11534 Background: Patients with advanced GIST who progress after four lines of therapy, including imatinib, sunitinib, regorafenib, and ripretinib, face limited treatment options. Ripretinib dose escalation is a potential option recommended by NCCN and CSCO guidelines, while combination therapy with TKIs targeting complementary pathways may offer an alternative for patients harboring multiple resistance mutations. This study aims to evaluate the efficacy of ripretinib dose escalation versus combination therapy following progression on standard-dose ripretinib to identify more effective treatment strategies. Methods: This study is a multicenter cohort study designed to evaluate the efficacy and safety of ripretinib dose escalation versus combination therapy with sunitinib in patients with advanced GIST who have progressed after four prior lines of therapy. Eligible patients receive ripretinib dose escalation group (150 mg twice daily) or the combination therapy group (ripretinib 150 mg once daily plus sunitinib 25 mg once daily). The primary endpoint was progression-free survival (PFS). Results: Between September 2023 and December 2025, 30 patients were enrolled (16 in the ripretinib dose escalation group and 14 in the combination group). Primary KIT11 mutation were identified in 17 patients, 62.5%(10/16) in the dose escalation group and 50% (7/14) in the combination group, while KIT 9 mutations were 2 patients both in the combination group . As of December 30, 2025, 5 patients in the ripretinib dose escalation group remained on treatment with stable disease, whereas all patients in the combination group had experienced disease progression; 3 of these showed slow progression and continued therapy. mPFS1 with standard-dose ripretinib was comparable between groups (6.0 months [95% CI: 4.7–7.3] vs. 7.0 months [95% CI: 5.2–8.8]). Following progression, ripretinib dose escalation achieved a mPFS2 of 8.3 months (95% CI: 4.7–12.0), significantly longer than combination therapy (3.1 months [95% CI: 2.0–4.3]) . OS data remain immature. Ripretinib dose escalation demonstrated better tolerability, with no grade ≥3 adverse events reported. In contrast, the combination group experienced higher toxicity, 35.7% discontinued treatment due to severe adverse reactions. Conclusions: Preliminary results indicate that ripretinib dose escalation demonstrated superior efficacy and a more favorable safety profile compared with combination therapy involving sunitinib. These findings support ripretinib dose escalation as the preferred treatment option for patients with advanced GIST who have progressed after four lines of standard therapy. However, the sample size in this study is still small, and further research with a larger sample is needed to validate this conclusion.

386 Background: Although adjuvant chemotherapy improvs the survival rate of stage III gastric cancer after curative D2 gastrectomy, the overall benefit is unsatisfactory. Therefore, the study was designed to evaluate the efficacy and safety of adjuvant nab-paclitaxel plus S-1 (AS) versus oxaliplatin plus capecitabine (CAPOX) in the treatment of stage III gastric adenocarcinoma (GAC) after curative D2 gastrectomy. Methods: This phase 3, open-label, randomized study was conducted in patients with stage III GAC after curative D2 gastrectomy. Patients were randomized (1:1) to receive adjuvant AS (100 mg/m2 nab-paclitaxel on days 1 and 8; 40-60 mg oral S-1 twice daily on days 1-14) or CAPOX (130 mg/m2 oxaliplatin on day 1; 1000 mg/m2 oral capecitabine twice daily on days 1-14), repeat every 3 weeks for 8 cycles. The primary endpoint was the 3-year disease-free survival (DFS) rate by intention-to-treat analysis. Secondary endpoints included overall survival (OS) and safety. Results: Between March 2020 and August 2022, 280 patients were screened and 233 were randomly assigned to study treatment (AS, 115; CAPOX, 118). The median age was 62 years (range, 27-77) in AS and 63 years (range, 35-75) in CAPOX. The pathological stages were 42.61% stage IIIA, 34.78% stage IIIB, and 22.61% stage IIIC in AS, while those of CAPOX were 47.46% stage IIIA, 30.51% stage IIIB, and 22.03% stage IIIC. The 1-year DFS rate was 89.0% in AS versus 76.9% in CAPOX. The 1-year OS rate was higher in AS versus CAPOX (100% vs. 95.5%). Seven (6.09%) in AS and 11 (9.32%) in CAPOX experienced recurrence during follow-up; thereinto, one in CAPOX confirmed recurrence with tumor markers and clinical manifestations. Recurrence sites in AS and CAPOX involved the peritoneum (1 vs. 4), locoregional (1 vs. 2), and distant (5 vs. 6), of which, certain patients had 2 simultaneously. Among 6 deaths in CAPOX, 3 died from GAC, 1 died from other diseases and 2 died from unknown. The median relative dose intensity was 96.91% for nab-paclitaxel and 88.00% for S-1 in AS, 82.77% for oxaliplatin and 79.36% for capecitabine in CAPOX. Certain patients in AS (38.26%) and CAPOX (22.03%) experienced grade 3/4 adverse events (AEs). The most common AEs in AS and CAPOX included anemia (20.96% vs. 19.63%), neutropenia (30.70% vs. 21.02%), and thrombocytopenia (1.10% vs. 15.47%). Conclusions: In this study, AS showed longer trends in the DFS rate, OS rate, and manageable safety profile in patients with stage III GAC after curative D2 gastrectomy compared with CAPOX, suggesting a potential therapeutic option for this population. Clinical trial information: NCT04135781 .

