-2022 (n=1,431). Five-year overall survival (OS), recurrence-free survival (RFS), and post-recurrence survival (PRS) were compared between the two periods. Results: Of 3,167 patients included (1,736 in 2011-2016; 1,431 in 2017-2022), those in the later period had lower incidence of macrovascular invasion (11.3% vs. 15.4%, P=0.001) and advanced stage disease (BCLC stage C: 14.5% vs. 18.9%, P<0.001). Utilisation of preoperative downstaging therapy (6.7% vs. 3.1%, P<0.001) and postoperative adjuvant therapy (37.1% vs. 22.3%, P<0.001) increased significantly, as did laparoscopic approaches (42.8% vs. 21.0%, P<0.001). Five-year overall survival increased significantly from 48.0% to 63.1% (P<0.001), with corresponding improvement in recurrence-free survival from 31.9% to 42.2% (P<0.001). Multivariable analysis identified surgical period as an independent predictor of OS (HR: 0.77; 95% CI: 0.67-0.88; P<0.001), RFS (HR: 0.72; 95% CI: 0.60-0.86; P=0.001), and PRS (HR: 0.74; 95% CI: 0.62-0.85; P<0.001). Patients with recurrence in the later period had improved 5-year PRS (24.8% vs. 17.5%, P<0.001), associated with increased use of combined locoregional and systemic therapies (37.8% vs. 19.3%, P<0.001). Conclusions: This large multicentre analysis demonstrates substantial improvements in long-term oncological outcomes after HCC resection over the past decade. Better patient selection, increased utilisation of systemic therapies, and more effective management of recurrence have collectively enhanced long-term survival.

Background Precise preoperative risk stratification is critical for hepatocellular carcinoma (HCC) patients undergoing hepatectomy. This multicenter study aimed to develop and validate a laboratory-based prognostic score for survival prediction in patients undergoing hepatectomy for HCC. Methods Patients who underwent curative hepatectomy between January 2015 and December 2022 from six hospitals were divided into the training and validation cohorts. Preoperative laboratory parameters were analyzed by univariate and multivariate Cox regression. Based on alpha-fetoprotein (AFP, A), protein induced by vitamin K absence or antagonist-II (PIVKA-II, P), albumin (ALB, A), aspartate aminotransferase (AST, S), and total bilirubin (TBIL, L), we constructed a prognostic model named APASL. The prognostic performance was assessed using concordance index (C-index), time-dependent receiver operating characteristic curves, and calibration plots. Results A total of 1669 patients undergoing curative hepatectomy for HCC were included, 1239 as the training cohort and 430 as the validation cohort. The APASL score showed strong prognostic performance, with C-indices of 0.702 and 0.706 for predicting 5-year survival in the training and validation cohorts, respectively. X-tile analysis identified an optimal cutoff of 1.6, effectively separating patients into low-risk (≤ 1.6) and high-risk (> 1.6) groups, with significant differences in 5-year survival rates (61.4% vs. 37.2%, P < 0.001). The APASL score demonstrated superior predictive accuracy compared with conventional staging systems (TNM, BCLC, CLIP and Milan) and liver-function-based scores (ALBI and APRI). Multivariate Cox analysis confirmed that a high APASL score (> 1.6) was independently associated with decreased overall survival (hazard ratio: 1.248, 95% confidence interval: 1.036-1.502, P = 0.019). Conclusions The APASL score provides an effective, exclusively laboratory-based prognostic tool for predicting long-term survival after hepatectomy for HCC. This straightforward scoring system facilitates objective preoperative risk assessment without requiring histopathologic information, potentially improving surgical decision-making and patient counseling for patients with HCC.

