Prognostic relevance of circulating CK19 mRNA in advanced malignant biliary tract diseases

AIM: To determine the role of circulating tumor cells (CTCs) in prediction of the overall survival of patients with advanced malignant biliary tract obstruction. METHODS: We investigated the prognostic value of CTCs by examining two markers, cytokeratin (CK) 19 and human telomerase reverse transcriptase (hTERT) mRNA, in 40 patients diagnosed with advanced malig- nant biliary tract diseases. Quantitative real-time re- verse transcription polymerase chain reaction was used to detect CK19 and hTERT mRNA in the peripheral blood of these patients. Overall survival was analyzed using the Kaplan-Meier method and Cox regression modeling.RESULTS: Positive CK19 and hTERT mRNA expression was detected in 45% and 60%, respectively, of the 40 patients. Univariable analysis indicated that positive CK19 mRNA expression was significantly associated with worse overall survival (P = 0.009). Multivariable analysis determined that positive CK19 mRNA expres- sion, patient's age and serum bilirubin were each inde- pendently associated with overall survival. CONCLUSION: CK19 mRNA expression levels in pe- ripheral blood appear to provide a valuable marker to predict the overall survival of patients with advanced malignant biliary tract obstruction.

Clinical analysis of multiple primary gastrointestinal malignant tumors:A 10-year case review of a single-center

BACKGROUND Multiple primary malignant tumors(MPMTs)was first described by Billroth as early as 1889,with the first report published by Warren and Gates in 1932.Since then,numerous cases have been reported.A literature review of 1104269 patients with cancer revealed that the incidence of MPMTs ranged from 0.73 to 11.7%.In recent years,however,there has been a significant upward trend in the incidence of this phenomenon,which may be associated with many different factors,including the advancement of modern diagnostic procedures facilitating the examination and diagnosis of more MPMTs,increased exposure to chemotherapy and radiotherapy that exacerbate the risk of new malignant tumors in patients with cancer,and prolonged survival of patients with cancer allowing sufficient time for the development of new primary cancers.AIM To analyze the incidence,clinical features,treatment factors,prevalence,and prognosis of patients with MPMTs in the gastrointestinal tract treated in a single center.Additionally,we analyzed the different tumor combinations,time interval between the occurrence of tumors,and staging.METHODS This retrospective cohort study analyzed 8059 patients with pathologically confirmed gastrointestinal malignant tumors treated at the Gansu Province Hospital in Lanzhou,Gansu,China between June 2011 and June 2020.Of these,85 patients had MPMTs.The clinical features,treatment factors,prevalence,and prognosis of this latter cohort were analyzed.RESULTS The incidence of MPMTs in patients with gastrointestinal malignant tumors was 1.05%(85/8059),including 83 double primary malignant tumors and two triple primary malignant tumors of which 57(67.06%)were synchronous MPMTs(SMPMTs)and 28(32.94%)were metachronous MPMTs(MMPMTs).The most frequent associations were found between the rectum colon cancers within the SMPMT category and the gastric-colon cancers within the MMPMT category.For the MMPMTs,the median interval was 53 months.The overall 1-,3-and 5-year survival rates from diagnosis of the first primary cancer were 91.36%,65.41%,and 45.97%,respectively;those from diagnosis of the second primary cancer were 67.90%,29.90%,and 17.37%,respectively.CONCLUSION MPMTs in the gastrointestinal tract have a high incidence and poor prognosis.Thus,it is necessary to perform both gastroscopy and colonoscopy in patients with gastrointestinal tumors.Multidisciplinary comprehensive diagnosis and treatment may improve the diagnosis rate and treatment efficiency of MPMTs.

Analysis of load status and management strategies of main caregivers of patients with malignant tumors of digestive tract

Caregiver load refers to the subjective and objective negative impact of caregivers in the care of patients,and excessive load will have a serious impact on patients and caregivers themselves and can reduce their quality of life.For the main caregivers,it not only needs to care for the patients in life and daily life,but also needs to pay the cost of treatment for the patients,coupled with the need to carry out their own original work,life,etc.excessive life pressure,economic pressure,work pressure,emotional pressure,etc.lead to heavy load of the main caregivers,which can easily cause caregivers to have different degrees of psychological problems,which will cause serious adverse effects on the caregivers themselves and cancer patients,not conducive to the construction of a harmonious family and society.This article analyzes the current situation of primary caregiver burden in patients with gastrointestinal malignant tumors,analyzes its influencing factors,and specifies specific treatment strategies.It is hoped to provide scientific guidance for later related research and application.

