Objective:To investigate the long-term outcome of centrally located hepatocellular carcinoma treated by radical resection and adjuvant radiotherapy(RT).Methods:A retrospective study was used to collect and analyze the clinical and pathological data of 193 patients with centrally located HCC who underwent surgery from Jun 2015 to Jun 2020. According to whether RT was used, these patients were allocated into liver resection (LR) combined RT (88 cases) and LR alone group (105 cases).Results:The 1-, 3-, and 5-year OS rates were 98%, 85%, and 74% for patients in the LR+RT group, and 79%, 66%, and 59% for patients in the LR group, respectively. The 1-, 3-, 5-year RFS rates were 76%, 55% and 44% for patients in the LR+RT group, and 51%, 40%, and 37% for patients in the LR group, respectively. OS and RFS was significantly different in LR+RT group compared with that in LR group (χ 2=5.825, P=0.016;χ 2=5.230, P=0.022, respectively). Cox analysis showed that RT was the independent prognostic factor for centrally located HCC in OS and RFS ( P=0.009, P=0.017, respectively). Subgroup analysis suggested that RT could reduce early recurrence ( HR=0.41,95% CI:0.21-0.80, P=0.002). Conclusion:Liver resection combined with adjuvant radiotherapy for centrally located HCC is safe and effective.

Objective:To investigate the therapeutic effect and mechanism of lenvatinib on regorafenib-resistant hepatocellular carcinoma cells.Methods:CCK-8 and clone formation assay were used to observe the inhibitory effect of lenvatinib on the growth of hepatocellular carcinoma cells. Flow cytometry was used to detect the apoptosis of regorafenib-resistant hepatocellular carcinoma cells treated with lenvatinib. The expression levels of related proteins were detected by western blot and immunohistochemical staining. The inhibitory effect of lenvatinib on the tumor formation ability of regorafenib-resistant hepatocellular carcinoma cells in vivo was observed by subcutaneous tumor formation experiment in mice.Results:CCK-8 and clone formation assay showed that lenvatinib could inhibit the proliferation of regorafenib-resistant hepatocellular carcinoma cells. The number of clones of HepG2, SMMC7721 and regorafenib-resistant HepG2, SMMC7721 cells in lenvatinib group (120.67±11.06, 53.00±11.14, 55.00±9.54, 78.67±14.64) were all lower than those in control group (478.00±24.52, 566.00±27.87, 333.67±7.02, 210.00±12.77, all P<0.05). Flow cytometry showed that lenvatinib could promote apoptosis of regorafenib-resistant hepatocellular carcinoma cells, the apoptosis rates of HepG2, SMMC7721 and regorafenib-resistant HepG2, SMMC7721 cells in lenvatinib group [(12.30±0.70)%, (9.83±0.38)%, (15.90±1.32)%, (10.60±0.00)%] were all higher than those in control group [(7.50±0.87)%, (5.00±1.21)%, (8.10±1.61)%, (7.05±0.78)%, all P<0.05]. The apoptosis-related protein levels suggested that apoptosis was increased in the treatment of lenvatinib. The animal study showed that lenvatinib can inhibit the growth of regorafenib-resistant cells in vivo. Immunohistochemistry and western blot results showed that lenvatinib could down-regulate the abnormally activated IGF1R/Mek/Erk signaling pathway in regorafenib-resistant cells. Conclusion:Lenvatinib can reverse regorafenib resistance in hepatocellular carcinoma, possibly by down-regulating IGF1R/Mek/Erk signaling pathway.