Liver cancer has long ranked among the leading causes of cancer-related deaths in China. Although hepatitis B virus (HBV) and hepatitis C virus (HCV) were historically the predominant etiologies, their associated disease burden has significantly declined in recent years due to widespread vaccination and antiviral therapies. Concurrently, the burden of liver cancer originating from metabolic dysfunction–associated steatotic liver disease (MASLD), which often progresses to metabolic dysfunction–associated steatohepatitis (MASH), has risen rapidly in association with the growing prevalence of metabolic disorders such as obesity and diabetes. This suggests a structural shift in the etiological landscape of liver cancer in China. Based on data from the Global Burden of Disease Study 2021 (GBD 2021), we systematically analyzed trends from 1990 to 2021 in liver cancer burden attributable to four major causes—HBV, HCV, alcohol consumption, and MASLD—in the Chinese population. Key metrics included ASPR and disability-adjusted life years (DALYs). We further assessed DALY changes attributable to four key risk factors: high body mass index (BMI), high fasting plasma glucose (FPG), alcohol consumption, and tobacco use. Future trends from 2022 to 2036 were projected using a Bayesian age-period-cohort (BAPC) model. From 1990 to 2021, the ASPR for HBV-related liver cancer declined significantly (estimated annual percentage change [EAPC] = − 0.15, 95

Background & aims: With the rising prevalence of non-alcoholic fatty liver disease (NAFLD) as a significant etiology for hepatocellular carcinoma (HCC), lean NAFLD-HCC has emerged as a specific distinct subtype. This study sought to investigate long-term outcomes following curative-intent hepatectomy for early-stage NAFLD-HCC among lean patients compared with overweight and obese individuals. Methods: A multicenter retrospective analysis was used to assess early-stage NAFLD-HCC patients undergoing curative-intent hepatectomy between 2009 and 2022. Patients were stratified by preoperative body mass index (BMI) into the lean (<23.0 kg/m(2)), overweight (23.0-27.4 kg/m(2)) and obese (>= 27.5 kg/ m(2)) groups. Study endpoints were overall survival (OS) and recurrence-free survival (RFS), which were compared among groups. Results: Among 309 patients with NAFLD-HCC, 66 (21.3 %), 176 (57.0 %), and 67 (21.7 %) were lean, overweight, and obese, respectively. The three groups were similar relative to most liver, tumor, and surgery-related variables. Compared with overweight patients (71.3 % and 55.6 %), the lean individuals had a worse 5-year OS and RFS (55.4 % and 35.1 %, P = 0.017 and 0.002, respectively), which were comparable to obese patients (48.5 % and 38.2 %, P = 0.939 and 0.442, respectively). After adjustment for confounding factors, multivariable Cox-regression analysis identified that lean bodyweight was independently associated with decreased OS (hazard ratio: 1.69; 95 % confidence interval: 1.06-2.71; P = 0.029) and RFS (hazard ratio: 1.72; 95% confidence interval: 1.17-2.52; P = 0.006) following curative- intent hepatectomy for early-stage NAFLD-HCC. Conclusions: Compared with overweight patients, individuals with lean NAFLD-HCC had inferior longterm oncological survival after hepatectomy for early-stage NAFLD-HCC. These data highlight the need for examination of the distinct carcinogenic pathways of lean NAFLD-HCC and its potential consequences in HCC recurrence. (c) 2024 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).