Primary malignant melanoma of the biliary tract: A case report and literature review

BACKGROUND Primary malignant melanoma of the biliary tract (MBT) is a rare condition whose diagnosis requires excluding a primary origin in another location.This paper reviews the most important characteristics of MBT cases published in the literature and reports a new case.The patient reported here is the first case of primary malignant melanoma of the biliary tract with pulmonary metastasis treated with immunotherapy.This patient remains disease-free 36 mo after the treatment of metastatic lung lesions.CASE SUMMARY A 51-year-old man was admitted to the gastrointestinal department to study obstructive jaundice of a 1 wk clinical course.Magnetic resonance cholangiopancreatography revealed dilatation of the intrahepatic biliary tract and stenosis of the common hepatic duct.Given the suspicion of biliary tract neoplasia,cholecystectomy and resection of the common hepatic duct were performed with hepatic jejunostomy free of complications.Anatomo-pathological diagnosis was melanoma.After intervention,the patient was referred to the Department of Medical Oncology,where a primary origin was excluded in the skin,mucosa,and eyes.This confirmed diagnosis of primary biliary tract melanoma.Computed tomography was performed 12 mo after the procedure revealed several subcentimetric lung nodules.Wedge resection was performed.After confirming the diagnosis of pulmonary metastasis of primary melanoma of the biliary tract,the patient was started on immunotherapy with nivolumab.Tolerance to treatment was excellent.The patient remains disease-free 36 mo after the treatment of metastatic lung lesions.CONCLUSION The patient reported here is the first case of primary malignant melanoma of the biliary tract with lung metastases successfully treated with immunotherapy.

Immunotherapy in biliary tract cancers:Current evidence and future perspectives

Bile duct tumors are comprised of tumors that originate from both intrahepatic and extrahepatic bile ducts and gallbladder tumors.These are aggressive tumors and chemotherapy is still the main treatment for advanced-stage disease and most of these cases have a poor overall survival.Strategies are aimed at treatments with better outcomes and less toxicity which makes immunotherapy an area of significant importance.Recent Food and Drug Administration approvals of immune checkpoint inhibitors(ICI)for agnostic tumors based on biomarkers such as microsatellite instability-high and tumor mutation burden-high are important steps in the treatment of patients with advanced bile duct tumors.Despite limited responses with isolated checkpoint inhibitors in later lines of systemic treatment in advanced disease,drug combination strategies have been demonstrating encouraging results to enhance ICI efficacy.

Efficacy and safety of percutaneous transhepatic biliary radiofrequency ablation in patients with malignant obstructive jaundice

BACKGROUND Percutaneous transhepatic cholangiodrainage(PTCD)and endoscopic retrograde cholangiopancreatography/endoscopic nasobiliary drainage are the most common clinical procedures for jaundice control in patients with unresectable malignant obstructive jaundice,yet the safety and effect of endobiliary radiofrequency ablation(EB-RFA)combined PTCD is rarely reported,in this article,we report our experience of EB-RFA combined PTCD in such patients.AIM To retrospectively study the efficacy and safety of EB-RFA combined PTCD in patients with unresectable malignant obstructive jaundice.METHODS Patients with unresectable malignant obstructive jaundice treated with EB-RFA under PTCD were selected,the bile ducts of the right posterior lobe was selected as the target bile ducts in all cases.The general conditions of all patients,preoperative tumour markers,total bilirubin(TBIL),direct bilirubin(DBIL),albumin(ALB),alkaline phosphatase(ALP),and glutamyl transferase(GGT)before and on the 7th day after the procedure,as well as perioperative complications,stent patency time and patient survival were recorded.RESULTS All patients successfully completed the operation,TBIL and DBIL decreased significantly in all patients at the 7th postoperative day(P=0.009 and 0.006,respectively);the values of ALB,ALP and GGT also decreased compared with the preoperative period,but the difference was not statistically significant.Perioperative biliary bleeding occurred in 2 patients,which was improved after transfusion of blood and other conservative treatments,pancreatitis appeared in 1 patient after the operation,no serious complication and death happened after operation.Except for 3 patients with loss of visits,the stent patency rate of the remaining 14 patients was 100%71%and 29%at the 1^(st),3^(rd),and 6^(th)postoperative months respectively,with a median survival of 4 months.CONCLUSION EB-RFA under PTCD in patients with unresectable malignant obstructive jaundice has a satisfactory therapeutic effect and high safety,which is worthy of further clinical practice.

