C-reactive protein to albumin ratio predict responses to programmed cell death-1 inhibitors in hepatocellular carcinoma patients

BACKGROUND Over the years,programmed cell death-1(PD-1)inhibitors have been routinely used for hepatocellular carcinoma(HCC)treatment and yielded improved survival outcomes.Nonetheless,significant heterogeneity surrounds the outcomes of most studies.Therefore,it is critical to search for biomarkers that predict the efficacy of PD-1 inhibitors in patients with HCC.AIM To investigate the role of the C-reactive protein to albumin ratio(CAR)in evaluating the efficacy of PD-1 inhibitors for HCC.METHODS The clinical data of 160 patients with HCC treated with PD-1 inhibitors from January 2018 to November 2022 at the First Affiliated Hospital of Guangxi Medical University were retrospectively analyzed.RESULTS The optimal cut-off value for CAR based on progression-free survival(PFS)was determined to be 1.20 using x-tile software.Cox proportional risk model was used to determine the factors affecting prognosis.Eastern Cooperative Oncology Group performance status[hazard ratio(HR)=1.754,95%confidence interval(95%CI)=1.045-2.944,P=0.033],CAR(HR=2.118,95%CI=1.057-4.243,P=0.034)and tumor number(HR=2.932,95%CI=1.246-6.897,P=0.014)were independent prognostic factors for overall survival.CAR(HR=2.730,95%CI=1.502-4.961,P=0.001),tumor number(HR=1.584,95%CI=1.003-2.500,P=0.048)and neutrophil to lymphocyte ratio(HR=1.120,95%CI=1.022-1.228,P=0.015)were independent prognostic factors for PFS.Two nomograms were constructed based on independent prognostic factors.The C-index index and calibration plots confirmed that the nomogram is a reliable risk prediction tool.The ROC curve and decision curve analysis confirmed that the nomogram has a good predictive effect as well as a net clinical benefit.CONCLUSION Overall,we reveal that the CAR is a potential predictor of short-and long-term prognosis in patients with HCC treated with PD-1 inhibitors.If further verified,CAR-based nomogram may increase the number of markers that predict individualized prognosis.

Da Vinci robot-assisted pancreato-duodenectomy in a patient with situs inversus totalis:A case report and review of literature

BACKGROUND Situs inversus totalis(SIT)is an extremely rare congenital malformation characterized by mirror displacement of the thoracoabdominal organs such as the heart,liver,spleen,and stomach.Herein,we describe a patient with SIT complicated with cholangiocarcinoma who underwent successful pancreaticoduodenectomy with the assistance of a da Vinci robot.CASE SUMMARY A 58-year-old female presented to the hospital with paroxysmal pain in her left upper abdomen,accompanied by jaundice and staining of the sclera as chief complaints.Imaging examination detected a mass at the distal end of the common bile duct,with inverted thoracic and abdominal organs.Endoscopic retrograde cholangiopancreatography forceps biopsy revealed the presence of a well-differentiated adenocarcinoma.The patient successfully underwent robotic-assisted pancreaticoduodenectomy;the operation lasted 300 min,the intraoperative blood loss was 500 mL,and there were no intraoperative and postoperative complications.CONCLUSION SIT is not directly related to the formation of cholangiocarcinoma.Detailed preoperative imaging examination is conducive to disease diagnosis and also convenient for determining the feasibility of tumor resection.Robot-assisted pancreaticoduodenectomy for SIT complicated with cholangiocarcinoma provides a safe,feasible,minimally invasive,and complication-free alternative with adequate preoperative planning combined with meticulous intraoperative procedures.