BACKGROUND The relationship between preoperative inflammation status and tumorigenesis as well as tumor progression is widely acknowledged.AIM To assess the prognostic significance of preoperative inflammatory biomark...BACKGROUND The relationship between preoperative inflammation status and tumorigenesis as well as tumor progression is widely acknowledged.AIM To assess the prognostic significance of preoperative inflammatory biomarkers in patients with distal cholangiocarcinoma(dCCA)who underwent pancreat-oduodenectomy(PD).METHODS This single-center study included 216 patients with dCCA after PD between January 1,2011,and December 31,2022.The individuals were categorized into two sets based on their systemic inflammatory response index(SIRI)levels:A low SIRI group(SIRI<1.5,n=123)and a high SIRI group(SIRI≥1.5,n=93).Inflam-matory biomarkers were evaluated for predictive accuracy using receiver operating characteristic curves.Both univariate and multivariate Cox proportional hazards analyses were performed to estimate SIRI for overall survival(OS)and recurrence-free survival(RFS).RESULTS The study included a total of 216 patients,with 58.3%being male and a mean age of 65.6±9.6 years.123 patients were in the low SIRI group and 93 were in the high SIRI group after PD for dCCA.SIRI had an area under the curve value of 0.674 for diagnosing dCCA,showing better performance than other inflammatory biomarkers.Multivariate analysis indicated that having a SIRI greater than 1.5 independently increased the risk of dCCA following PD,leading to lower OS[hazard ratios(HR)=1.868,P=0.006]and RFS(HR=0.949,P<0.001).Additionally,survival analysis indicated a significantly better prognosis for patients in the low SIRI group(P<0.001).CONCLUSION It is determined that a high SIRI before surgery is a significant risk factor for dCCA after PD.展开更多
BACKGROUND Distal cholangiocarcinoma(DCC)presents as one of the relatively rare malignant tumors in the digestive system and has a poor long-term prognosis.Curative resection is currently the most appropriate therapy ...BACKGROUND Distal cholangiocarcinoma(DCC)presents as one of the relatively rare malignant tumors in the digestive system and has a poor long-term prognosis.Curative resection is currently the most appropriate therapy for patients with DCC because of the lack of effective adjuvant therapies.Therefore,it is important to accurately predict the prognosis for formulating a reasonable treatment plan and avoiding unnecessary surgical trauma.AIM To minimize the interference of obstructive jaundice on carbohydrate antigen 19-9(CA19-9)level by adapting CA19-9 toγ-glutamyltransferase(GGT)as an indicator,to determine the strong associations between CA19-9/GGT and postoperative neoplasm recurrence and long-term outcome of DCC.METHODS We enrolled 186 patients who were diagnosed with DCC between January 2010 and December 2019 and performed radical excision with strict criteria as follows in our hospital.Receiver operating characteristic curves were drawn according to preoperative CA19-9/GGT and 1-year survival.Based on this,patients were divided into two groups(group 1,low-ratio,n=81;group 2,high-ratio,n=105).Afterwards,by the way of univariate and multivariate analysis,the risk factors influencing postoperative tumor recrudesce and long-term prognosis of patients with DCC were screened out.RESULTS Optimum cut-off value of CA19-9/GGT was 0.12.Patients in group 2 represented higher CA19-9 and lymphatic metastasis rate accompanied by lower GGT,when compared with group 1(P<0.05).The 1-,3-and 5-year overall survival rates of patients in groups 1 and 2 were 88.3%,59.2%and 48.1%,and 61.0%,13.6%and 13.6%,respectively(P=0.000).Multivariate analysis indicated that CA19-9/GGT,lymphatic metastasis and tumor differentiation were independent risk factors for tumor recurrence and long-term prognosis of DCC.CONCLUSION Elevation of CA19-9/GGT performed better as a biomarker of aggressive carcinoma and predictor of poor clinical outcomes by reducing the effect of obstruction of biliary tract on CA19-9 concentration in patients with DCC.展开更多