Biliary tract tumors: past, present and future

Tumors ofthe biliary tract （gallbladder tumors, cholangiocarcinomas and ampullary carcinomas） are low incidence tumors with poor prognosis. The five-year overall survival is 50% for stage I, 30% stage II, 10% stage III and 0% stage IV. Treatment is based on surgery for potentially resectable tumors. Chemotherapy and chemo-radiotherapy is the treatment of choice when surgery is not amenable, however it has not achieved encouraging results. These patients use to have very few symptoms, which is the reason for the delay in diagnosis and the poor prognosis. They frequently develop biliary obstruction： obstructive jaundice, right upper quadrant pain and weight loss. Ampullary carcinomas are frequently related to steatorrhea due to malabsorption. The most effective chemotherapy drugs used in monotherapy are 5FU （response rate 20%） and gemcitabine （response rate of 13%-60%）, so they have been selected for further development in multiple phase II clinical trials to explore their efficacy and safety in combination with other agents. In a phase III clinical trial, combination of gemcitabine and cisplatin has been selected as the schedule of choice. Target therapies are also being developed in this malignancy. The present work reviews the most current knowledge of the pathogenesis, diagnosis and natural history of biliary tract tumors. Further, review of surgery, current adjuvant treatment and therapies for unresectable and advanced disease is provided. The most recent understanding for target therapies and molecular biology is also summarized.

Biliary hemorrhage caused by a malignant small round cell tumor in the common bile duct:A case report

BACKGROUND Malignant small round cell tumor(MSRCT)metastasis to the common bile duct associated with recurrent biliary hemorrhage is extremely rare.Thus far,there have been no reports of metastatic small round cell tumors of the common bile duct.CASE SUMMARY Herein,we report the case of a 77-year-old female patient with an MSRCT in the common bile duct.The patient was admitted to hospital due to gastrointestinal hemorrhage and abdominal pain.We found a neoplasm in the common bile duct with active bleeding through a spyglass.We performed biopsy through the spyglass and placed a metal stent to stop bleeding.The pathological result suggested that it was an MSRCT metastasized from the back to the common bile duct.Later,we found using fluorescence in situ hybridization that the SS18 gene break test was negative,ruling out the diagnosis of synovial sarcoma.CONCLUSION MSRCT is a group of tumors with similar cell morphology and diffuse histological structure.Complete tumor resection results in improved survival in patients with MSRCT.Roux-en-Y cholangiojejunostomy was performed.After excision of the common bile duct tumor,the patient felt that the abdominal pain improved and hemorrhage disappeared.The patient underwent routine fecal examination one month after surgery,indicating a negative fecal occult blood test.On May 22,2023,the patient was reexamined by abdominal computed tomography,and no abdominal space occupying lesions or abdominal lymphadenopathy was found.

Biliary stent combined with iodine-125 seed strand implantation in malignant obstructive jaundice

