Choledochal cysts are characterized by single or multiple cystic dilatations of the intrahepatic and / or extrahepatic biliary ducts. The typical presentation of this condition is non-specific. Clinicians must have a high clinical suspicion of choledochal cysts while investigating patients with jaundice, abdominal pain, and abdominal mass. There are multiple classifications for choledochal cysts . The Todani classification system is the most widely used in clinical practice. Based on clinical practice and thinking, we established a new “three regions and five types” classification system on the basis of Todani classification to guide clinical work, but further verification is needed. Surgery is the mainstay of treatment for choledochal cysts and the approach depends on the cyst type and the extent of hepatobiliary pathology. The principles of treatment include complete excision of the cyst and restoration of biliary-intestinal continuity. In view of the risk of biliary malignancy continues to be high after surgery, long-term follow-up is strongly recommended.
ObjectiveTo explore the combined application of neutrophil to lymphocyte ratio (NLR) and systemic immune inflammation index (SII) on the prognosis of hepatitis B-related hepatocellular carcinoma after resection.MethodsRetrospectively collected data of 180 patients with hepatitis B-related hepatocellular carcinoma who were hospitalized in the Department of Infectious Diseases and Hepatobiliary Surgery of the Affiliated Hospital of Southwest Medical University and received surgical treatment from January 2013 to December 2019, including general information, laboratory examination and abdominal CT or MRI results. NLR and SII values were measured at one week before operation, and their critical values of NLR and SII were determined by ROC curve analysis. Univariate and multivariate analysis were performed to determine the risk factors to predict the survival status of patients with hepatitis B-related hepatocellular carcinoma after hepatectomy.ResultsUnivariate analysis showed that AFP, platelets, TNM staging, portal vein tumor thrombus, tumor differentiation, NLR, SII, and NLR+SII combined score were significantly correlated with the prognosis of patients with hepatitis B-related hepatocellular carcinoma (P<0.05). Multivariate analysis showed that PLT [HR=1.791, 95%CI (1.124, 2.854), P=0.014], NLR [HR=4.289, 95%CI (2.571, 7.156), P<0.001], SII [HR=5.317, 95%CI (3.016, 9.374), P<0.001], and NLR+SII combined score [HR=7.901, 95%CI (4.124, 15.138), P<0.001] were independently correlated with the survival of patients with hepatitis B-related hepatocellular carcinoma.ConclusionsThe preoperative NLR+SII combined score can be used to evaluate the postoperative prognosis of patients with hepatitis B-related hepatocellular carcinoma. The higher the score, the lower the postoperative survival rate.
ObjectiveTo investigate the impact of primary tumor site on prognosis of colorectal cancer after radical resection in different stages.MethodsFour hundreds and twenty patients with colorectal cancer in our hospital from Jan. 2008 to Dec. 2016 were selected as study subjects, all patients were confirmed by pathology. According to the location of colorectal cancer, the patients were divided into rectum group (n=220), left colon group (n=105) and right colon group (n=95). The difference of clinicopathological features of patients with different group were compared. The risk factors affecting the prognosis of colorectal cancer patients were analyzed by single factor and multi factor unconditional Cox regression analysis, and the survival curve was drawn by Kaplan-Meier method, and the difference test was carried out by log-rank method.ResultsThere were no significant differences between the three groups in age, BMI, smoking history, alcohol history, family history, vascular tumor thrombus, N staging, tumor diameter, nerve invasion and cancer nodule (P>0.05). There were significant differences in sex, pathological type, anterior intestinal obstruction, TNM staging, T staging and M staging (P<0.05). The results of single factor Cox regression analysis showed that sex, pathological type, anterior intestinal obstruction, TNM staging, T staging, M staging, primary tumor site, nerve invasion and cancer nodule were the risk factors for the prognosis of the patients (P<0.05). Multivariate Cox regression analysis showed that TNM staging, location of primary tumor and nerve invasion were risk factors affecting prognosis of patients (P<0.05). The total 5-year survival rate of the rectal group was 80.45% (177/220), the total 5-year survival rate of the left hemicolon group was 67.62% (71/105), and the total 5-year survival rate of the right hemicolon group was 68.42% (65/95). The survival curves of Kaplan-Meier showed that the difference between the three groups was statistically significant (P<0.05).ConclusonsThe 5-year survival rate of patients with rectal cancer is significantly higher than that of patients with left colon cancer and right colon cancer. For patients with different stage of colorectal cancer after radical resection, the prognosis of colorectal cancer can be predicted by the location of primary tumor.
