ObjectiveTo explore the advantages and disadvantages of preoperative biliary drainage, the timing of preoperative biliary drainage, and the characteristics of various drainage methods for resectable hilar cholangiocarcinoma.MethodsBy reviewing relevant literatures at home and abroad in the past 20 years, the controversies related to the preoperative biliary drainage, surgical biliary drainage, and various drainage methods for resectable hilar cholangiocarcinoma were reviewed.ResultsThere is still a great deal of controversy about whether preoperative bile duct drainage is required for resectable hilar cholangiocarcinoma routinely, but there is a consensus on the timing of preoperative biliary drainage, and various drainage methods have their own characteristics.ConclusionsThe main treatment for hilar cholangiocarcinoma is radical surgical resection, but cholestasis is often caused by malignant biliary obstruction, which makes it difficult to manage perioperatively. A large number of prospective studies are needed to provide more evidence for the need for routine preoperative biliary drainage in patients with hilar cholangiocarcinoma who can undergo resection.
ObjectiveTo explore the treatment and prognostic factors of typeⅢhilar cholangiocarcinoma. MethodsThe data of 170 cases of typeⅢhilar cholangiocarcinoma treated in our hospital from Jan. 2002 to Dec. 2011 were retrospectively analyzed. ResultsAmong these 170 patients of typeⅢhilar cholangiocarcinoma, 109 patients underwent surgical exploration in which 60 patients underwent resection and the remaining 49 patients were found unresectable and underwent U-tube or metallic stent drainage. Sixty one patients were preoperatively assessed as unresectable in which 14 patients underwent percutaneous transhepatic cholangial drainage and the remaining 47 patients refused any surgical intervention. Results of Cox proportional hazard model showed that residual tumor status (HR=4.621, 95% CI:1.907-11.199, P=0.001), lymph node metastasis (HR=2.792, 95% CI:1.393-5.598, P=0.004), and hepatectomy (HR=3.003, 95% CI:1.373-6.569, P=0.006) were independent prognostic factors which associated with patients in resection group. Besides, treatmentR0 resection (HR=0.177, 95% CI:0.081-0.035, P < 0.001), no treatment (HR=5.568, 95% CI:2.733-11.342, P < 0.001)] and vascular invasion (HR=1.667, 95% CI:1.152-2.412, P=0.007) were prognostic factors associated with all patients. ConclusionsTreatment and vascular invasion are the most important predictors of prolonging survival associated with typeⅢhilar cholangiocarcinoma. Besides, R0 resection including hepatectomy without lymph nodes metastasis is feasible in the majority of patients with resectable hilar cholangiocarcinoma.
ObjectiveTo detect the expressions of takeda G protein-coupled receptor 5 (TGR5) and mortalin protein 75 in the tissues of patients with intrahepatic cholangiocarcinoma (ICC), and to explore their relationship with prognosis.MethodsA total of 94 ICC patients who were admitted to Anyang District Hospital and received surgical treatment from March 2015 to March 2018 were selected as the research objects. The expressions of TGR5 and mortalin protein 75 in ICC cancer tissues and adjacent tissues were detected by immunohistochemistry and Western blot (WB). The relationship between the expressions of TGR5 and mortalin protein 75 in ICC cancer tissues and clinicopathological parameters and prognosis was analyzed. Multivariate Cox proportional hazards regression was used to analyze the risk factors of poor prognosis in patients with ICC. ROC curve was used to analyze the diagnostic value of TGR5 and mortalin protein 75 for poor prognosis in patients with ICC.ResultsImmunohistochemical results showed that the positive expression rates of TGR5 and mortalin protein 75 in cancer tissues were significantly higher than those in adjacenttissues (P<0.05). WB results showed that the protein expression levels of TGR5 and mortalin protein 75 in cancer tissues were significantly higher than those in adjacent tissues (P<0.05). The expression of TGR5 protein in cancer tissues of ICC patients was correlated with gender, tumor diameter, degree of differentiation, TNM staging, satellite focus, and liver cirrhosis (P<0.05). The expression of mortalin protein 75 was correlated with tumor diameter, TNM staging, nerve involvement, satellite focus, and liver cirrhosis (P<0.05). There were significant differences in gender, tumor diameter, TNM staging, microvascular invasion, satellite focus, liver cirrhosis, and the expressions of TGR5 and mortalin protein 75 between the poor prognosis group and the good prognosis group (P<0.05). The cumulative 3-year overall survival rate of TGR5 positive patients (32.00%) was significantly lower than that of TGR5 negative patients (63.16%), χ2=6.228, P=0.013; the cumulative 3-year overall survival rate of mortalin protein 75 positive patients (32.91%) was significantly lower than that of mortalin protein 75 negative patients (66.67%), χ2=6.079, P=0.014. Multivariate Cox proportional hazards regression analysis showed that the positive expression of TGR5 and mortalin protein 75, TNM Ⅲ+Ⅳphase, satellite focus, and cirrhosis were risk factors for poor prognosis in ICC patients (P<0.05). ROC results showed that when the expression level of TGR5 was 0.932 as the cut-off value, its AUC in the diagnosis of poor prognosis of ICC patients was 0.783, the sensitivity was 72.4%, the specificity was 72.2%; when the expression level of mortalin protein 75 was 0.756 as the cut-off value, its AUC in the diagnosis of poor prognosis of ICC patients was 0.805, the sensitivity was 84.4%, the specificity was 63.9%; the AUC of combined diagnosis of TGR5 and mortalin protein 75 was 0.884, the sensitivity was 79.3%, the specificity was 83.3%.ConclusionsThe high expressions of TGR5 and mortalin protein 75 in cancer tissues of ICC patients are associated with poor prognosis, and they are risk factors for poor prognosis. The combined detection of TGR5 and mortalin protein 75 has a certain value in predicting poor prognosis, and can be used as potential biological indicators.