Background: Gastric cancer (GC) has been identified as one of the most common malignancies. It was found that microRNAs can be used as potential biomarkers for GC diagnosis. The aim of this study was to estimate the diagnostic value of 4 potential microRNAs in GC. Methods: PubMed, Embase, Cochrane Library, and Web of Science were used to search published studies. The quality of the studies was scored with the Quality Assessment of Diagnostic Accuracy Studies. The pooled sensitivity and specificity, diagnostic odds ratio (DOR) and area under the curve (AUC) were calculated. The heterogeneity was evaluated using Cochrane Q statistics and the inconsistency index. Results: A total of 22 studies reporting the diagnostic value of miR-21 (n = 9), miR-106 (n = 10), miR-421 (n = 5) and miR-223 (n = 3) were included. Quality Assessment of Diagnostic Accuracy Studies scores showed the high quality of the selected 22 articles. The random effects model was adopted by evaluating the heterogeneity between articles. The DOR, AUC, and Q value of miRNA-21 were 12.37 (95% confidence interval [CI]: 5.36-28.54), 0.86 and 0.79, respectively. The DOR, AUC and Q value of miRNA-106 were 12.98 [95% CI: 7.14-23.61], 0.85 and 0.78, respectively. The DOR, AUC and Q value of miRNA-421 were 27.86 [95% CI: 6.04-128.48], 0.92 and 0.86, respectively. The DOR, AUC and Q value of miRNA-223 were 18.50 [95% CI: 7.80-43.86], 0.87 and 0.80, respectively. These results indicate that miRNA-421 has the highest diagnostic accuracy, followed by miR-223, miRNA-21, and miRNA-106 among the 4 microRNAs in GC. Conclusions: miR-21, miR-106, miR-421, and miR-223 have good diagnostic efficacy, especially miR-421, could be used as auxiliary diagnostic indicator for GC.

Gastric cancer (GC) has been identified as one of the most common malignancies. It was found that microRNAs can be used as potential biomarkers for GC diagnosis. The aim of this study was to estimate the diagnostic value of 4 potential microRNAs in GC.PubMed, Embase, Cochrane Library, and Web of Science were used to search published studies. The quality of the studies was scored with the Quality Assessment of Diagnostic Accuracy Studies. The pooled sensitivity and specificity, diagnostic odds ratio (DOR) and area under the curve (AUC) were calculated. The heterogeneity was evaluated using Cochrane Q statistics and the inconsistency index.A total of 22 studies reporting the diagnostic value of miR-21 (n = 9), miR-106 (n = 10), miR-421 (n = 5) and miR-223 (n = 3) were included. Quality Assessment of Diagnostic Accuracy Studies scores showed the high quality of the selected 22 articles. The random effects model was adopted by evaluating the heterogeneity between articles. The DOR, AUC, and Q value of miRNA-21 were 12.37 (95% confidence interval [CI]: 5.36-28.54), 0.86 and 0.79, respectively. The DOR, AUC and Q value of miRNA-106 were 12.98 [95% CI: 7.14-23.61], 0.85 and 0.78, respectively. The DOR, AUC and Q value of miRNA-421 were 27.86 [95% CI: 6.04-128.48], 0.92 and 0.86, respectively. The DOR, AUC and Q value of miRNA-223 were 18.50 [95% CI: 7.80-43.86], 0.87 and 0.80, respectively. These results indicate that miRNA-421 has the highest diagnostic accuracy, followed by miR-223, miRNA-21, and miRNA-106 among the 4 microRNAs in GC.miR-21, miR-106, miR-421, and miR-223 have good diagnostic efficacy, especially miR-421, could be used as auxiliary diagnostic indicator for GC.