BACKGROUND:Tertiary lymphoid structures (TLSs) have emerged as critical regulators of antitumor immunity and prognostic indicators in various malignancies. However, the distribution patterns and prognostic significance of TLSs in hepatoblastoma (HB) remain poorly understood. This study aimed to investigate the presence, distribution, and prognostic value of TLSs in HB patients following neoadjuvant chemotherapy and to explore the underlying mechanisms linking TLSs to the tumor immune microenvironment. METHODS:A total of 112 HB patients who underwent neoadjuvant chemotherapy and surgical resection at Shandong Provincial Hospital between 2015 and 2024 were retrospectively enrolled. The presence of TLSs was evaluated using hematoxylin and eosin (H&E) staining, and patients were classified into TLS-positive and TLS-negative groups. Univariate and multivariate Cox regression analyses were performed to identify independent prognostic factors for overall survival (OS). In addition, transcriptome data from the GEO database (GSE133039) were analyzed to construct a TLS gene signature score and explore immune-related mechanisms associated with TLS presence. RESULTS:TLSs were identified in 45 out of 112 hepatoblastoma patients (40.2%). Kaplan-Meier survival analysis demonstrated that TLS-positive patients had significantly longer overall survival (OS) compared to TLS-negative patients (p = 0.0017). Multivariate Cox regression analysis further confirmed the presence of TLSs as an independent favorable prognostic factor (HR = 0.061, p = 0.027). In contrast, advanced PRETEXT stage (III/IV), vascular invasion, and distant metastasis were identified as independent adverse prognostic factors, indicating that patients diagnosed at later stages tended to have a worse prognosis. Transcriptomic analysis revealed that TLS-positive tumors exhibited higher expression of antigen presentation and immune activation-related genes (e.g., HLA-DQA1, HLA-DQB1, SLAMF7), along with enriched infiltration of B cells, CD8+ T cells, and NK cells, suggesting a more active antitumor immune microenvironment. CONCLUSION:The presence of TLSs is significantly associated with favorable prognosis in HB patients and may contribute to enhanced antitumor immunity by recruiting and activating cytotoxic immune cells. TLSs represent a promising prognostic biomarker and potential immunotherapeutic target for HB patients. IMPACT:Tertiary lymphoid structures (TLSs) serve as a promising prognostic biomarker in hepatoblastoma (HB). Our study demonstrates that TLS-positive patients exhibit significantly prolonged overall survival. TLSs contribute to the tumor immune microenvironment by recruiting cytotoxic immune cells. These findings provide new insights into TLSs as a potential immunotherapeutic target for HB patients.

Objective This study aims to identify the optimal treatment strategy and conduct a prognostic analysis for patients with locally advanced Upper Tract Urothelial Carcinoma (UTUC). Methods and materials The study included 3,829 patients diagnosed with pT3-4N0/+M0 UTUC from 2004 to 2015, with data obtained from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were randomly assigned to a training group (70%) and a validation group (30%) for nomogram development. Variables that were significant in univariate COX regression analysis (P < 0.05) were included in the multivariate COX regression model, and a nomogram was formulated based on the variables that remained statistically significant (P < 0.05) in the multivariate analysis. The nomogram's predictive precision and ability to differentiate were evaluated through the concordance index(C-index), area under the curve (AUC), and calibration curves. The model's clinical validity was confirmed through the use of decision curve analysis (DCA). Results Within the pN+ subgroup, the combination of surgery with both adjuvant chemotherapy and radiotherapy (S + R + C) group and S + C group yielded superior results over the S group, with the S + R + C group regimen showing the most favorable outcomes. The 3-year OS rates for patients in the S + R + C, S + C, and S groups were recorded as 40.00%, 31.43%, and 12.5%. The corresponding 3-year CSS rates were 47.56%, 34.02%, and 17.5%. Multivariate COX regression analysis identified age, primary tumor location, T and N stages, treatment modality, tumor size, and lymph node count as significant predictors of OS and CSS. These factors were integrated into precisely developed nomograms for predicting OS and CSS, with concordance indices of 0.651 and 0.667 in both sets. Conclusion For patients with pT3-4N + M0 stage UTUC, the addition of radiotherapy to the surgical and chemotherapy regimen has proven to enhance survival rates. Our predictive nomogram reliably forecasts OS and CSS rates for locally advanced patients. This tool can assist clinicians in identifying high-risk individuals, thereby aiding in the formulation of informed treatment decisions.