AIM To evaluate the prognostic value of the number of retrieved lymph nodes(LNs) and other prognostic factors for patients with distal cholangiocarcinomas, and to determine the optimal retrieved LNs cut-off number.MET...AIM To evaluate the prognostic value of the number of retrieved lymph nodes(LNs) and other prognostic factors for patients with distal cholangiocarcinomas, and to determine the optimal retrieved LNs cut-off number.METHODS The Surveillance, Epidemiology and End Results database was used to screen for patients with distal cholangiocarcinoma. Patients with different numbers of retrieved LNs were divided into three groups by the X-tile program. X-tile from Yale University is a useful tool for outcome-based cut-point optimization. The Kaplan-Meier method and Cox regression analysis were utilized for survival analysis.RESULTS A total of 449 patients with distal cholangiocarcinoma met the inclusion criteria. The Kaplan-Meier survival analysis for all patients and for N1 patients revealed no significant differences among patients with different retrieved LN counts in terms of overall and cancerspecific survival. In patients with node-negative distal cholangiocarcinoma, patients with four to nine retrieved LNs had a significantly better overall(P = 0.026) and cancer-specific survival(P = 0.039) than others. In the subsequent multivariate analysis, the number of retrieved LNs was evaluated to be independently associated with survival. Additionally, patients with four to nine retrieved LNs had a significantly lower overall mortality risk [hazard ratio(HR) = 0.39; 95% confidence interval(CI): 0.20-0.74] and cancer causespecific mortality risk(HR = 0.32; 95%CI: 0.15-0.66) than other patients. Additionally, stratified survival analyses showed persistently better overall and cancerspecific survival when retrieving four to nine LNs in patients with any T stage of tumor, a tumor between 20 and 50 mm in diameter, or a poorly differentiated or undifferentiated tumor, and in patients who were ≤ 70-years-old. CONCLUSION The number of retrieved LNs was an important independent prognostic factor for patients with nodenegative distal cholangiocarcinoma. Additionally, patients with four to nine retrieved LNs had better overall and cancer-specific survival rates than others, but the reason and mechanism were unclear. This conclusion should be validated in future studies.展开更多
Cholangiocarcinoma is a malignancy derived from biliary epithelial cells,a relatively rare but highly malignant type of malignancy.Cholangiocarcinoma located below the convergence of gallbladder duct and common hepati...Cholangiocarcinoma is a malignancy derived from biliary epithelial cells,a relatively rare but highly malignant type of malignancy.Cholangiocarcinoma located below the convergence of gallbladder duct and common hepatic duct is defined as distal cholangiocarcinoma(dCCA),accounting for 20-30%of total cholangiocarcinoma.In spite of the highly developed adjuvant therapy,surgical treatment remains the core in dCCA treatment,and radical pancreaticoduodenectomy is still the only potential cure for dCCA.However,the overall prognosis of dCCA after radical surgery is still unsatisfying,with a post-operative 5-year survival rate less than 40%.展开更多
目的探讨中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)与可切除远端胆管癌远期预后的相关性。方法回顾性分析2011年1月-2019年12月于首都医科大学附属北京朝阳医院因远端胆管癌行胰十二指肠切除术的115例患者临床资料...目的探讨中性粒细胞/淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)与可切除远端胆管癌远期预后的相关性。方法回顾性分析2011年1月-2019年12月于首都医科大学附属北京朝阳医院因远端胆管癌行胰十二指肠切除术的115例患者临床资料。收集术前1周内外周血常规检查资料,并依此计算NLR,绘制受试者工作特征(ROC)曲线确定NLR最佳截点,根据该临界值将患者分为高NLR组和低NLR组,并比较两组患者的临床特征和预后。结果全组男性70例,女性45例,平均年龄29~84(64.9±9.2)岁,其中高分化29例(25.2%),中分化52例(45.2%),低分化34例(29.6%)。ROC曲线分析得到NLR的临界值为3.38,按此临界值将患者分为高NLR组(NLR≥3.38,47例)和低NLR组(NLR<3.38,68例)。两组基本特征差异无统计学意义(P>0.05)。高NLR组和低NLR组术后1年、3年、5年分别为51.9%vs 89.5%、20.3%vs 51.5%、13.5%vs 43.5%,差异有统计学意义(P均<0.05)。结论术前NLR水平预测可切除远端胆管癌远期预后,高NLR值提示患者预后不良。展开更多