Objective To explore safety and efficacy of total laparoscopic radical resection of hilar cholangiocarcinoma. Methods From April 2016 and January 2017, 6 patients with hilar cholangiocarcinoma underwent laparoscopic radical resection in the Affiliated Hospital of Xuzhou Medical University were collected. The intra- and post-operative situation and the postoperative complications were analyzed. Results The radical resections of hilar cholangiocarcinoma were completed laparoscopically in all the patients. There was no conversion to the laparotomy. The procedure was finished within a time of (231.3±94.5) min and with an intraoperative blood loss of (123.3±46.8) mL. The first postoperative exhausting time and the postoperative hospital stay was (2.7±0.3) d and (11.9±1.7) d, respectively. All the patients had the R0 resection and the numbers of dissected lymph nodes were 9.4±2.7. The postoperative complications occurred in 2 patients, they were all cured spontaneously in one week, and there was no perioperative death. None of patients had a local recurrence and metastasis during an average 8 months of following-up. Conclusions Preliminary results of limited cases in this study show that with suitable case and skillful laparoscopic technique, laparoscopic radical resection of hilar cholangiocarcinoma is feasible and safe. Further studies are still needed to confirm benefits of this approach.
ObjectiveTo develop and validate a nomogram for predicting the cancer-specific survival in patients with intrahepatic cholangiocarcinoma (ICC) after hepatectomy. MethodsSuitable patient cases were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Nomograms were established based on the independent prognostic factors identified by COX and Lasso regression models. The performance of the nomograms was validated internally and externally by using the concordance index (c-index), calibration plot, and decision curve analysis. ResultsThe multi factor COX regression results showed that: age, gender, T stage, tumor grade, tumour diameter and number of positive lymph nodes were independent prognostic predictors for cancer-specific survival (CSS) in ICC patients. Nomogram predicting CSS had a c-index of 0.66 (95%CI 0.64 to 0.69) in the training cohort and 0.67 (95%CI 0.63 to 0.72) in the internal validation cohort. The 1-, 3- and 5-year areas under the curve (AUC) of nomogram were 0.68, 0.74 and 0.75 in the training cohort respectively. In the validation cohort, the 1-, 3- and 5-year AUC of nomogram were 0.69, 0.68 and 0.71, respectively. ConclusionThe prediction model constructed based on six factors, including age, gender, pathological stage, T-stage, tumour diameter and number of positive lymph nodes, shows good prediction accuracy.
ObjectiveTo investigate the value of diffusion weighted imaging (DWI) combined with three-dimensional volumetric interpolated breath-hold examination (3D-VIBE) in evaluating metastatic lymph nodes secondary to hilar cholangiocarcinoma. MethodsFrom July 2009 to March 2011, DWI examination was performed in 37 patients with hilar cholangiocarcinoma, which was compared with 3D-VIBE sequences. The morphological characteristics and distribution were analyzed for metastatic and nonmetastatic lymph nodes. Signal intensity (SI) was measured on DWI images and apparent diffusion coefficient (ADC) was calculated for each lymph node. The SI of lymph nodes (SILN） and liver (SIliver) were also measured and the ratio of SI was calculated. The ADC and the ratio of SI were compared between metastatic and nonmetastatic lymph nodes. ResultsThere were fifty-nine groups of lymph nodes in 37 patients with hilar cholangiocarcinoma, fifty-one groups were revealed in both DWI and 3D-VIBE sequences, and eight groups were only demonstrated in one sequence (P=0.070). The short diameters were (1.05±0.42) cm and (0.78±0.22) cm on 3D-VIBE images for metastatic and nonmetastatic lymph nodes, respectively (P=0.030). The ADC value in metastatic lymph nodes was (1.64±0.3)×10-3 mm2/s, which was significantly lower than that in nonmetastatic lymph nodes 〔(2.28±0.79)×10-3 mm2/s〕 on DWI images (P=0.033). There were no significant differences in SILN/SIliver between metastatic and nonmetastatic lymph nodes on images of portal venous phase and 3 min delayed contrast-enhanced phase. ConclusionsDifferences of ADC and short diameter can provide valuable information to differentiate metastatic lymph nodes with nonmetastatic lymph nodes. When combined with 3D-VIBE sequence, DWI is more effective in evaluating metastatic lymph nodes secondary to hilar cholangiocarcinoma.