BACKGROUND:Non-functional gastroenteropancreatic neuroendocrine neoplasms (GEP-NENs) are rare tumors, and liver metastasis is the leading cause of death in patients with GEP-NENs. Due to the difficulty in conducting large cohort studies, no reliable tool currently exists to predict the risk of liver metastasis in these patients. This study aimed to develop and validate a nomogram model based on large cohort clinical data to accurately predict the risk of liver metastasis in patients with non-functional GEP-NENs. METHODS:A retrospective cohort study was conducted, encompassing 838 patients with non-functional GEP-NENs diagnosed between 2009 and 2023. Independent risk factors for liver metastasis were identified through univariate and multivariate logistic regression analyses. A nomogram was constructed based on significant predictors, including T stage, N stage, Ki-67 index, primary tumor site, and BMI. The model's performance was evaluated using the C-index, calibration curves, and decision curve analysis (DCA) for both training and validation cohorts. RESULTS:The nomogram demonstrated excellent predictive performance, with C-index values of 0.839 and 0.823 for the training and validation sets, respectively. Risk stratification using the nomogram's total score effectively differentiated high-risk from low-risk patients. Kaplan-Meier survival analysis revealed significant survival differences between these groups (P < 0.0001). Moreover, the calibration curves indicated strong agreement between predicted and observed outcomes. CONCLUSIONS:The developed nomogram is a reliable tool for predicting the risk of liver metastasis in non-functional GEP-NENs. It facilitates early identification of high-risk patients, thereby enabling personalized treatment and timely intervention. Future research should focus on multicenter validation and the integration of molecular markers to enhance the robustness and clinical applicability of the model.

To compare outcomes of LLR in VI/VII of the liver in Left-lateral Decubitus Jackknife Position (LDJP) and traditional Supine Position (SP). We used propensity score matching (PSM) to analyze clinical outcomes. This study retrospectively analyzed patients undergoing LLR for liver tumors in segments VI and/or VII at Shandong Provincial Hospital from 2018 to 2023. A total of 218 cases were included (LDJP, n = 94; SP, n = 124). Matched 1:1 PSM groups were created and clinical indicators compared between groups. 218 LLR patients, 94 LDJP and 124 supine. After 1:1 PSM, each group had 62 patients. No significant differences in clinical or laboratory parameters. All surgeries were successful, 1 LDJP conversion to open resection and 4 SP conversions (P = 0.375). LDJP average surgery duration: 220.6 ± 29.9 min, supine position: 262.6 ± 35.6 min (P < 0.001). LDJP perioperative blood loss: 169.0 ± 74.4 mL, supine position: 231.6 ± 84.6 mL (P < 0.001). Four LDJP patients required intraoperative blood transfusion compared to 16 supine position patients (P = 0.012). All cases had negative margins postoperatively. No significant differences in postoperative complications (8 LDJP vs 9 supine, P = 0.675) or length of hospital stay (25 LDJP vs 26 supine, ≥ 7 days) (P = 1.000). Laparoscopic partial hepatectomy in LDJP for hepatic VI/VII tumor safe and feasible. Reduces operative time, blood loss, transfusion requirement, improving outcomes.

BACKGROUND:Postoperative pulmonary complications (PPCs) can significantly reduce quality of life and may be life-threatening. While predictors of PPCs have been studied in various surgeries, specific data on pancreaticoduodenectomy is limited. METHODS:We conducted a retrospective analysis of 338 patients who underwent pancreaticoduodenectomy for biliary, pancreatic, and duodenal tumors at our hospital from 2017 to 2023. We compared demographic, clinical, and laboratory variables between patients with and without PPCs within 30 days post-surgery. Independent risk factors were identified using multivariate logistic regression analysis, and a nomogram was developed to predict PPC risk. Model accuracy was validated with the concordance index (C-index) and calibration curves. RESULTS:Of the 338 patients, 149 (44.1%) developed PPCs. Significant variables associated with PPCs included age, smoking, alcohol consumption, type and duration of surgery, timing of nasogastric tube removal, tumor size, tumor location, and preoperative albumin levels. Multivariate logistic regression analysis identified independent risk factors: type and duration of surgery, tumor location, maximum tumor diameter, and preoperative albumin levels. The nomogram incorporating these factors had a C-index of 0.749. The ROC curve showed an AUC of 0.75, indicating satisfactory predictive performance. Calibration curves, decision curve analysis (DCA), and clinical impact curves confirmed the model's validity and reliability. CONCLUSION:Type and duration of surgery, tumor location, maximum tumor diameter, and preoperative albumin levels are independent risk factors for PPCs after pancreaticoduodenectomy. We developed a new nomogram to predict PPCs in these patients.