目的探讨3.0 T MR扩散加权成像(DWI)序列评估远端胆管癌病理分化程度的价值。方法 20例远端胆管癌按病理分化程度分组,分析不同分化程度组胆管癌的DWI图像;观察病灶的信号强度并测量表观扩散系数(ADC)值。结果 20例远端胆管癌在DWI上主...目的探讨3.0 T MR扩散加权成像(DWI)序列评估远端胆管癌病理分化程度的价值。方法 20例远端胆管癌按病理分化程度分组,分析不同分化程度组胆管癌的DWI图像;观察病灶的信号强度并测量表观扩散系数(ADC)值。结果 20例远端胆管癌在DWI上主要呈稍高信号和高信号(95%)。不同分化程度组间胆管癌的ADC值分别为(1.684±0.166)×10-3mm2/s,(1.443±0.135)×10-3mm2/s,(1.266±0.040)×10-3mm2/s,(1.190±0.031)×10-3mm2/s.胆管癌的ADC值随分化程度的降低逐渐下降(rs=0.928,P=0.000)。各组间ADC值的差异有统计学意义(P<0.05)。结论 3.0 T MR DWI序列能够一定程度地判断远端胆管癌的病理分化程度。展开更多
文摘BACKGROUND The relationship between preoperative inflammation status and tumorigenesis as well as tumor progression is widely acknowledged.AIM To assess the prognostic significance of preoperative inflammatory biomarkers in patients with distal cholangiocarcinoma(dCCA)who underwent pancreat-oduodenectomy(PD).METHODS This single-center study included 216 patients with dCCA after PD between January 1,2011,and December 31,2022.The individuals were categorized into two sets based on their systemic inflammatory response index(SIRI)levels:A low SIRI group(SIRI<1.5,n=123)and a high SIRI group(SIRI≥1.5,n=93).Inflam-matory biomarkers were evaluated for predictive accuracy using receiver operating characteristic curves.Both univariate and multivariate Cox proportional hazards analyses were performed to estimate SIRI for overall survival(OS)and recurrence-free survival(RFS).RESULTS The study included a total of 216 patients,with 58.3%being male and a mean age of 65.6±9.6 years.123 patients were in the low SIRI group and 93 were in the high SIRI group after PD for dCCA.SIRI had an area under the curve value of 0.674 for diagnosing dCCA,showing better performance than other inflammatory biomarkers.Multivariate analysis indicated that having a SIRI greater than 1.5 independently increased the risk of dCCA following PD,leading to lower OS[hazard ratios(HR)=1.868,P=0.006]and RFS(HR=0.949,P<0.001).Additionally,survival analysis indicated a significantly better prognosis for patients in the low SIRI group(P<0.001).CONCLUSION It is determined that a high SIRI before surgery is a significant risk factor for dCCA after PD.
基金Supported by the Beijing Municipal Science&Technology Commission,No.Z181100001718164and Capital’s Funds for Health Improvement and Research,No.CFH 2020-2-2036.
文摘BACKGROUND Distal cholangiocarcinoma(DCC)presents as one of the relatively rare malignant tumors in the digestive system and has a poor long-term prognosis.Curative resection is currently the most appropriate therapy for patients with DCC because of the lack of effective adjuvant therapies.Therefore,it is important to accurately predict the prognosis for formulating a reasonable treatment plan and avoiding unnecessary surgical trauma.AIM To minimize the interference of obstructive jaundice on carbohydrate antigen 19-9(CA19-9)level by adapting CA19-9 toγ-glutamyltransferase(GGT)as an indicator,to determine the strong associations between CA19-9/GGT and postoperative neoplasm recurrence and long-term outcome of DCC.METHODS We enrolled 186 patients who were diagnosed with DCC between January 2010 and December 2019 and performed radical excision with strict criteria as follows in our hospital.Receiver operating characteristic curves were drawn according to preoperative CA19-9/GGT and 1-year survival.Based on this,patients were divided into two groups(group 1,low-ratio,n=81;group 2,high-ratio,n=105).Afterwards,by the way of univariate and multivariate analysis,the risk factors influencing postoperative tumor recrudesce and long-term prognosis of patients with DCC were screened out.RESULTS Optimum cut-off value of CA19-9/GGT was 0.12.Patients in group 2 represented higher CA19-9 and lymphatic metastasis rate accompanied by lower GGT,when compared with group 1(P<0.05).The 1-,3-and 5-year overall survival rates of patients in groups 1 and 2 were 88.3%,59.2%and 48.1%,and 61.0%,13.6%and 13.6%,respectively(P=0.000).Multivariate analysis indicated that CA19-9/GGT,lymphatic metastasis and tumor differentiation were independent risk factors for tumor recurrence and long-term prognosis of DCC.CONCLUSION Elevation of CA19-9/GGT performed better as a biomarker of aggressive carcinoma and predictor of poor clinical outcomes by reducing the effect of obstruction of biliary tract on CA19-9 concentration in patients with DCC.