BACKGROUND Malignant obstructive jaundice is mainly caused by cholangiocarcinoma.Only a few patients are indicated for surgical resection,and the 3-year survival rate is<50%.For patients who are not eligible for surgery,biliary stent placement can relieve biliary obstruction and improve liver function and quality of life.However,restenosis after biliary stents has a poor prognosis and is a clinical challenge.Biliary stent combined with iodine-125(125I)seed implantation can prolong stent patency and improve survival.AIM To evaluate the safety and efficacy of biliary stent combined with 125I seed strand implantation in malignant obstructive jaundice.METHODS We enrolled 67 patients between January 2016 and June 2018 with malignant obstructive jaundice and randomized them into a biliary stent combined with 125I seed strand treatment(combined)group(n=32)and biliary stent(control)group(n=35).All patients underwent enhanced computed tomography and magnetic resonance imaging and were tested for biochemical and cancer markers.Twelve patients underwent pathological examination before surgery.All patients were followed up by telephone or clinical visit.Postoperative liver function improvement,postoperative complications,stent patency time,and survival time were compared between the two groups.Prognostic risk factors were evaluated.RESULTS Technical success was achieved in all patients in both groups.Postoperative liver function improved significantly in all patients(total bilirubin,direct bilirubin,alanine aminotransferase,and aspartate aminotransferase decreased significantly in all patients,the P values were less than 0.05).There was no significant difference in preoperative or postoperative indexes between the two groups for changes in total bilirubin(P=0.147),direct bilirubin(P=0.448),alanine aminotransferase(P=0.120),and aspartate aminotransferase(P=0.387)between the two groups.The median stent patency time of the combined group was 9.0±1.4 mo[95%confidence interval(CI):6.3-11.8 mo],which was significantly longer than the that of the control group(6.0±0.3 mo,95%CI:5.5-6.5 mo,P=0.000).The median survival time of the combined group was 11.0±1.4 mo(95%CI:8.2-13.7 mo),which was significantly longer than that of the control group(7.0±0.3 mo,95%CI:6.4-7.6 mo,P=0.000).Location of obstruction and number of stents were independent risk factors affecting prognosis.CONCLUSION Biliary stent combined with 125I seed strand implantation is safe and effective in malignant obstructive jaundice and improves stent patency time and median survival time.

Different percutaneous transhepatic biliary stent placements and catheter drainage in the treatment of middle and low malignant biliary obstruction

BACKGROUND For cases of middle and low biliary obstruction with left and right hepatic duct dilatation,the type of approach and whether different approaches affect the difficulty of puncture operation and intraoperative and postoperative complications have not been discussed in detail.AIM To compare the efficacy of different percutaneous transhepatic biliary stent placements and catheter drainage in treating middle and low biliary obstruction.METHODS A retrospective analysis was performed on the medical records of 424 patients with middle and low biliary obstruction who underwent percutaneous liver puncture biliary stent placement and catheter drainage at the Department of Interventional Radiology,Shaanxi Provincial People’s Hospital between March 2016 and March 2022.Based on the puncture path,patients were categorized into two groups:Subxiphoid left hepatic lobe approach group(Group A,224 cases)and right intercostal,right hepatic lobe approach group(Group B,200 cases).Liver function improvement,postoperative biliary bleeding incidence,postoperative pain duration,and abdominal effusion leakage around the drainage tube were compared between the two groups at 3 d and 1 wk after the surgery.Patient survival time was recorded during follow-up.RESULTS All 424 surgeries were successful without adverse events.Group A comprised 224 cases,and Group B had 200 cases.There was no statistically significant difference in basic data between Group A and Group B(P>0.05).No significant difference in postoperative biliary bleeding incidence was observed between the groups(P>0.05).The decreased rates for total bilirubin(Group A:69.23±4.50,Group B:63.79±5.65),direct bilirubin(Group A:79.30±11.19,Group B:63.62±5.64),and alkaline phosphatase(Group A:60.51±12.23,Group B:42.68±23.56)in the 1st wk after surgery were significantly faster in Group A than in Group B.The decreased rate of gamma-glutamyl transpeptidase was also significantly faster in Group A at both 3 d(Group A:40.56±10.32,Group B:32.22±5.12)and 1 wk(Group A:73.19±7.05,Group B:58.81±18.98)after surgery(P<0.05).Group A experienced significantly less peritoneal effusion leakage around the drainage tube than Group B(P<0.05).The patient survival rate was higher in Group A compared to Group B(P<0.05).CONCLUSION In treating jaundice patients with middle and low biliary obstruction,a percutaneous left liver puncture demonstrated better clinical efficacy than a percutaneous right liver puncture.