Objective:To evaluate the safety and feasibility of A-P-R triangle dissection combined with ICG fluorescence staining in laparoscopic anatomical S5 segmentectomy.Methods:Clinical data of 7 patients with primary liver cancer undergoing laparoscopic anatomical S5 segmentectomy in Cancer Hospital of Peking Union Medical College, Chinese Academy of Medical Sciences and Shengli Oilfield Central Hospital from December 1, 2020 to May 30, 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them,5 patients were male and 2 female, aged from 54 to 72 years, with a median age of 65 years. Intraoperatively, A-P-R triangle dissection combined with ICG fluorescence staining were adopted to display the boundary of liver segments, and laparoscopic anatomical S5 segmentectomy was performed. Intraoperative and postoperative conditions of all patients were observed.Results:All the patients underwent the surgery successfully without conversion to open surgery. Among them, 3 cases underwent S5 segmentectomy alone, 1 case underwent S5 segmentectomy combined with partial S4b segmentectomy and 3 cases ofS5 segmentectomy combined with partial S6 segmentectomy, respectively. The median operation time was 211(162-265) min, the hepatic portal occlusion time was 32(15-75) min, and intraoperative blood loss was 150(50-300) ml. No blood transfusion was delivered. The length of postoperative hospital stay was7(3-14) d. No severe complications, such as abdominal hemorrhage and liver failure, occurred after surgery. Postoperative bile leakage occurred in 1 case, who received drainage and extubation at postoperative 20 d. All patients were followed up till the day of manuscript submission. No tumor recurrence, metastasis or death was reported.Conclusions:It is safe and feasible to perform A-P-R triangle dissection combined with ICG fluorescence staining in laparoscopic anatomical S5 segmentectomy.

Objective: In order to better understand nutritional status and management on hepatobiliary surgery patients in our hospital, as well as the nutritional evaluation and intervention for inpatients with malignant tumors, a nutrition day questionnaire survey and a prediction model was carried out, to provide a theoretical and practical basis for clinical rational decision-making. Methods: According to the nutritionDay Worldwide requirements and the approval of the ethics committee of our hospital, a questionnaire survey was conducted on the inpatients of hepatobiliary surgery department in our hospital on the nutrition days between 2016 and 2020. In addition to the general nutrition questionnaire items, the survey also included the special questionnaire for tumor patients. Machine learning models were used to predict nutrition risk using R language software. Results: This study included 103 male patients and 61 female patients with a return visit rate of 97.6%, an average age of（57.3 ± 11.8） years, and an average BMI of（24.3 ± 3.3） kg/m~2. About 25% patients with MST score greater than 2 are at nutritional risk. The main treatment goals of patients are "Curative ",tumor stage is "Localized ", nutrition treatment is " No special diet". There was a certain proportion of enteral nutrition and parenteral nutrition. Enteral nutrition has been strengthened in the past five years. The proportion of patients who were "Discharged home" on the 30th day follow-up was 73.2%. Predictive evaluation from support vector machine（SVM） was far better than that from Logistic regression and discriminant analysis models. Conclusions: The nutrition intervention for tumor patient in our hospital has not been effectively implemented. The trainings for doctors and nurses on nutritional concepts and knowledge, as well as the guidance of patients’ reasonable diet and nutrition education need to be strengthened. SVM could be selected for prediction, which is helpful to improve tumor treatment and patients’ quality of life.

目的 比较国产和进口中长链脂肪乳/氨基酸(16)/葡萄糖(16％)注射液的质量.方法 参照国内外同类产品的质量检测标准,测定两厂家生产药品的关键质量指标以及混合后的营养液关键质量指标.用SPSS24统计软件分析检测结果.结果 两厂家产品的各检测指标均符合国家标准规定,其中,国产厂家的过氧化值、甲氧基苯胺值、溶血磷脂酰胆碱、溶血磷脂酰乙醇胺和5-羟甲基糠醛含量等杂质指标均低于进口厂家,差异具有统计学意义.国产药比进口药混合后脂肪乳平均粒径大;但＞5 μm乳粒的百分比却更低.国产药的渗透压浓度约840 mOsmol·L-1,还可于用于外周静脉输注.结论 国产和进口的脂肪乳的质量指标均符合国家标准,且国产脂肪乳的质量更优于进口脂肪乳,能保证患者的用药安全.