BACKGROUND Alpha-fetoprotein (AFP) has been widely used as a tumor marker in the treatment of hepatocellular carcinoma (HCC) in patients with cirrhosis. However, a large number of HCC patients are diagnosed without cirrhosis, and the prognostic capability of AFP was unclear in HCC patients without cirrhosis. Our purpose was to investigate the prognostic efficiency of AFP in patients with non-cirrhosis, single, and small HCC who were treated with surgical resection. METHODS Among the 111 374 liver cancer patients included in the Surveillance, Epidemiology, and End Results database, we selected 224 patients without cirrhosis with a single HCC ≤3 cm in diameter who were identified at diagnosis and treated with surgical resection. The AFP test results were recorded as AFP-positive and AFP-negative levels. RESULTS Kaplan-Meier method showed that there was no significant survival difference between the AFP-positive and AFP-negative groups (P = .566). The same results were found in the subgroups of patients with tumor size ≤2 cm and 2-3 cm (P = .710 and .687, respectively). Receiver operating characteristic (ROC) curve analysis showed that AFP had inadequate accuracy to discriminate survivors and deceased patients in subgroups of patients with tumor size ≤3 cm, 2-3 cm, or ≤2 cm (area under the ROC curve = 0.449, 0.458, 0.443; 95% confidence interval = 0.366-0.533, 0.346-0.571, 0.317-0.569, respectively). CONCLUSION AFP levels have no predictive value in well-compensated non-cirrhosis patients with single, small HCC (≤3 cm) treated with surgical resection for curative intent.

Nilotinib has been used as a third-line drug for gastrointestinal stromal tumors (GISTs) after a failure of sunitinib. In this study, we aimed to evaluate the efficacy of nilotinib in different genomic subtypes of GISTs. We searched the English articles through EMBASE, Cochrane Library and PubMed Database regarding to the use of nilotinib on GISTs, which published up to February 15, 2019. Inclusion criteria were: GISTs patients received nilotinib in a clinical trial and had detailed genetic subtype records (such as KIT exon 9, KIT exon 11, or PDGFRA mutations, or wild-type). The clinical benefit rate was used to assess the efficacy of nilotinib. A total of 3 studies involving 218 GISTs were included in this meta-analysis. The overall OR (KIT group vs WT group) was 3.26 (95% CI: 1.14-9.28; P = 0.027, Pheterogeneity = 0.613). The overall OR in KIT exon 11 group vs WT group was 5.30 (95% CI: 1.79-15.68; P = 0.003, Pheterogeneity = 0.409). The overall OR in KIT exon 9 group vs WT group was 0.13 (95% CI: 0.02-0.86; P = 0.035, Pheterogeneity = 0.229). The overall OR in KIT exon 11 group vs exon 9 group was 9.96 (95% CI: 0.39-254.66; P < 0.0001, Pheterogeneity = 0.024). Different genotypes of GISTs showed different responses to nilotinib, and KIT exon 11-mutant GISTs mostly benefited from nilotinib, followed by KIT exon 9-mutant or WT one.

BACKGROUND:Immunoinflammatory markers such as the peripheral blood neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) have gained considerable attention as prognostic markers in gastrointestinal stromal tumors (GISTs).AIM:To assess the prognostic value of Onodera's Prognostic Nutritional Index (OPNI) for GISTs.METHODS:All patients who had undergone surgical resection for a primary, localized GIST from 2009 to 2016 at our cancer center were initially and retrospectively identified. Recurrence-free survival (RFS) was calculated by the Kaplan-Meier method and compared by the log-rank test. We used multivariate Cox proportional hazard regression models to identify associations with outcome variables.RESULTS:A total of 235 GISTs were identified and included for analysis under our inclusion criteria. Univariate and multivariate analyses both identified the OPNI as an independent prognostic marker, and the OPNI was associated with the primary site, tumor size, mitotic index, tumor rupture, necrosis, and modified NIH risk classification. Low OPNI (< 51.30; hazard ratio = 5.852; 95% confidence interval: 1.072-31.964; P = 0.0414) was associated with worse RFS. The 2- and 5-year RFS rates of the patients with a low OPNI were 92.83% and 76.22%, respectively, whereas 100% and 98.41% were achieved by the patients with a high OPNI.CONCLUSION:The preoperative OPNI is a novel and useful prognostic marker for GISTs.