CA19-9 antigen levels can distinguish between benign and malignant pancreaticobiliary disease

BACKGROUND:CA19-9 is a carbohydrate tumor-associated antigen which is frequently upregulated in pancreatobiliary neoplasia.However,it may also be elevated in patients with jaundice in the absence of a tumor due to biliary obstruction,and in other non-hepato-pancreatico-biliary conditions.This study aimed to evaluate whether CA19-9 levels could accurately differentiate between benign and malignant pancreatobiliary disease.METHODS:All patients referred to a single surgeon for investigation of pancreaticobiliary disease in 2003 in whom a firm diagnosis had been established were included.For malignant disease,a histological diagnosis was required but for benign disease a firm radiological diagnosis was deemed adequate.The patients were divided into 4 categories:pancreatic adenocarcinoma(PCa);cholangiocarcinoma(CCa);chronic pancreatitis(CP)and biliary calculous disease(Calc).Bilirubin and alkaline phosphatase levels corresponding to the point of assessment of CA19-9 were also noted.RESULTS:Final diagnoses were made of pancreatic adenocarcinoma(PCa,n=73),cholangiocarcinoma(CCa,n=19),ampullary carcinoma(Amp,n=7),neuroendocrine carcinoma(Neu,n=4),duodenal carcinoma(Duo,n=3),chronic pancreatitis(CP,n=115),and biliary calculous disease(Calc,n=27).Median CA19-9 levels(U/ml)were:PCa,653;CCa,408;Duo,403;Calc,27;CP,19;Neu,10.5;Amp,8(reference range:0-37).The CA19-9 levels were significantly greater for malignant than for benign disease,could differentiate PCa from CCa/Duo,and were significantly higher in unresectable than in resectable PCa.The sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)for CA19-9 were 84.9%,69.7%,67.7%and 86.1%,respectively.A ROC analysis provided an area under the curve for CA19-9 of 0.871(0.820-0.922),giving an optimal CA19-9 of 70.5 U/ml for differentiating benign from malignant pathology.Using this cut-off,the sensitivity was 82.1%,while specificity,PPV and NPV improved to 85.9%,81.3%and 86.5%,respectively.When standard radiology was included(US/ CT/MRCP)in the decision process,the results improved to 97.2%,88.7%,86.6%,and 97.7%.For benign disease,the CA19-9 correlated directly with the serum bilirubin,but for malignant disease,CA19-9 levels were elevated independent of the bilirubin level.CONCLUSIONS:CA19-9 is useful in the differentiation of pancreatobiliary disease and when using an optimized cut-off and combining with routine radiology,the diagnostic yield is improved significantly,thus stressing the importance of a multi-disciplinary approach to pancreatobiliary disease.

Biliary tract intraductal papillary mucinous neoplasm: Report of 19 cases

AIM: To gain a better understanding of biliary tract intraductal papillary mucinous neoplasm(BT-IPMN).METHODS: From January 2000 to December 2013, 19cases of BT-IPMN were retrospectively identified from a total of 343 biliary tract tumors resected in our single institution.Demographic characteristics, clinical data, pathology, surgical strategies, and long-term follow-up were analyzed.RESULTS: The mean age of the 19 BT-IPMN cases was 53.8 years(range: 25-74 years).The most common symptom was abdominal pain(15/19; 78.9%), followed by jaundice(7/19; 36.8%).Cholangitis was associated with most(16/19; 84.2%) of the BT-IPMN cases.Macroscopically visible mucin was detected in all 19 patients, based on original surgical reports.The most common abnormal preoperative imaging findings for BT-IPMN were bile duct dilation(19/19; 100%) and intraluminal masses(10/19; 52.6%).Thirteen(68.4%) cases involved the intrahepatic bile duct and hilum.We performed left hepatectomy in 11/19(57.9%), right hepatectomy in 2/19(10.5%), bile duct resection in 4/19(21.1%), and pancreatoduodenectomy in 1/19(5.3%) patients.One(5.3%) patient was biopsied and received a choledochojejunostomy because of multiple tumors involving the right extrahepatic and left intrahepatic bile ducts.Histology showed malignancy in 10/19(52.6%) patients.The overall median survival was 68 mo.The benign cases showed a non-significant trend towards improved survival compared to malignant cases(68 mo vs 48 mo, P = 0.347).The patient without tumor resection died of liver failure 22 mo after palliative surgery.CONCLUSION: BT-IPMN is a rare biliary entity.Complete resection of the tumor is associated with good survival, even in patients with malignant disease.

