Hepatobiliary & Pancreatic Diseases International最新文献

Background: The pathological diagnostic purpose of the tumor component proportion of combined hepatocellular-cholangiocarcinoma (CHC) remains a perplexing issue, hindering clinicians from characterizing its biological behavior and formulating intervention strategies.

Methods: A multicenter database of patients with CHC who underwent therapeutic hepatectomy was analyzed. Based on a > 70% hepatocellular carcinoma (HCC) or cholangiocarcinoma (CCA) component, the patients were stratified into three groups: CHC^HCC-dominant, CHC^balanced, and CHC^CCA-dominant. Survival outcomes were assessed using Kaplan-Meier analysis. Tumor markers and recurrence patterns were compared via Chi-square test, and prognostic factors were identified through Cox regression analysis. Postoperative adjuvant transarterial chemoembolization (PA-TACE) benefits were further evaluated.

Results: Among 19 641 patients with primary liver cancer, 306 with CHC were classified: 93 (30.4%) in the CHC^HCC-dominant group, 101 (33.0%) in the CHC^balanced group, and 112 (36.6%) in the CHC^CCA-dominant group. The best and the worst prognoses were observed in the CHC^HCC-dominant group and CHC^CCA-dominant group, respectively (median RFS time: CHC^HCC-dominant group 1.02 years, CHC^balanced group 0.36 years, CHC^CCA-dominant group 0.30 years; median OS time: CHC^HCC-dominant group 3.16 years, CHC^balanced group 1.93 years, CHC^CCA-dominant group 1.86 years). The highest ratios of elevated alpha-fetoprotein and carbohydrate antigen 19-9 were recorded in the CHC^HCC-dominant group and the CHC^CCA-dominant group, respectively. CHC^HCC-dominant and CHC^CCA-dominant patients showed the most frequent intrahepatic and extrahepatic recurrences, respectively. PA-TACE improved early RFS (< 2 years) only in CHC^HCC-dominant patients. Multivariate analysis confirmed that tumor component proportion was an independent prognostic factor for all survival endpoints.

Conclusions: Predominant HCC or CCA components (> 70% tumor composition) critically shape CHC biology and prognosis. Tumor component proportion emerges as a novel parameter for therapeutic decision-making. We proposed a comprehensive flow chart integrating pathological sampling, histological component evaluation, clinical data mapping, and postoperative intervention strategies for CHC.

Background: Splanchnic vein thrombosis (SVT) and sinistral portal hypertension (SPH) are vascular complications that can occur following acute pancreatitis (AP), with a risk of gastrointestinal bleeding. This study aimed to identify risk factors for SVT and SPH in AP patients and evaluate the effectiveness of anticoagulation therapy for SVT and SPH.

Methods: We enrolled 141 AP patients, 47 with SVT, 47 with SPH, and 47 as controls. Baseline characteristics, serum indicators, complications, treatments and prognoses were collected and analyzed.

Results: Multivariate analysis identified elevated fibrinogen [odds ratio (OR) = 1.335, 95% confidence interval (CI): 1.050-1.697; P = 0.018] as an independent risk factor for SVT. Pancreatic pseudocyst (OR = 5.663, 95% CI: 1.739-18.437; P = 0.004) and recurrent AP (OR = 6.494, 95% CI: 1.805-23.365; P = 0.004) were independently associated with SPH. Subgroup analyses showed that the location of pseudocyst in body-tail of pancreas, as well as multiple recurrences of AP, were associated with the development of SPH. Among patients with SVT, the recanalization rate was significantly higher in those receiving anticoagulation compared to those who did not (69.0% vs. 31.3%, P = 0.015). Two SPH patients with thrombosis achieved resolution of varices after anticoagulation treatment. No bleeding events occurred in patients with anticoagulation therapy.

Conclusions: In AP patients, elevated fibrinogen is an independent risk factor for SVT. Pancreatic pseudocyst and recurrent AP are independent risk factors for SPH. Anticoagulation therapy was effective and safe for patients with SVT.

Background: Hepatitis B virus (HBV) infection is the main cause of cirrhosis and hepatocellular carcinoma (HCC) in China. Microvascular invasion (MVI) is a key pathological indicator of tumor invasiveness associated with HCC prognosis. This study aimed to investigate the association of cirrhosis with MVI incidence and postoperative prognosis in patients with HBV-related HCC.

Methods: Patients with HBV-related HCC who underwent resection in 13 centers in China between February 2011 and June 2023 were included in this study. Risk factors of MVI were analyzed using logistic regression analysis. A propensity score matching (PSM) was performed to eliminate confounders between the groups. Recurrence-free survival (RFS) and overall survival (OS) were estimated based on the Kaplan-Meier method and compared using the log-rank test. Independent risk factors for RFS and OS were identified using Cox regression analysis.

Results: Of 3048 patients with HBV-related HCC, 2271 (74.5%) had cirrhosis. Compared to patients without cirrhosis, the incidence of MVI was higher in patients with cirrhosis (47.8% vs. 41.2%, P = 0.001). Cirrhosis was independently associated with MVI (odds ratio = 1.41, P < 0.001). In patients with MVI, RFS and OS were significantly shorter in patients with cirrhosis than those without cirrhosis (after PSM, median RFS: 13.90 vs. 33.37 months, P < 0.001; median OS: 42.07 vs. 63.67 months, P < 0.001). Cirrhosis was an independent risk factor for RFS and OS in patients with MVI [RFS: hazard ratio (HR) = 1.62, P < 0.001; OS: HR = 1.56, P < 0.001].

Conclusions: Among patients with HBV-related HCC, cirrhosis was associated with the presence of MVI. Cirrhosis was an indicator of worse RFS and OS in patients with MVI.

Background: Metabolic syndrome (MS) influences the development of pancreatic ductal adenocarcinoma (PDAC), but its effect on oncological outcomes remains unclear. This study aimed to investigate the role of MS in the patients' perioperative and long-term oncological outcomes.

Methods: Patients undergoing R0 resection of PDAC in seven centers from June 2015 to May 2022 were included. A propensity score matching (PSM) was performed to eliminate confounders between the groups. Perioperative outcomes of patients with and without MS were compared. Additionally, the prognosis was analyzed separately for the MS subgroup and the tumor site subgroup.

Results: Of 1548 patients, 388 (25.1%) had MS. After PSM, 1071 patients were enrolled in a 1:2 ratio. Compared with non-MS patients, MS patients had significantly higher rates of major complications, including grade B/C delayed gastric emptying and grade B/C postoperative pancreatic fistula, 90-day readmission, 90-day mortality (all P < 0.05), worse overall survival (OS) (22.7 vs. 31.5 months, P < 0.001) and recurrence-free survival (RFS) (11.9 vs. 15.8 months, P < 0.001). Multivariate analysis revealed that MS, carbohydrate antigen 19-9 > 37 U/mL, lymphatic metastasis, and major complications were independent risk factors for OS and RFS. In the subgroup analysis, patients in the high-risk MS group (4 or 5 components) showed shorter OS (20.6 vs. 23.8 months, P < 0.05) and RFS (11.1 vs. 12.6 months, P < 0.05) than patients in the low-risk MS group (3 components). Combined diabetes mellitus, obesity, and dyslipidemia in PDAC patients yielded the poorest OS and RFS outcomes following R0 resection.

Conclusions: Perioperative and oncological prognosis was significantly worse in PDAC patients with MS after R0 resection. Patients experienced worse long-term survival outcomes with the increase in the number of MS components. PDAC patients with diabetes mellitus, obesity, and dyslipidemia should undergo closer follow-up monitoring after R0 resection.