Backgrounds Controversy surrounding CpG island methylator phenotype (CIMP) in glioma exists with regard to its prognostic value.Methods PubMed, EMBASE, and Cochrane Library databases were searched for studies describing molecular and clinicopathological features, and overall survival of gliomas stratified by CIMP status. Associations of CIMP with outcome parameters were estimated using odds ratio (OR) or hazard ratios (HRs) with a 95% confidence interval (CI) using a fixed or random effects model.Results A total of 12 studies involving 2386 gliomas (1051 CIMP-positive and 1335 CIMP-negative) were included. Molecular analysis showed that CIMP is more frequent in IDH1-mutated gliomas (OR 229.07; 95% CI 138.72–378.26) and 1p19q LOH gliomas (OR 5.65; 95% CI 2.66–12.01), though CIMP was not associated with EGFR mutation (OR 0.14; 95% CI 0.05–0.43) or MGMT promoter methylation (OR 3.01; 95% CI 0.79–11.48). Clinicopathological analysis showed that CIMP is more frequent in oligodendroglioma (OR 5.51; 95% CI 3.95–7.70), but less frequent in glioblastoma (OR 0.14; 95% CI 0.10–0.19). However, CIMP was not associated with anaplastic oligoastrocytomas (OR 1.57; 95% CI 1.24-2.00) or oligoastrocytoma (OR 0.79; 95% CI 0.35–1.76). We found that CIMP-positive glioma was associated with a longer overall survival (HR -0.57; 95% CI -0.97– -0.16).Conclusions A CIMP-positive glioma has better prognosis and its own molecular features (such as IDH1 and 1p19q LOH mutations) and clinicopathological features. These conditions suggest CIMP could be used as an independent prognostic marker for glioma.

Mesenteric fibromatosis is a locally invasive myofibroblastic proliferation and rarely metastasize to other organs. Hollow organ perforation and acute diffuse peritonitis caused by mesenteric fibromatosis rarely occurred. Here we report a case of huge mesenteric fibromatosis who complained a paroxysmal epigastric pain, and CT scan showed a huge mass, pneumoperitoneum and ascites. An urgent laparotomy showed an intro-abdominal mass and perforation locating at the jejunum. Postoperative histology confirmed it to be mesenteric fibromatosis. With one-year follow-up, the patient had no recurrence. We wish to share our treating experience of this interesting case because it did not belong to a typical type but presenting with acute diffuse peritonitis, and total resection and R0 margin is a key to treat acute case. This atypical one has not been reported in the literature till now.

Peritoneal loose body (PLB) is a rare finding and it is usually incidentally discovered during laparotomy, examination or autopsy, as it is usually asymptomatic or presents with non-specific symptoms. In particular, giant PLBs, measuring >50 mm in maximum diameter, are even more rare, and only a few cases of laparoscopic extraction of these giant bodies have been reported in the literature to date. We herein describe our experience with the diagnosis and treatment of a giant PLB in a 49-year-old male patient who was admitted with complaints of intermittent pain the in lower abdomen 3 months earlier. An abdominal computed tomography scan revealed a 5.5x5.0-cm midline mass with central high density. The diagnosis was confirmed by open surgery and postoperative pathological examination. The postoperative recovery of the patient was uneventful and he was discharged from the hospital 7 days after surgery.