Endoscopic stenting for inoperable malignant biliary obstruction: A systematic review and meta-analysis

AIM: To analyze through meta-analyses the benefits of two types of stents in the inoperable malignant biliary obstruction.METHODS: A systematic review of randomized clinical trials(RCT) was conducted, with the last update on March 2015, using EMBASE, CINAHL(EBSCO), MEDLINE, LILACS/CENTRAL(BVS), SCOPUS, CAPES(Brazil), and gray literature. Information of the selected studies was extracted in sight of six outcomes: primarily regarding dysfunction, complication and reintervention rates; and secondarily costs, survival, and patency time. The data about characteristics of trial participants, inclusion and exclusion criteria and types of stents were also extracted. The bias was mainly assessed through the JADAD scale. This meta-analysis was registered in the PROSPERO database by the number CRD42014015078. The analysis of the absolute risk of the outcomes was performed using the software Rev Man, by computing risk differences(RD) of dichotomous variables and mean differences(MD) of continuous variables. Data on RD and MD for each primary outcome were calculated using the MantelHaenszel test and inconsistency was qualified and reported in χ2 and the Higgins method(I2). Sensitivity analysis was performed when heterogeneity was higher than 50%, a subsequent assay was done and other findings were compiled. Student's t-test was used for the comparison of weighted arithmetic means regarding secondary outcomes.RESULTS: Initial searching identified 3660 studies; 3539 were excluded through title, repetition, and/or abstract, while 121 studies were fully assessed and were excluded mainly because they did not compare self-expanding metal stents(SEMS) and plastic stents(PS), leading to thirteen RCT selected, with 13 articles and 1133 subjects meta-analyzed. The mean age was 69.5 years old, that were affected mostly by bile duct(proximal) and pancreatic tumors(distal). The preferred SEMS diameter used was the 10 mm(30 Fr) and the preferred PS diameter used was 10 Fr. In the metaanalysis, SEMS had lower overall stent dysfunction compared to PS(21.6% vs 46.8%, P < 0.00001) and fewer re-interventions(21.6% vs 56.6%, P < 0.00001), with no difference in complications(13.7% vs 15.9%, P = 0.16). In the secondary analysis, the mean survival rate was higher in the SEMS group(182 d vs 150 d, P < 0.0001), with a higher patency period(250 d vs 124 d, P < 0.0001) and a lower cost per patient(4193.98 vs 4728.65 Euros, P < 0.0985).CONCLUSION: SEMS are associated with lower stent dysfunction, lower re-intervention rates, better survival, and higher patency time. Complications and costs showed no difference.

Imaging features and appropriate treatment strategy of a rare biliary tract neoplasm

Mucin-producing bile duct tumors （MPBTs） are characterized by intraductal papillary tumorsproducing large amounts of mucin. The tumor comprises macroscopically prominent intraductal papillary neoplastic epithelia and produces a large amount of viscid mucin, resulting in dilatation of the bile ducts.1 These tumors of the peripheral bile duct, which include benign and malignant lesions, have also been referred to as intraductal growth- type peripheral cholangiocarcinomas,2 mucin-producing cholangiocellular carcinomas,3 intraductal papillary neoplasms （IPNs） of the biliary tract,4 IPNs of the liver,5 or IPNs of the bile duct.6 MPBTs have been the subject of recent attention due to its peculiar histopathology, biological and clinical behavior, varied radiological manifestations, and good prognosis of the patients] Due to the rarity of this disease entity and the non-specific clinical presentation, MPBTs are not well characterized. The purpose of this study was to define the precise diagnosis and correct management of MPBTs with the help of nine clinical cases observed in the last 10 years. The preoperative differential diagnosis, surgical procedure, and postoperative course of these nine cases were retrospectively reviewed.

Biliary drainage in inoperable malignant biliary distal obstruction: A systematic review and meta-analysis