目的 探讨Glisson蒂横断尾背侧入路腹腔镜左半肝切除术的安全性和可行性.方法 回顾性分析2017年10月至2020年12月完成的29例Glisson蒂横断尾背侧入路腹腔镜左半肝切除术的临床资料.结果 男性19例,女性10例,年龄46～70岁,27例为肝脏恶性肿瘤,2例肝内外胆管结石.29例均顺利完成手术,均全程暴露肝中静脉,手术时间在171±41min.术中失血量在135±114ml,无术中大出血、气体栓塞、中转开腹等,术后无出血、二次手术等并发症,仅1例出现胆漏,延迟拔管引流治愈.术后平均住院时间为5天.结论 Glisson蒂横断尾背侧入路腹腔镜左半肝切除术是一种安全可行、高效的手术方式.

Objective: From December 2019, the new coronavirus pneumonia (COVID-19) broke out in Wuhan, Hubei, and spread rapidly to the nationwide. On January 20, 2020, the National Health Committee classified COVID-19 pneumonia as one of B class infectious diseases and treated it as class A infectious disease. During the epidemic period, the routine diagnosis and treatment of tumor patients was affected with varying degrees. In this special period, we performed the superiority of the multi-disciplinary team of diagnosis and treatment, achieved accurate diagnosis and treatment of patients with hepatobiliary malignant tumors, provided support for these patients with limited medical resources, and helped them to survive during the epidemic period.On the basis of fully understanding the new coronavirus pneumonia, the treatment strategy should be changed timely during the epidemic, and more appropriate treatment methods should be adopted to minimize the adverse effect of the epidemic on tumor treatment.

Objective: To investigate the risk factors of prolonged postoperative length of stay (LOS) in patients with gastric cancer. Methods: A retrospective study was performed on 2033 patients who underwent curative surgery in Department of Pancreatic-gastric, Cancer Hospital, Chinese Academy of Medical Sciences. Eightieth percentile of postoperative hospital stay for all patients was taken as the cutoff, the patients were divided into the normal group (1 532 patients) and the extended group (501 patients). Logistic regression model was used to determine the risk factors related to prolonged postoperative LOS in gastric cancer. Results: A total of 417 cases with postoperative complications were recruited in extended group. The five highest complications accounting for prolonged LOS were: abdominal infection in 69 cases (13.77%), pleural effusion in 60 cases (11.98%), anastomotic leakage in 43 cases (8.58%), poor wound healing in 34 cases (6.79%), and bleeding in 25 cases (4.99%). Logistic regression analysis showed that age (OR=1.348, P=0.013), surgical procedure (OR=2.712, P<0.001), extent of resection (OR=2.035, P<0.001), degree of incision healing(OR=4.867, P<0.001), and perioperative blood transfusion (OR=1.711, P<0.001) were independent risk factors for prolonged postoperative LOS. Conclusions: The most common complication associated with prolonged postoperative LOS for gastric cancer patients is abdominal infection. Age, surgical procedure, extent of resection, degree of incision healing, and perioperative blood transfusion are the independent risk factors for prolonged postoperative LOS.

OBJECTIVE To explore the significance of resection margin and tumor number on survival of patients with small liver cancer after hepatectomy. METHODS We collected 219 cases with small liver cancer undergoing hepatectomy in Cancer Hospital, Chinese Academy of Medical Sciences between December 2003 to July 2013. The survival rates were compared by log-rank test between two resection margin groups (≥ 1 cm vs. <1 cm), different tumor number groups (single tumor vs. multiple tumors). We also performed a multifactor analysis by Cox model. RESULTS The 1-, 3-, 5- and 10- year overall survival rates were 95.9%, 85.3%, 67.8% and 53.3%, respectively, in all patients. The median survival time was 28 months in the group of <1 cm resection margin and 36 months in the group of ≥ 1 cm resection margin (P=0.249). The median survival time was 36 months in the group of single tumor and 26 months in the group of multiple tumors (P=0.448). The multifactor analysis also did not show significant effect of resection margin and tumor number on the patients' survival. CONCLUSIONS For small liver cancer, the resection margin of 1 cm might be advised. Increasing resection margin in further could probably not improve therapeutic effect. Standardized operation and combined treatment will decrease the negative influence of multiple tumors on overall survival.