Background . To determine the ideal surgical approach (total gastrectomy (TG) vs. proximal gastrectomy (PG)) for Siewert type II adenocarcinoma of the esophagogastric junction (AEG), we searched and analyzed the Surveillance, Epidemiology, and End Results (SEER) data. Methods . Patients with Siewert type II AEG treated by TG or PG were identified from the 2004–2014 SEER dataset. We obtained the patients’ overall survival (OS) and cancer-specific survival (CSS) and stratified the patients by surgical approach. We performed a propensity score 1 : 1 matching (PSM) analysis and a univariate and multivariate Cox proportional hazards model. Results . A total of 2,217 patients with 6th AJCC stage IA–IIIB Siewert type II AEG was examined: 1,584 patients (71.4%) underwent PG, and 633 patients (28.6%) underwent TG. The follow-up time was 1–131 months. OS favored total gastrectomy before the PSM analysis ( χ 2 = 3.952, p = 0.047), but after this analysis, there was no significant difference between TG and PG ( χ 2 = 2.227, p = 0.136). The univariate and multivariate analyses identified age as an independent factor, and an X-tail analysis revealed 70 years as a cut-off point. The patients aged ≥ 70 years obtained a significant long-term OS benefit from PG compared to TG ( χ 2 = 8.245, p = 0.004), and those aged < 70 years showed no difference between TG and PG ( χ 2 = 0.167, p = 0.682). Conclusions . PG showed an equivalent survival benefit to TG in both the early and locally advanced stages of Siewert type II AEG. For elderly patients, PG is strongly recommended because of its clearer OS benefit compared to TG.

BACKGROUND/AIMS:Splenectomy is regarded as an effective curative treatment for thrombocytopenia caused by hypersplenism in patients with cirrhosis. However, in clinical practice, thrombocytopenia is not resolved by splenectomy in all patients. This study aimed to evaluate the adverse factors responsible for platelet (PLT) counts below the normal lower limit following laparoscopic splenectomy and azygoportal disconnection (LSD). MATERIALS AND METHODS:We retrospectively evaluated the outcomes of 123 cirrhotic patients with portal hypertensive bleeding and secondary hypersplenism, who underwent LSD and who had PLT counts <125×109/L (non-normal group) or >125×109/L (normal group) at the postoperative month (POM) 3, between April 2014 and March 2017. RESULTS:Sixteen patients (13.01%) had PLT counts <125×109/L at POM 3 after LSD, while the remaining 107 patients had normal counts. We analyzed 25 perioperative variables in both groups. A logistic multivariate regression identified age (relative risk [RR] 1.082, 95% confidence interval [CI] 1.018-1.150) and longitudinal spleen diameter (RR 0.977, 95% CI 0.955-1.000) as significant independent factors for the PLT count <125×109/L at POM 3. Bivariate correlation analysis showed that age >50 years and longitudinal spleen diameter <160 mm were threshold values for an increased risk of the PLT count <125×109/L at POM 3 after LSD. CONCLUSION:Age was an independent positive predictor and longitudinal spleen diameter an independent negative predictor of PLT count <125×109/L at POM 3 after LSD.

The effects of post-mastectomy radiotherapy (PMRT) on different subtypes of T1-2N1M0 breast cancer remain controversial. Patients with T1-2N1M0 breast cancer treated by mastectomy or mastectomy and PMRT were identified from the 2010-2013 dataset from the Surveillance, Epidemiology and End Results (SEER) registry. A total of 7,466 patients with the 7th American Joint Committee on Cancer stage (Tumor-Node-Metastasis stages 1-2, 1 and 0, respectively) including 2,760 cases (36.97%) treated by mastectomy and PMRT and 4,706 cases (63.03%) treated by mastectomy alone were analyzed in this study. The follow-up time for patients in the dataset used from the SEER registry was 0-59 months. The breast cancer-specific survival (BCSS) of the patients was derived from the SEER dataset and stratified by treatment approach. A propensity score matching (PSM) analysis (experimental group: Control group ratio, 1:1) was conducted. Using univariate and multivariate analyses Cox proportional hazards analyses, PMRT was identified as an independent prognostic factor for triple-negative breast cancer (TNBC). Before PSM analysis, the BCSS favored PMRT in the hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)+ (P=0.025) and HR-/HER2- groups (P=0.010) but not in the HR+/HER2- (P=0.346) and HR-/HER2+ (P=0.288) groups. Following PSM analysis, BCSS favored PMRT alone in the TNBC (HR-/HER2-) group (P=0.025). Patients with T1-2N1M0 TNBC may benefit from radiotherapy post-mastectomy.

Retroperitoneal liposarcoma (RPLS) is a very rare type of tumor, accounting for less than 1% of all malignancies, especially the “large retroperitoneal liposarcoma” (GRPLS) of more than 20 kg (kilograms). Herein, we describe the treatment experience in a case of recurrent GRPLS. A 70-year-old woman was admitted with an enlarged abdomen, and computed tomography (CT) showed a large, low- density, homogeneous retroperitoneal mass (40×37×26 cm). In laparotomy, this 55×40×20 cm liposarcoma was completely removed and pathologically diagnosed as low-grade myxoid liposarcoma. The patient did not receive any adjuvant therapy, and CT showed no evidence of recurrence during follow-up.