BACKGROUND:Liver metastasis impacts survival in patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs); however, current guidelines lack consensus on post-resection surveillance and adjuvant therapy. A comprehensive risk stratification tool is needed to guide personalized management. OBJECTIVE:We aimed to develop and validate a predictive model for liver metastasis risk after surgical resection of GEP-NETs that incorporates pathological factors and adjuvant therapy. METHODS:Patients with GEP-NETs who underwent surgical resection with curative intent at three major Chinese hospitals (2010-2022) were identified. Univariable and multivariable Cox regression analysis identified independent risk factors of liver metastasis. The liver metastasis score (LMS) was developed using weighted risk factors and validated by tenfold cross-validation. RESULTS:Among the 724 patients included in the analytic cohort, liver metastasis occurred in 66 patients (9.1%) at a median of 36 months; patients with liver metastasis had a worse 5-year overall survival (no liver metastasis 63.6% vs. liver metastasis 95.8%; p < 0.001). Independent predictors were Ki-67 index (hazard ratio [HR] 10.36 for Ki-67 3-20%, HR 18.30 for Ki-67 >20%, vs. <3%), vascular invasion (HR 5.03), lymph node metastases (HR 2.24), and lack of adjuvant therapy (HR 3.03). The LMS demonstrated excellent discrimination (C-index 0.888) and stratified patients into low, intermediate, and high-risk relative to 5-year risk of liver metastasis: 2.9%, 20.8%, and 49.7%, respectively (p < 0.001). CONCLUSIONS:The novel LMS effectively predicted the risk of liver metastasis after surgical resection of GEP-NETs. This validated model can help guide personalized surveillance and adjuvant treatment strategies, potentially improving outcomes for high-risk patients.

486 Background: When applied in the second-line treatment for biliary tract cancer (BTC) pts, surufatinib (a small-molecule inhibitor of VEGFR1-3, FGFR1 and CSF-1R) monotherapy has demonstrated moderate clinical efficacy and has demonstrated favorable tolerability and safety profiles. This study was to evaluate the efficacy and safety of surufatinib as a therapy for BTC in a real-world setting. In particular, pts who received resection for BTC with positive margins would be eligible for this study. This population indicates a poor prognosis, for their tumor environment is complex, which is an obstacle to R0 resection. However, no proper treatment for this population has been recommended yet. Methods: This is an ongoing single-arm, multi-center, open-label real-world study conducted in China. The study would enroll 200 pts with unresectable or surgical resection with positive margins BTC. Pts would receive surufatinib with or without combination as adjuvant (namely pts with positive margin after resection), first- or further-line therapy, at a proper dose (200-300mg) judged by physicians once per day in 28-day cycles. The primary endpoint is relapse-free survival (RFS) for pts whose primary lesions were resected, and progression-free survival (PFS) for those had evaluable lesions. If available, tumor assessments were performed every 2 cycles ± 7 days according to RECIST version 1.1. Results: By Sep 10, 2023, 56 eligible pts had been enrolled, of whom 16 (28.6%) were female. The median age was 64 (range: 39-81). 28 (50.0%), 24 (42.9%), and 4 (7.1%) pts received surufatinib as adjuvant, first-line, and above treatment, respectively. As to location, 23 cases were intrahepatic cholangiocarcinoma (ICC), and 33 cases were extrahepatic cholangiocarcinoma (ECC) or gallbladder cancer (GBC). With a median follow-up time of 9.5 (range: 1.1-20.3) mo, the global mRFS/mPFS was 10.4 (95% CI: 9.0-13.9) mo. The mRFS of pts who received surufatinib as adjuvant treatment was 11.3 (95% CI: 10.4-NA) mo, and mPFS of those who received surufatinib as systematic treatment was 9.0 (95% CI: 7.8-10.8) mo. Pts with ICC demonstrated an mRFS/mPFS of 10.4 (5.8-NA) mo, and those with ECC or GBC demonstrated 10.4 (9.5-NA) mo. The global mOS was 15.8 (12.4-NA) mo. Among those with primary lesion unresected (n=28), 2 pts (7.1%) achieved CR, 5 (17.9%) pts PR, 16 (57.1%) pts SD, and 5 (17.9%) pts suffered PD. The ORR was 25.0%, and DCR was 82.1%. No new safety signal was observed. Conclusions: Surufatinib exhibited promising efficacy and manageable toxicity on pts with BTC in the real-world setting. Clinical trial information: NCT05064852 .