ObjectiveTo understand the current progress in the application of artificial intelligence (AI) technology in intrahepatic cholangiocarcinoma (ICC). MethodA systematic review was conducted on recent domestic and international research literature regarding AI applications in ICC, with a focus on radiomics and deep learning (DL). ResultsICC is a critical subtype of primary liver cancer characterized by high malignancy and mortality. We systematically reviewed the current status and prospects of AI-based approaches in preoperative diagnosis, treatment guidance, and prognosis prediction for ICC. ConclusionsDespite the progress made by AI in the field of ICC, it still faces challenges such as model accuracy, data integration, and clinical application. With technological advancements and deeper research, AI is expected to play a more significant role in ICC prevention and treatment. Interdisciplinary collaboration will also drive sustainable progress in this domain.
ObjectiveTo summarize the surgical treatment and explore factors which influencing prognosis of hilar cholangiocarcinoma. MethodsClinical data of 189 cases of hilar cholangiocarcinoma who treated in our hospital from Jan. 2000 to Dec. 2010 and clinicopathological factors that might influence survival were analyzed retrospectively. A multivariate factor analysis was performed through Cox proportional hazard model. ResultsOf 189 cases, 62 cases received radical resection, 54 cases received palliative surgery, and 73 cases received non-resection surgery. Operative procedure (RR=0.165), differentiated degree (RR=2.692), lymph node metastasis (RR=3.014), neural infiltration (RR=2.857), and vascular infiltration (RR=2.365) were found to be the statistically significant factors that influenced survival by multivariate factor analysis through the Cox proportional hazard model. ConclusionsRadical resection is the best treatment for hilar cholangiocarcinoma. Skeletonized hepatoduodenal ligament, complete excision of infiltrated nerve and blood vessel are important influence factors to improve the prognosis of hilar cholangiocarcinoma.
ObjectiveTo investigate the expression of proapoptosis gene bad in intrahepatic cholangiocarcinoma (ICC) and its relationship to differentiation of the tumor.MethodsThe immunohistochemistry technique by Dako Envision system and rabbit antihuman bad polyclonal antibodies were adopted. The expression of bad was detected in 48 cases of ICC and 25 cases of control tissues.ResultsBad immunoreactivity in 48 cases of ICC was higher than that of bile duct epithelium in 25 cases of control tissues. And contrasted with 21 cases of well differentiated ICC, bad immunoreactivity was higher in 27 cases of middle and poor differentiated ICC.ConclusionThe expression of bad gene may be related to the differentiation of ICC.
Objective To research the effect of γ-ray released from 103Pd radioactive stent on the expression of Fas gene and its relation with apoptosis of cholangiocarcinoma cell and the significances through the establishment of human cholangiocarcinoma model. Methods The model of nude mouse with implanted human cholangiocarcinoma was established. The mice were divided into study group and control group, 37 MBq 103Pd biliary stent was implanted in the study group and the ordinary metal biliary stent was implanted in the control group. The volume of tumor was measured, the cell apoptosis was detected by the TUNEL method and the expression of Fas gene of the cell apoptosis of the induced human cholangiocarcinoma was checked out by immunohistochemistry staining 10 d after the implantation. Results Compared with the control group, the growing speed of the volume of tumor in study group was significantly reduced (Plt;0.05), the expression positive rate of Fas gene was significantly higher (Plt;0.05), and the apoptotic rate of cancer cells was also higher (Plt;0.01). Conclusions The 103Pd radioactive stent can induce the cell apoptosis in nude mouse model with implanted human cholangiocarcinoma inhibit the cell growth of bile duct cancer and may promote the apoptosis of cancer cells by increasing the expression of Fas gene. It may be helpful for the further study of treatment for bile duct cancer using 103Pd radioactive stent.