BACKGROUND/AIMS In patients who survive the first esophageal variceal bleeding (EVB) resulting from portal hypertension, the probability of fatal esophageal variceal re-bleeding (EVR) is high. We have developed a sandwich-style sequential therapy combining laparoscopic splenectomy and azygoportal disconnection (LSD) with preoperative and postoperative endoscopic intervention (LSDE). The aim of the present study was to investigate whether LSDE is safe and effective and to evaluate whether the postoperative EVR rate for LSDE was lower than that for LSD without periodical postoperative endoscopic intervention (NLSDE). MATERIALS AND METHODS We retrospectively investigated the outcomes of 226 patients with cirrhosis with EVB and secondary hypersplenism who all received preoperative endoscopic variceal ligation (EVL) to manage emergency EVB then underwent NLSDE (n=106) or LSDE (n=120) between February 2012 and April 2016. The perioperative and follow-up variables of the two groups were evaluated. RESULTS Between the two groups, there were no differences in number of blood transfusions, intraoperative blood loss, postoperative complications, and hospital stay. LSDE showed shorter operation time (p=0.001) and lower EVR rates during the periods ranging from 1 to 12 months, 4 to 6 months, 4 to 12 months, and 7 to 12 months (all p<0.05) than NLSDE. Dynamic changes in the diameter of the esophageal varices and the rates of EVL in the LSDE group both decreased gradually and significantly over the 12-month follow-up period (all p<0.0001). CONCLUSION Laparoscopic splenectomy and azygoportal disconnection with periodical postoperative endoscopy is safe and effective for reducing the EVR rate in cirrhotic portal hypertension.

Background Although the prognostic implications of negative lymph nodes (NLNs) has been reported for a variety of tumors, little information has been published about the NLNs in gallbladder cancer (GBC). Patients and methods In this study, clinicopathological characteristics and survival times of patients who had undergone surgery for GBC were collected from the Surveillance, Epidemiology, and End Results Program-registered TNM stage database and analyzed. Univariate and multivariate Cox proportional hazards models were used to identify the predictors of survival. Results It was found that a cutoff of one to two NLNs is optimal when assessing the association with survival, survival rates being consistently better with two or more NLNs than with fewer than two. This optimal cutoff value of 2 was identified as an independent prognostic factor by univariate and multivariate analyses (all P<0.001). Specifically, patients with two or more NLNs had better 5-year gallbladder cancer cause-specific survival than those with fewer than NLNs examined for stage I/II, stage III/IV, and all TNM stages (all P<0.001). Conclusion Our findings indicate that the number of NLNs is an independent prognostic factor after GBC surgery, and, together with the number of positive lymph nodes, this will provide better prognostic information than the number of positive lymph nodes alone.

BACKGROUND:Liver resection was not formerly recommended in patients with both hepatocellular carcinoma (HCC) and portal hypertension because of difficult perioperative bleeding control and postoperative liver failure. Splenectomy is a proven method with which to overcome these problems. To investigate the safety and feasibility of synchronous laparoscopic splenectomy and azygoportal disconnection with hepatectomy (LSDH) for treatment of portal hypertension accompanied with HCC, we describe a clinical cohort of 10 patients who underwent a new technique of synchronous LSDH.METHODS:A cohort of 10 cirrhotic patients with HCC, esophageal/gastric variceal bleeding, and hypersplenism received LSDH. A 6-port method was used for LSDH. This procedure comprises 5 steps: laparoscopic splenectomy, intraoperative splenic blood salvage, laparoscopic azygoportal disconnection, laparoscopic partial hepatectomy, and removal of spleen and liver specimens. Intraoperative autologous cell salvage was performed before hepatectomy.RESULTS:LSDH was successful in all patients. There was no conversion to open operations. The operative time was 220.5 ± 19.8 minutes, blood loss was 264.0 ± 160.3 mL, and postoperative hospital stay was 10.2 ± 1.8 days.CONCLUSIONS:Selective synchronous LSDH is a feasible, effective, and safe surgical procedure with satisfactory short-term efficacy. It is a promising minimally invasive treatment option for patients with cirrhotic HCC and portal hypertension.