A 40-year-old male patient was admitted due to abdominal distension and discomfort in the upper abdomen persisting for three days. Enhanced CT of the upper abdomen revealed an irregularly dense soft tissue area in the body and tail of the pancreas, approximately 7.6 × 3.1 cm in size, with blurred boundaries, and indistinct separation from the splenic artery and vein. Multiple liver lesions of varying sizes and slightly lower densities were also observed. Liver tumor biopsy considering a neuroendocrine tumor G2, combined with the medical history, led to a diagnosis of pancreatic neuroendocrine tumor G2 with liver metastasis. Physical examination showed mild tenderness in the upper abdomen but no other significant positive signs. During treatment, the patient developed multiple red papular rashes around the mouth, on both lower limbs, and the perineum, accompanied by itching. The glucagon level was 1138.3 pg/L. The patient underwent resection of the pancreatic body and tail, splenectomy, partial liver tumor resection, and cholecystectomy. Within five days post-surgery, the skin lesions began to crust and flake off. On the 14th day post-surgery, the serum glucagon level was rechecked at 136.4 pg/L. As of April 2024, progression of liver lesions was noted, with no significant skin symptoms during the period.

AbstractBackgroundThe Barcelona Clinic Liver Cancer (BCLC) staging system is an internationally recognized clinical staging system for hepatocellular carcinoma (HCC). However, this staging system does not address the staging and surgical treatment strategies for patients with spontaneous rupture hemorrhage in HCC. In this study, we aimed to investigate the prognosis of patients with BCLC stage A undergoing liver resection for HCC with spontaneous rupture hemorrhage and compare it with the prognosis of patients with BCLC stage A undergoing liver resection without rupture.MethodsClinical data of 99 patients with HCC who underwent curative liver resection surgery were rigorously followed up and treated at Shandong Provincial Hospital from January 2013 to January 2023. A retrospective cohort study design was used to determine whether the presence of ruptured HCC (rHCC) is a risk factor for recurrence and survival after curative liver resection for HCC. Prognostic comparisons were made between patients with ruptured and non‐ruptured BCLC stage A HCC (rHCC and nrHCC, respectively) who underwent curative liver resection.ResultsrHCC (hazard ratio [HR] = 2.974, [p] = 0.016) and tumor diameter greater than 5 cm (HR = 2.819, p = 0.022) were identified as independent risk factors for overall survival (OS) after curative resection of BCLC stage A HCC. The postoperative OS of the spontaneous rupture in the HCC group (Group I) was shorter than that in the BCLC stage A group (Group II) (p = 0.008). Tumor invasion without penetration of the capsule was determined to be an independent risk factor for recurrence‐free survival (RFS) after liver resection for HCC (HR = 2.584, p = 0.002).ConclusionHCC with concurrent spontaneous rupture hemorrhage is an independent risk factor for postoperative OS after liver resection. The BCLC stage A1 should be added to complement the current BCLC staging system to provide further guidance for the treatment of patients with spontaneous rupture of HCC.