Typing of biliary tumor thrombus influences the prognoses of patients with hepatocellular carcinoma

Objective:To establish a new classification of biliary tumor thrombus(BTT).Methods:Overall survival of patients with BTT was first used to determine whether it correlated with current hepatocellular carcinoma staging systems.Univariate and multivariate analyses were used to determine factors affecting the overall survival(OS)to form the basis of our new classification for BTT.Results:All 6 international staging systems showed overlapping survival curves.Univariate followed by multivariate analyses showed that total bilirubin and intrahepatic/extrahepatic BTT were significant risk factors of OS.Based on these data,a new BTT classification was defined as:TypeⅠ:intrahepatic BTT;and TypeⅡ:extrahepatic BTT involving a common bile duct or common hepatic duct.TypeⅠwas further subdivided into type Ia:BTT involving a second-order intrahepatic duct or above,and type Ib:BTT involving a first-order intrahepatic duct.TypeⅡwas further subdivided into typeⅡa and typeⅡb using a cut-off total bilirubin(TB)>300μmol/L.The numbers(percentages)of patients with typesⅠandⅡBTT were 69(34.2%)and 133(65.8%),respectively.The median OS of typeⅠpatients was significantly higher than that of typeⅡpatients(37.5 months vs.23.2 months;P=0.002).Using subgroup analyses,OS outcomes were significantly different between the subgroups of typeⅡb and type IIa,although there was no significant difference between the type Ia and type Ib subgroups(P=0.07).Conclusions:A new BTT classification was established to predict prognoses of HCC patients with BTT who underwent liver resection.

Radiofrequency ablation in the management of primary hepatic and biliary tumors

In the United States,80%-90%of primary hepatic tumors are hepatocellular carcinomas and 10%-15%are cholangiocarcinomas(CCA),both with high mortality rate,particularly CCA,which portends a worse prognosis.Traditional management with surgery has good outcomes in appropriately selected patients;however,novel ablative treatment options have emerged,such as radiofrequency ablation(RFA),which can improve the prognosis of both hepatic and biliary tumors.RFA is aimed to generate an area of necrosis within the targeted tissue by applying thermal therapy via an electrode,with a goal to completely eradicate the tumor while preserving surrounding healthy tissue.Role of RFA in management of hepatic and biliary tumors forms the focus of our current mini-review article.

Effect Observation of Clinical Treatment with Oxaliplatin and Tiggio for Biliary Tract Tumors on Advanced Stage

Objective:To investigate the effect of oxaliplatin combined with tiggio in the treatment of advanced biliary tract tumors.Methods:The research period was from November 2019 to November 2020.80 patients with advanced biliary tumor disease were enrolled.They were divided into groups according to the order of admission,with 40 cases in each group.The control group received oxaliplatin combined with gemcitabine,and the experimental group received oxaliplatin combined with tiggio.Incidence of adverse reactions,time to disease progression,survival time and clinical efficacy were checked and assessed.Results:Compared with the incidence of adverse reaction of the experimental group,which was 5.00%(2/40),the incidence of adverse reaction of the control group was 25.00%(10/40).The chi-square value=6.2745,p-value=0.0122.The time to progression and survival time of patients in the experimental group were shorter than those of the control group,with significant differences between the groups(p<0.05);the clinical efficacy of the experimental group and the control group were 97.50%(39/40)and 77.50%(31/40)respectively,the comparative chi-square value=7.3143,p-value=0.0068.Conclusion:The combined treatment of oxaliplatin and Tiggio in the treatment of advanced biliary tract tumors has higher safety and reduces the incidence of adverse reactions.

3D-bioprinted cholangiocarcinoma-on-a-chip model for evaluating drug responses

Cholangiocarcinoma(CCA)is characterized by heterogeneous mutations and a refractory nature.Thus,the development of a model for effective drug screening is urgently needed.As the established therapeutic testing models for CCA are often ineffective,we fabricated an enabling three-dimensional(3D)-bioprinted CCA-on-a-chip model that to a good extent resembled the multicellular microenvironment and the anatomical microstructure of the hepato-vascular-biliary system to perform high-content antitumor drug screening.Specifically,cholangiocytes,hepatocytes,and vascular endotheliocytes were employed for 3D bioprinting of the models,allowing for a high degree of spatial and tube-like microstructural control.Interestingly,it was possible to observe CCA cells attached to the surfaces of the gelatin methacryloyl(GelMA)hydrogelembedded microchannels and overgrown in a thickening manner,generating bile duct stenosis,which was expected to be analogous to the in vivo configuration.Over 4000 differentially expressed genes were detected in the CCA cells in our 3D coculture model compared to the traditional two-dimensional(2D)monoculture.Further screening revealed that the CCA cells grown in the 3D traditional model were more sensitive to the antitumoral prodrug than those in the 2D monoculture due to drug biotransformation by the neighboring functional hepatocytes.This study provides proof-of-concept validation of our bioprinted CCA-on-a-chip as a promising drug screening model for CCA treatment and paves the way for potential personalized medicine strategies for CCA patients in the future.

Liquid biopsy in cholangiocarcinoma:Current status and future perspectives

Cholangiocarcinoma(CCA)are a heterogeneous group of tumors in terms of aetiology,natural history,morphological subtypes,molecular alterations and management,but all sharing complex diagnosis,management,and poor prognosis.Several mutated genes and epigenetic changes have been detected in CCA,with the potential to identify diagnostic and prognostic biomarkers and therapeutic targets.Accessing tumoral components and genetic material is therefore crucial for the diagnosis,management and selection of targeted therapies;but sampling tumor tissue,when possible,is often risky and difficult to be repeated at different time points.Liquid biopsy(LB)represents a way to overcome these issues and comprises a diverse group of methodologies centering around detection of tumor biomarkers from fluid samples.Compared to the traditional tissue sampling methods LB is less invasive and can be serially repeated,allowing a real-time monitoring of the tumor genetic profile or the response to therapy.In this review,we analysis the current evidence on the possible roles of LB(circulating DNA,circulating RNA,exosomes,cytokines)in the diagnosis and management of patients affected by CCA.