OBJECTIVE To investigate the role of CCL20/CCR6/Th17 axis in vascular invasion and metastasis of primary hepatocellular carcinoma (HCC). METHODS Expression levels of CCL20 mRNA in the normal human liver cell line L-02, and human hepatocellular carcinoma cell lines Hep3B, Huh7 and HepG2 were quantified by using SYBR green real time PCR. CCL20 secretions from these cell lines were quantified by using ELISA. The chemotactic effect of HCC cell line Hep3B on human peripheral blood mononuclear cells was determined by using transwell chemotaxis assay. Pre-therapy serum levels of IL-1α, IL-1β, IL-6, IL-8, IL-10, IL-17, IL-23, IFN-γ, TNF-α and CCL20 in 93 patients with HCC were measured by using 9-plex array and ELISA. All the patients were chronic hepatitis B virus associated HCC, and 51 cases were those with vascular invasion and metastasis (metastasis group) and 42 cases were not (non-metastasis group). CCL20 and CCR6 mRNA expressions in the HCC and tumor-adjacent tissues were determined by using SYBR Green real time PCR in 41 patients, among them, 20 cases were from the group of patients with metastasis and 21 cases were from the group of patients without metastasis. The CCL20 expression was further determined by immunohistochemistry. RESULTS The HCC cell lines expressed and secreted higher amount of CCL20, which effectively recruited CCR6(+) T cells. Pre-therapy serum levels of CCL20 in 93 HCC patients were (38.2 ± 28.4)pg/ml, significantly increased than those with benign hepatic hemangiomas [(7.8 ± 17.8)pg/ml, P < 0.01]. In addition, the serum levels of CCL20 were positively correlated with the tumor diameters in HCC patients (r = 0.32, P = 0.0018). CCL20 was dominantly expressed in the cytoplasm in HCC cells, and it was also expressed by some infiltrating immune cells. The mRNA expression levels of CCL20 of the tumor tissues were significantly higher than that in the tumor-adjacent tissues (P < 0.05). Multivariate logistic regression analysis showed that serum levels of IL-17 and CCL20 were independent risk factors of metastasis in HCC patients (P < 0.05 for both). CCL20 mRNA showed no statistically significant differences between patients with metastasis and without metastasis in both tumor tissues and tumor-adjacent tissues (P > 0.05 for both). But the patients with metastasis showed significantly higher expressions of CCR6 both in their tumor [5.75 (1.79, 19.13)]and tumor-adjacent tissues [7.99 (4.49, 19.54)] than those with non-metastasis [1.69 (0.76, 2.87) and 3.58 (1.84, 4.32), P < 0.05 for both]. CONCLUSION CCL20/CCR6/Th17 axis may promote vascular invasion and metastasis hepatocellular carcinoma.