基金Supported by the National Natural science Foundation of China,No.81301975the Chongqing Natural Science Foundation,No.cstc2016jcyj A016
文摘AIM To evaluate the prognostic value of the number of retrieved lymph nodes(LNs) and other prognostic factors for patients with distal cholangiocarcinomas, and to determine the optimal retrieved LNs cut-off number.METHODS The Surveillance, Epidemiology and End Results database was used to screen for patients with distal cholangiocarcinoma. Patients with different numbers of retrieved LNs were divided into three groups by the X-tile program. X-tile from Yale University is a useful tool for outcome-based cut-point optimization. The Kaplan-Meier method and Cox regression analysis were utilized for survival analysis.RESULTS A total of 449 patients with distal cholangiocarcinoma met the inclusion criteria. The Kaplan-Meier survival analysis for all patients and for N1 patients revealed no significant differences among patients with different retrieved LN counts in terms of overall and cancerspecific survival. In patients with node-negative distal cholangiocarcinoma, patients with four to nine retrieved LNs had a significantly better overall(P = 0.026) and cancer-specific survival(P = 0.039) than others. In the subsequent multivariate analysis, the number of retrieved LNs was evaluated to be independently associated with survival. Additionally, patients with four to nine retrieved LNs had a significantly lower overall mortality risk [hazard ratio(HR) = 0.39; 95% confidence interval(CI): 0.20-0.74] and cancer causespecific mortality risk(HR = 0.32; 95%CI: 0.15-0.66) than other patients. Additionally, stratified survival analyses showed persistently better overall and cancerspecific survival when retrieving four to nine LNs in patients with any T stage of tumor, a tumor between 20 and 50 mm in diameter, or a poorly differentiated or undifferentiated tumor, and in patients who were ≤ 70-years-old. CONCLUSION The number of retrieved LNs was an important independent prognostic factor for patients with nodenegative distal cholangiocarcinoma. Additionally, patients with four to nine retrieved LNs had better overall and cancer-specific survival rates than others, but the reason and mechanism were unclear. This conclusion should be validated in future studies.
文摘Cholangiocarcinoma is a malignancy derived from biliary epithelial cells,a relatively rare but highly malignant type of malignancy.Cholangiocarcinoma located below the convergence of gallbladder duct and common hepatic duct is defined as distal cholangiocarcinoma(dCCA),accounting for 20-30%of total cholangiocarcinoma.In spite of the highly developed adjuvant therapy,surgical treatment remains the core in dCCA treatment,and radical pancreaticoduodenectomy is still the only potential cure for dCCA.However,the overall prognosis of dCCA after radical surgery is still unsatisfying,with a post-operative 5-year survival rate less than 40%.
文摘目的探讨3.0 T MR扩散加权成像(DWI)序列评估远端胆管癌病理分化程度的价值。方法 20例远端胆管癌按病理分化程度分组,分析不同分化程度组胆管癌的DWI图像;观察病灶的信号强度并测量表观扩散系数(ADC)值。结果 20例远端胆管癌在DWI上主要呈稍高信号和高信号(95%)。不同分化程度组间胆管癌的ADC值分别为(1.684±0.166)×10-3mm2/s,(1.443±0.135)×10-3mm2/s,(1.266±0.040)×10-3mm2/s,(1.190±0.031)×10-3mm2/s.胆管癌的ADC值随分化程度的降低逐渐下降(rs=0.928,P=0.000)。各组间ADC值的差异有统计学意义(P<0.05)。结论 3.0 T MR DWI序列能够一定程度地判断远端胆管癌的病理分化程度。