Objectives Sunitinib (a second-line chemotherapeutic agent that inhibits multiple kinases, including KIT and PDGFR) is widely used in imatinib-resistant patients with gastrointestinal stromal tumors (GISTs). However, diverse responses to sunitinib have been observed in the clinic. We aimed to evaluate whether the different GIST genotypes could be used to stratify patient response to sunitinib. Methods We searched the PubMed, Embase, and Cochrane databases and included English-language literature published up to August 31, 2017. Inclusion criteria were GIST patients with KIT exon 9, KIT exon 11, or PDGFRA mutations and those without KIT/PDGFRA mutations (termed the wild-type genotype) who were receiving sunitinib within a clinical trial, and the efficacy evaluation was clinical benefit rate (CBR), median progression-free survival (PFS), and overall survival (OS). Odds ratios (ORs) for CBR and hazard ratios (HRs) for PFS and OS with 95% confidence intervals (CIs) in sunitinib-treated GIST patients with different genotypes were compared. Results Seven studies totaling 531 patients were included. Patients with KIT mutations showed an improved CBR to sunitinib compared to those with PDGFRA mutations. In particular, those with the KIT exon 9 or 11 mutation showed improved CBR over those with PDGFRA mutation. Moreover, GIST patients with the KIT exon 9 mutation showed improved CBR over those with the KIT exon 11 mutation. Patients without KIT/PDGFRA mutations (wild-type genotype) showed better CBR than those with PDGFRA mutations. Conclusion GIST genotypes may be useful for stratifying patient response to sunitinib after imatinib resistance.

The purpose of this study was to conduct a comprehensive study of the clinical correlation between the alpha-fetoprotein (AFP) level at diagnosis and pathological grades, progression, and survival of patients with hepatocellular carcinoma (HCC). A total of 78,743 patients in Surveillance, Epidemiology, and End Results Program (SEER)-registered HCC was analyzed. The AFP test results for patients with HCC were mainly recorded as AFP-negative and AFP-positive. Logistic regression analysis revealed that the AFP level at diagnosis was an independent risk factor of pathological grade (odds ratio [OR], 2.559; 95% confidence interval [CI], 2.075–3.157; P < 0.001), TNM-7 stage (OR, 2.794; CI, 2.407–3.242; P < 0.001), and tumor size (OR, 1.748; 95% CI, 1.574–1.941; P < 0.001). Multivariable Cox regression analyses identified AFP level as an independent predictor of survival risk of patients with HCC who did not undergo surgery (hazard ratio [HR], 1.660; 95% CI, 1.534–1.797; P < 0.001), and those who underwent surgery (HR, 1.534; 95% CI, 1.348–1.745; P < 0.001). The AFP level at diagnosis was an independent risk predictor associated with pathological grade, progression, and survival. Further, surgery may not significantly reverse the adverse effects of AFP-positive compared with AFP-negative.

Background: Ki67 is a good marker of cell proliferation in a variety of tumors. High ki67 levels are usually associated with poor prognosis. However, the relationship between Ki67 expression and the risk of malignancy of gastrointestinal stromal tumors (GISTs) is still poorly defined. The current meta-analysis was initiated to address this issue. Methods: Studies reporting Ki67 expression and the risk of malignancy in GIST were found by searching Cochrane Library, PubMed, Medline, and Embase until October 31, 2016. A total of 9 studies involving 982 patients were included. Pooled odds ratio (OR) estimates and 95% confidence intervals (CIs) were calculated using a fixed-effect model. Results:Meta-analysis showed no significant difference in the incidence of Ki67 overexpression between the very low NIH group and the low NIH group (OR: 0.66, 95% CI: 0.25–1.76; P= .41, Pheterogeneity= .25). However, the incidence of Ki67 overexpression gradually increased from the low NIH group to the high NIH group (OR: 0.46, 95% CI: 0.27–0.80; P= .005, Pheterogeneity= .13) and (OR: 0.22, 95% CI: 0.15–0.34; P< .00001, Pheterogeneity= .33). Conclusions: There were more GIST patients with Ki67 overexpression in the intermediate and high NIH groups than in the low NIH group. Ki67 overexpression may be a useful marker of the risk of malignant GIST transformation. Abbreviations: AFIP = Armed Forces Institute of Pathology, CI = confidence interval, GIST = gastrointestinal stromal tumor, NCCN = National Comprehensive Cancer Network, NIH = National Institutes of Health, OR = odds ratio.