OBJECTIVE:R0 resection, Pringle maneuver, intraoperative massive blood loss and perioperative blood transfusion have been definitely recognized to be surgery-related risk factors of recurrence of hepatocellular carcinoma (HCC) in recent years. The aim of this study was to investigate the post-operative risk factors of recurrence of HCC after control of the above mentioned risk factors.METHODS:288 consecutive HCC patients underwent hepatectomy with selective regional vascular occlusion by the same surgical team. All patients had R0 resection, less than 800 ml blood loss and had no perioperative blood transfusion. The clinical and pathological factors were retrospectively analyzed.RESULTS:The total 1-year, 3-year and 5-year disease-free survival rate (DFS) was 74.9%, 49.3% and 34.3%, respectively. Univariate analysis showed that serum gamma-glutamyl-transferase rise >55 U/L, AFP > 400 ng/ml, tumor diameter >5 cm, multi-focal lesions, satellite nodules, poor differentiation, microvascular invasion, envelope invasion, postoperative liver insufficiency, preoperative TACE and postoperative TACE were significantly associated with poor DFS. Multivariate Cox analyses revealed that tumor size, satellite nodules, poor differentiation, microvascular invasion and postoperative liver insufficiency were independent prognostic predictors associated with shorter DFS. According to the results of multivariate Cox analysis of 158 cases with at least one risk factor selected from the whole group, further analysis demonstrated that perioperative TACE was not significantly associated with the median DFS (P > 0.05 for all).CONCLUSIONS:Selective regional vascular occlusion may effectively control the surgiury-related risk factors of recurrence of HCC. Tumor features are the main affecting factors of DFS. Preoperative or postoperative TACE do not benefit patients who received curative resection.

For successful therapy, hepatocellular carcinoma (HCC) must be detected at an early stage. Herein, we used a proteomic approach to analyze the secretory/releasing proteome of HCC tissues to identify plasma biomarkers. Serum-free conditioned media (CM) were collected from primary cultures of cancerous tissues and surrounding noncancerous tissues. Proteomic analysis of the CM proteins permitted the identification of 1365 proteins. The enriched molecular functions and biological processes of the CM proteins, such as hydrolase activity and catabolic processes, were consistent with the liver being the most important metabolic organ. Moreover, 19% of the proteins were characterized as extracellular or membrane-bound. For validation, secretory proteins involved in transforming growth factor-β signaling pathways were validated in plasma samples. Alphafetoprotein (AFP), metalloproteinase (MMP)1, osteopontin (OPN), and pregnancy-specific beta-1-glycoprotein (PSG)9 were significantly increased in HCC patients. The overall performance of MMP1 and OPN in the diagnosis of HCC remained greater than that of AFP. In addition, this study represents the first report of MMP1 as a biomarker with a higher sensitivity and specificity than AFP. Thus, this study provides a valuable resource of the HCC secretome with the potential to investigate serological biomarkers. MMP1 and OPN could be used as novel biomarkers for the early detection of HCC and to improve the sensitivity of biomarkers compared with AFP.

胰腺实性假乳头状瘤是一类原发于胰腺的低度恶性肿瘤.多见于年轻女性,临床症状多不明显,生化指标、肿瘤标志物大多正常.影像学呈囊实性混杂表现,CT增强扫描呈高血供表现.SPT组织来源尚不完全明确,病理诊断主要依靠形态学,免疫组化对鉴别诊断有一定参考意义.

Objective: To evaluate the clinical characteristics and different therapeutic methods for treating cholangiocellular carcinoma and to examine the factors correlated with outcome in order to guide clinical treatment and improve prognosis. Methods: Clinical data of 41 cases with cholangiocellular carcinoma from the Chinese Academy of Medical Science (CAMS) Cancer Hospital during the period from January of 1970 to January of 2005, were retrospectively reviewed. Follow up data for all patients were available. Results: In the 41 cases, the positive rate of alpha-fetoprotein (AFP) was 9.8% (4/41), and that of liver cirrhosis was 22.0% (9/41). In the group with radical excision, the 1-, 3- and 5-year survival rate was 82.3%, 45.8% and 45.8%, respectively, and in the group with non-radical excision, the 1- and 3-year survival rate was 9.2% and 0%. Multifactor analysis with the Cox proportional-hazards model indicated that radical excision (P<0.01), lymphatic metastasis (P<0.01) and preoperative level of direct bilirubin (P=0.012) were independent factors affecting the prognosis. Conclusion: Surgical treatment is the main therapy for intrahepatic cholangiocellular carcinoma and radical excision is the only pathway for long term survival. Radical excision, lymphatic metastasis and preoperative level of direct bilirubin are independent factors affecting the prognosis.