ObjectiveTo evaluate the clinical efficacy of surgical intervention combined with endoscopic ultrasound-guided transluminal drainage in the treatment of infected pancreatic necrosis (IPN). MethodsA retrospective, historical control study was conducted. A total of 98 patients with acute pancreatitis (AP) complicated with IPN who met the inclusion and exclusion criteria and were admitted to the Third People’s Hospital of Chengdu from June 2016 to January 2023 were selected as the research objects. The endoscopic ultrasound-guided transluminal drainage was carried out in our hospital in June 2020. In this study, patients treated before May 2020 were divided into the non-EUS group (52 cases), and patients treated after June 2020 were divided into the EUS group (46 cases). The baseline data, surgical intervention, length of hospital stay, length of intensive care unit (ICU) stay, infection time, incidence of multiple organ dysfunction syndrome (MODS), survival situation, short-term and long-term complications, and other indicators were compared between the two groups. ResultsThe number of percutaneous catheter drainage (PCD, 1.0 vs. 1.0), the number of PCD drainage tube (1.0 vs. 2.0), the number of retroperitoneal debridement drainage (1.0 vs. 2.0), the total length of hospital stay (42.0 d vs. 45.5 d), the length of ICU stay (11.0 d vs. 14.0 d), the length of infection time (10.5 d vs. 18.5 d), the incidences of MODS [43.5% (20/46) vs. 67.3% (35/52)] and residual infection [28.3% (13/46) vs.48.1% (25/52)] in the EUS group were shorter (or lower) than those in the non-EUS group (P<0.05); but there were no significant differences in the number of endoscopic pancreatic stent implantation, the number of laparotomy, the number of laparoscopic surgery, and the incidences of abdominal bleeding, gastrointestinal fistula, gastrointestinal obstruction, chronic pancreatic fistula, chronic pancreatitis and incisional hernia between the two groups (P>0.05). ConclusionFor patients with AP complicated with IPN, surgical intervention combined with endoscopic ultrasound-guided transluminal drainage can reduce the number of PCD and drainage tube, shorten the total length of hospital stay, the length of ICU stay and infection, as well as reduce the incidences of MODS and residual infection.
Objective To investigate the relationship between thrombocytopenia after the restoration of spontaneous circulation and short-term prognosis of patients with in-hospital cardiac arrest. Methods The demographic data, post-resuscitation vital signs, post-resuscitation laboratory tests, and the 28-day mortality rate of patients who experienced in-hospital cardiac arrest at the Emergency Department of West China Hospital, Sichuan University between January 1st, 2016 and December 31st, 2016 were retrospectively analyzed. Logistic regression was used to analyze the correlation between thrombocytopenia after the return of spontaneous circulation and the 28-day mortality rate in these cardiac arrest patients. Results Among the 285 patients included, compared with the normal platelet group (n=130), the thrombocytopenia group (n=155) showed statistically significant differences in red blood cell count, hematocrit, white blood cell count, prothrombin time, activated partial thromboplastin time, and international normalized ratio (P<0.05). The 28-day mortality rate was higher in the thrombocytopenia group than that in the normal platelet group (84.5% vs. 71.5%, P=0.008). Multiple logistic regression analysis indicated that thrombocytopenia [odds ratio =2.260, 95% confidence interval (1.153, 4.429), P=0.018] and cardiopulmonary resuscitation duration [odds ratio=1.117, 95% confidence interval (1.060, 1.177), P<0.001] were independent risk factors for 28-day mortality in patients with in-hospital cardiac arrest. Conclusion Thrombocytopenia after restoration of spontaneous circulation is associated with poor short-term prognosis in patients with in-hospital cardiac arrest.
