A robust genomic-based prognostic model for the assessment ofcancer stemness and survival for patients with hepatocellularcarcinoma

To the Editor:Hepatocellular carcinoma(HCC)is an aggressive malignancy with poor long-term prognosis[1].Liver cancer stem cell(CSC)can drive the metastasis,drug resistance,and recurrence of HCC[2].The regulatory mechanisms about liver cancer stemness have been investigated,which encouraged the identification and characterization of novel prognostic and therapeutic strategies for HCC[3].

Endoscopic retrograde cholangiopancreatography management for choledochocele in a young female

To the Editor:Choledochocele,also known as type III choledochal cysts in the classification by Todani et al.[1],is a congenital abnormality of the biliary system.It is characterized by a cystic dilation of intramural segment of the distal common bile duct(CBD)protruding into the descending duodenum.Choledochocele makes up about 0.5%−4%of choledochal cysts[1,2].Compared with other subtypes,the incidence of choledochocele is extremely low and it frequently presents in adults at a relatively older age,with an average age of 51 years[3].The diagnosis and treatment are challenging.Here,we present a case of a young female patient with this rare disease entity,who recovered after effective endoscopic retrograde cholangiopancreatography(ERCP)management.

Assessment of clinical outcomes of advanced hilar cholangiocarcinoma

Background: Low resectability and poor survival outcome are common for hilar cholangiocarcinoma(HCCA), especially in advanced stages. The present study was to assess the clinical outcome of advanced HCCA, focusing on therapeutic modalities, survival analysis and prognostic assessment.Methods: Clinical data of 176 advanced HCCA patients who had been treated in our hospital between January 2013 and December 2015 were analyzed retrospectively. Prognostic effects of clinicopathological factors were explored by univariate and multivariate analysis. Survival predictors were evaluated by the receiver operating characteristic(ROC) curve.Results: The 3-year overall survival rate was 13% for patients with advanced HCCA. Preoperative total bilirubin(P = 0.009), hepatic artery invasion(P = 0.014) and treatment modalities(P = 0.020) were independent prognostic factors on overall survival. A model combining these independent prognostic factors(area under ROC curve: 0.748; 95% CI: 0.678–0.811; sensitivity: 82.3%, specificity: 53.5%) was highly predictive of tumor death. After R0 resection, the 3-year overall survival was up to 38%. Preoperative total bilirubin was still an independent negative factor, but not for hepatic artery invasion.Conclusions: Surgery is still the best treatment for advanced HCCA. Preoperative biliary drainage should be performed in highly-jaundiced patients to improve survival. Prediction of survival is improved significantly by a model that incorporates preoperative total bilirubin, hepatic artery invasion and treatment modalities.