BACKGROUND Endoscopic drainage remains the treatment of choice for unresectable or inoperable malignant distal biliary obstruction(MDBO).AIM To compare the safety and efficacy of plastic stent(PS)vs self-expanding metal stent(SEMS)placement for treatment of MDBO.METHODS This meta-analysis was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.A comprehensive search was performed in MEDLINE,Cochrane,Embase,Latin American and Caribbean Health Sciences Literature,and grey literature to identify randomized clinical trials(RCTs)comparing clinical success,adverse events,stent dysfunction rate,reintervention rate,duration of stent patency,and mean survival.Risk difference(RD)and mean difference(MD)were calculated and heterogeneity was assessed with I2 statistic.Subgroup analyses were performed by SEMS type.RESULTS Twelve RCTs were included in this study,totaling 1005 patients.There was no difference in clinical success(RD=-0.03,95%confidence interval[CI]:-0.01,0.07;I 2=0%),rate of adverse events(RD=-0.03,95%CI:-0.10,0.03;I2=57%),and mean patient survival(MD=-0.63,95%CI:-18.07,19.33;I2=54%)between SEMS vs PS placement.However,SEMS placement was associated with a lower rate of reintervention(RD=-0.34,95%CI:-0.46,-0.22;I2=57%)and longer duration of stent patency(MD=125.77 d,95%CI:77.5,174.01).Subgroup analyses revealed both covered and uncovered SEMS improved stent patency compared to PS(RD=152.25,95%CI:37.42,267.07;I2=98%and RD=101.5,95%CI:38.91,164.09;I2=98%;respectively).Stent dysfunction was higher in the covered SEMS group(RD=-0.21,95%CI:-0.32,-0.1;I²=205%),with no difference in the uncovered SEMS group(RD=-0.08,95%CI:-0.56,0.39;I²=87%).CONCLUSION While both stent types possessed a similar clinical success rate,complication rate,and patient-associated mean survival for treatment of MDBO,SEMS were associated with a longer duration of stent patency compared to PS.

Biliary tract cancer stem cells-translational options and challenges

Management of biliary tract cancer remains challenging. Tumors show high recurrence rates and therapeutic resistance, leading to dismal prognosis and short survival. The cancer stem cell model states that a tumor is a heterogeneous conglomerate of cells, in which a certain subpopulation of cells-the cancer stem cells-possesses stem cell properties. Cancer stem cells have high clinical relevance due to their potential contributions to development, progression and aggressiveness as well as recurrence and metastasis of malignant tumors. Consequently, reliable identification of as well as pharmacological intervention with cancer stem cells is an intensively investigated and promising research field. The involvement of cancer stem cells in biliary tract cancer is likely as a number of studies demonstrated their existence and the obvious clinical relevance of several established cancer stem cell markers in biliary tract cancer models and tissues. In the present article, we review and discuss the currently available literature addressing the role of putative cancer stem cells in biliary tract cancer as well as the connection between known contributors of biliary tract tumorigenesis such as oncogenic signaling pathways, micro-RNAs and the tumor microenvironment with cancer stem cells.

Analysis of sleep quality,disease uncertainty,and psychological tolerance in patients undergoing chemotherapy for digestive tract malignancies

BACKGROUND Colorectal cancer is the second leading cause of cancer-related deaths among digestive tract malignancies,following gastric cancer.Sleep is of great significance for maintaining human health.The incidence of sleep disorders in patients with cancer is approximately twice that observed in the general population.Lack of sleep can prolong hospital stays,increase the likelihood of infection,and increase mortality rates.Therefore,studying the factors related to sleep quality is significant for improving the quality of life of patients with malignant tumors of the digestive tract.AIM To investigate the relationships among sleep quality,disease uncertainty,and psychological resilience in patients undergoing chemotherapy for digestive tract malignancies.METHODS A total of 131 patients with malignant digestive tract tumors who were treated at Hefei BOE Hospital between April 2021 and September 2022 were selected as research participants.Based on their Pittsburgh Sleep Quality Index(PSQI)scores,participants were divided into either the sleep disorder group(PSQI score>7)or the normal sleep group(PSQI score≤7).The clinical data—together with the Mishel Uncertainty in Illness Scale for Adults(MUIS-A)and Connor-Davidson Resilience Scale(CD-RISC)scores—were compared.RESULTS In this study,78(59.54%)patients with digestive tract malignancies developed sleep disorders after chemotherapy.Sleep disorder incidence was higher in patients with colorectal cancer than in those with gastric and esophageal cancers(P<0.05).The total MUIS-A score and those for each item in the sleep disorder group were higher than those in the normal sleep group.The total CD-RISC score and those for each item in the sleep disorder group were lower than those in the normal sleep group(P<0.05).The PSQI scores of patients with malignant digestive tract tumors were positively correlated with the scores for lack of disease information,disease uncertainty,and unpredictability in the MUIS-A and negatively correlated with the scores for tenacity,self-improvement,and optimism in the CD-RISC(P<0.05).CONCLUSION Patients undergoing chemotherapy for digestive tract malignancies are prone to sleep problems related to disease uncertainty and psychological resilience.Therefore,interventions can be implemented to improve their sleep quality.