ObjectiveTo study on the first metastasis pattern and prognostic factors in patients with recurrent and metastatic breast cancer.MethodsThe study selected 147 patients with metastatic breast cancer who were diagnosed for the first time in the Breast Thyroid Center and Oncology Department, the People's Hospital of Wuhan University from June 2016 to June 2018. The model of first metastasis and the first diagnosis of prognosis may be affected. The age at diagnosis of breast cancer, tumor size, lymph node metastasis, hormone receptor status, HER-2 status, number of metastatic organs, tumor location, molecular typing, etc. were retrospective analyzedResultsThe most common metastatic sites for breast cancer was bone metastases in 55 patients (37.41%), followed by lung metastasis and liver metastases, 29 (19.73%) and 24 (16.33%), respectively. Univariate analysis showed that the number of lymph node metastasis, HER-2 status, organ number of first-time metastasis, and endocrine therapy were significant factors affecting metastatic survival time, and the difference was statistically significant (P<0.05). Multivariate analysis showed that the number of lymph node metastasis, the number of metastatic organs and HER-2 were independent risk factors for advanced breast cancer (P<0.05).ConclusionsThe most common metastasis of breast cancer patients after surgery is bone, followed by lung metastasis and liver metastasis. The number of lymph node metastases, the number of metastatic organs, HER-2 status, and endocrine therapy are independent factors influencing the prognosis of patients with recurrent metastasis.
ObjectiveTo explore the predictive value of preoperative serum heat shock protein 90α (HSP90α) level in combination with the prognostic nutritional index (PNI) for patients with hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE). MethodsThe HCC patients confirmed by histopathological examination and underwent TACE at Guigang People’s Hospital from January 2022 to June 2023 were as the observation group, the healthy individuals who underwent physical examinations during the same period and same hospital as the control group. The blood before treatment and on the day of the physical examination was collected to detected the HSP90α and albumin levels, as well as lymphocyte count. The PNI was calculated [PNI=albumin (g/L)+5×lymphocyte count (×109/L)]. The clinical outcome (tumor progression or death) was observed within one year after TACE treatment, those without tumor progression or death were defined as a good prognosis, while those with tumor progression or death were defined as a poor prognosis. Using the multivariate unconditional logistic regression analysis to identify the risk factors affecting the poor prognosis for HCC patients, and the receive operating characteristic (ROC) curve to evaluate the predictive value of serum HSP90α level in combination with PNI in distinguishing prognosis after TACE treatment.ResultsIn this study, there were 178 cases in the observation group and 100 cases in the control group. The serum HSP90α level (μg/L) in the observation group was higher than that in the control group (96.40±33.57 vs. 52.19±22.13, t=3.191, P<0.001), and the PNI value was lower than that in the control group (43.70±5.24 vs. 56.46±6.86, t=–16.144, P<0.001); Within one year after TACE treatment, there were 70 patients with poor prognosis and 108 patients with good prognosis. The serum HSP90α (μg/L) level in the patients with poor prognosis was higher than that in the patients with good prognosis (117.33±29.48 vs. 82.83±28.84, t=7.726, P<0.001), and the PNI was lower than that in the control group (40.49±4.18 vs. 45.78±4.80, t=–7.548, P<0.001). The multivariate unconditional logistic regression analysis found that the probabilities of incidence of poor prognosis after TACE treatment were higher in the patients with Chinese liver cancer staging Ⅲa–Ⅲb stage [reference: Ⅰ–Ⅱa stage, OR (95%CI)=5.332 (1.058, 26.875), P=0.043] and increased age and HSP90α level [OR (95%CI)=1.100 (1.025, 1.180), P=0.008; OR (95%CI)=1.049 (1.029, 1.070), P<0.001] , as well as decreased PNI value [OR (95%CI)=0.772 (0.686, 0.869), P<0.001]. The area under the ROC curve after TACE treatment in the HCC patients by serum HSP90α level in combination with PNI was 0.878 [95%CI=(0.820, 0.922)] in differentiating poor prognosis or not. ConclusionThe analysis results of this study suggest that preoperative serum HSP90α level in combination with PNI has a higher predictive value for prognosis of HCC patients after TACE treatment.