Research Progress of Circulating Tumor Cells in the Evaluation of Early Cholangiocarcinoma

Epidemiological data show that the incidence rate of cholangiocarcinoma(CCA)has been increasing over the past 20 years.Due to its concealment of clinical manifestations,most patients are diagnosed with CCA at a late stage.On this premise,this review not only discusses the research progress related to CCA diagnosis,but also focuses on the concept of circulating tumor cell(CTC),its evaluation value,application,and prospects for the early diagnosis of extrahepatic cholangiocarcinoma.

综合护理在行PICC置管术的消化道恶性肿瘤患者中的应用

目的 分析综合护理对消化道恶性肿瘤患者PICC置管术后负面情绪、遵医行为、并发症的影响。方法 260例行PICC置管术的消化道恶性肿瘤患者随机分为两组,常规护理组予以常规护理,综合护理组在常规护理基础上予以综合护理,比较两组的负面情绪、遵医行为、并发症。结果 护理后,综合护理组的HAMA、 HAMD评分均低于常规护理组,患肢功能锻炼、置管肢体无负重、洗澡时良好防护比例均高于常规护理组(P <0.05)。综合护理组的并发症总发生率为3.85%,低于常规护理组的10.77%(P <0.05)。结论 综合护理可缓解行PICC置管术的消化道恶性肿瘤患者的负面情绪,改善遵医行为,减少并发症的发生。

消化道恶性肿瘤相关静脉血栓栓塞的危险因素:一项回顾性病例对照研究

目的:明确消化道恶性肿瘤患者相关静脉血栓栓塞的危险因素,并探讨各项凝血检查指标对消化道恶性肿瘤相关静脉血栓栓塞的诊断价值。方法:本研究的对象是2021年7月至2023年7月在我院接受治疗的90名消化道恶性肿瘤患者,研究中,我们将出现静脉血栓的患者划分为血栓组(n=45),并根据血栓组患者的年龄、性别、体质量指数(BMI),采用倾向评分匹配法将同期住院治疗且未发生静脉血栓的患者划为非血栓组(n=45)。分析消化道恶性肿瘤患者相关静脉血栓形成的危险因素,比较两组患者的血栓弹力图、凝血四项、血常规及其他凝血指标[凝血酶原活动度(PTA)、D-二聚体(DD)、纤维蛋白降解产物(FDP)、抗凝血酶(AT)]的水平;分析消化道肿瘤患者血栓弹力图与凝血四项及其他凝血指标的相关性,并通过受试者工作特征(ROC)曲线对消化道恶性肿瘤相关静脉血栓栓塞的诊断价值进行分析。结果:两组中心静脉置管情况存在显著差异(P<0.001),在ANGLE、LY30、EPL、PT、FIB、WBC、PLT、NEU、MPV、DD、FDP水平上,血栓组明显高于非血栓组,而K值、TM、PTA水平均低于非血栓组,差异均具有统计学意义(P<0.05)。多因素分析结果显示,LY30、FIB、MPV、中心静脉置管是导致消化道肿瘤相关静脉血栓形成的独立危险因素。经Spearman相关性分析显示,R与TT、FDP存在相关性(P<0.05);MA与PT、FIB、WBC、PLT、MPV、PTA存在相关性(P<0.05);K值与PTA、PT、FIB、PLT、MPV、DD、FDP均存在相关性(P<0.05);ANGLE与PT、FIB、PLT、MPV、DD、FDP、PTA存在相关性(P<0.05);LY30、EPL值与凝血四项及其他凝血指标均不呈相关性。ROC曲线分析结果显示,ANGLE、LY30、EPL、PT、FIB、PLT、MPV各单项指标及中心静脉置管情况在诊断消化道肿瘤相关血栓形成上均具有较低的诊断价值,但各项指标联合使用时诊断价值更高,具有中等诊断价值。结论:LY30、FIB、MPV、中心静脉置管是消化道肿瘤相关静脉血栓形成的独立危险因素,血栓弹力图联合凝血四项及血常规对消化道恶性肿瘤患者相关静脉血栓形成具有较高的诊断价值。