Objective To systematically review the relationship between preoperative platelet-to-lymphocyte ratio (PLR) and prognosis in patients with pancreatic ductal adenocarcinoma (PDAC). Methods Studies on the relationship between preoperative PLR and prognosis of PDAC patients were retrieved from China National Knowledge Infrastructure, Chongqing VIP, SinoMed, Wanfang, PubMed, Embase, Web of Science, and Cochrane Library, with a search period from databases establishment to December 2023. A meta-analysis was conducted using RevMan 5.3 software. Results A total of 7 studies were included, including 1273 patients. The meta-analysis results showed that the postoperative overall survival [hazard ratio (HR)=1.69, 95% confidence interval (CI) (1.24, 2.30)] and disease-free survival [HR=1.83, 95%CI (1.49, 2.24)] of PDAC patients with high preoperative PLR were shortened (P<0.05). The results of subgroup analysis showed that when the cut off of PLR was<200, preoperative high PLR was associated with shortened overall survival (HR=1.91, P<0.05), but when the cut off of PLR was ≥200, there was no significant correlation between preoperative PLR and overall survival (P>0.05). When followed up for<3 years, preoperative high PLR was associated with shortened overall survival (HR=2.05, P<0.05), but when followed up for ≥3 years, there was no significant correlation between preoperative PLR and overall survival (P>0.05). Conclusion Current evidence suggests that preoperative high PLR may be a risk factor for poor prognosis in PDAC patients.
Objective To analyze the clinicopathological characteristics of thymoma patients and the influencing factors for prognosis. Methods Thymoma patients who received treatment in Sichuan Cancer Hospital from March 2015 to March 2021 were collected. Clinical data of the patients were analyzed using Kaplan-Meier and Cox regression analyses. Results A total of 177 patients were included. There were 89 males and 88 females aged 17-88 (52.3±13.0) years, including 160 surgical patients and 17 non-surgical patients. There were 160 patients survived, 17 died of thymoma, and 5 had recurrence and metastasis. Overall, the 1-year, 3-year and 5-year progression-free survival rates were 94.4%, 88.7%, 88.1%, respectively; the 1-year, 3-year and 5-year overall survival rates were 94.9%, 91.5%, 91.0%, respectively. The Kaplan-Meier analysis showed that World Health Organization classification, clinical symptoms, Masaoka-Koga staging, treatment methods and surgery were statistically associated with progression-free survival; clinical symptoms, age, treatment methods and surgery were statistically associated with overall survival (P<0.05). Patients with younger age (P=0.018), without clinical symptoms (P=0.039), and with surgical treatment (P=0.004) had higher overall survival rates; those patients undergoing surgery had a higher progression-free survival rate (P=0.002). Conclusion Age, clinical symptoms and surgical treatment are independent factors influencing the prognosis of patients with thymoma.
Objective To analyze the relationship between the expression of carbonic anhydrase 3 (CA3) in breast cancer tissues, its prognostic potential and the number of immune cells by a variety of online databases. Methods GEPIA2.0 and TIMER databases were used to analyze the difference of CA3 mRNA expression in breast cancer tissues. Bc-GenExMinerv4.7 database was used to analyze the difference of CA3 mRNA expression in breast cancer subcategories. Kaplan-Meier plotter, Bc-GenExMinerv4.7 and PrognoScan databases were used to analyze the effect of CA3 mRNA expression levels on prognosis of patient. LinkedOmics database was used to analyze of the biological behavior involved in CA3 co-expressed genes. TIMER database was used to analyze the relationship between CA3 mRNA expression and immune cells infiltration in breast cancer tissues. Results The expression of CA3 mRNA in breast cancer tissues was lower than that in normal breast tissues (P<0.05), and the expression levels of CA3 mRNA were higher in ER negative (P<0.05), PR negative (P<0.05), HER2 negative (P<0.05) and no lymphatic metastasis (P<0.05). In addition, the expression level of CA3 in breast cancer patients with high Ki67 expression was lower (P<0.05) and closely related to SBR and NPI grade (P<0.05). Breast cancer patients with low expression of CA3 mRNA had lower overall survivall, recurrence free survival, and disease free survival ( P<0.05). Ten of the top 50 positively correlated co-expressed genes screened out had low risk ratio (P<0.05), and 11 of the top 50 negatively correlated co-expressed genes screened out had high risk ratio (P<0.05). The expression of CA3 mRNA was positively correlated with CD4+ T cells and CD8+ T cells in breast cancer tissues (rs=0.175, P<0.001; rs=0.137, P<0.001), and negatively correlated with T cell failure markers LAG3, TIM-3 and PVRL2 (rs=–0.100, P<0.01; rs=–0.143, P<0.001; rs=–0.082, P<0.05). Conclusions The low expression of CA3 mRNA in breast cancer tissues is correlated with the occurrence, development and prognosis of breast cancer. CA3 can be used as a potential independent prognostic marker for breast cancer and may be related to immune infiltration.
