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Textbook outcome in gallbladder carcinoma after curative-intent resection:a 10-year retrospective single-center study

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Chinese medical Journal 2023年第14期136卷 1680-1689页

作者： Qi Li Hengchao Liu Qi Gao Feng Xue Jialu Fu Mengke Li Jiawei Yuan Chen Chen Dong Zhang Zhimin Geng department of hepatobiliary surgery The First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anShaanxi 710061China department of Pediatric surgery The Second Affiliated Hospital of Xi’an Jiaotong UniversityXi’anShaanxi 710004China

Background:Textbook outcome(TO)can guide decision-making among patients and clinicians during preoperative patient selection and postoperative quality improvement.We explored the factors associated with achieving a TO for gallbladder carcinoma(GBC)after curative-intent resection and analyzed the effect of adjuvant chemotherapy(ACT)on TO and non-TO patients.Methods:A total of 540 patients who underwent curative-intent resection for GBC at the department of hepatobiliary surgery of the first affiliated hospital of xi’an jiaotong university from January 2011 to December 2020 were retrospectively analyzed.Multivariable logistic regression was used to investigate the factors associated with TO.Results:Among 540 patients with GBC who underwent curative-intent resection,223 patients(41.3%)achieved a TO.The incidence of TO ranged from 19.0%to 51.0%across the study period,with a slightly increasing trend over the study period.The multivariate analysis showed that non-TO was an independent risk factor for prognosis among GBC patients after resection(P=0.003).Age≤60 years(P=0.016),total bilirubin(TBIL)level≤34.1 mmol/L(P<0.001),well-differentiated tumor(P=0.008),no liver involvement(P<0.001),and T1-2 stage disease(P=0.006)were independently associated with achieving a TO for GBC after resection.Before and after propensity score matching(PSM),the overall survival outcomes of non-TO GBC patients who received ACT and those who did not were statistically significant;ACT improved the prognosis of patients in the non-TO group(P<0.05).Conclusion:Achieving a TO is associated with a better long-term prognosis among GBC patients after curative-intent resection,and ACT can improve the prognosis of those with non-TO.

关键词： Gallbladder neoplasms Textbook outcome Curative-intent resection Adjuvant chemotherapy Prognosis Nomogram

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Clinical effect of magnetic compression anastomosis on ureterostenosis after kidney transplantation

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Chinese medical Journal 2023年第8期136卷 1006-1008页

作者： Jiangwei Zhang Wujun Xue Puxun Tian Hang Yan Jin Zheng xiao Li Ying Wang xiaoming Ding Yi Lyu department of Kidney Transplantation the First Affiliated Hospital of Xi’an Jiaotong UniversityXi’anShannxi 710061China department of hepatobiliary surgery of the first affiliated hospital of xi’an jiaotong university Xi’anShannxi 710061China

To the Editor:Ureterostenosis is one of the most common complications after kidney transplantation,with an incidence rate of 1.0–8.3%according to a relevant report.[1,2]This complication may cause postrenal obstructi... 详细信息

关键词： kidney stenosis anastomosis

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异种胰岛移植中供体猪的筛选:现状与进展(英文)

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Journal of Zhejiang university-Science B(Biomedicine & Biotechnology) 2014年第8期15卷 681-691页

作者： Hai-tao ZHU Liang YU Yi LYU Bo Wang department of hepatobiliary surgery the First Affiliated Hospital Medical College Xi'an Jiaotong University

猪胰岛细胞异种移植是一种极具潜力治疗糖尿病的方法。其临床应用主要面临两大挑战:高质量的活性胰岛短缺与异种免疫排斥反应。合适的猪供体筛选(年龄、性别、品系、基因表型)是获取充足的高性能胰岛移植物的重要前提,并可有效地减轻胰... 详细信息

猪胰岛细胞异种移植是一种极具潜力治疗糖尿病的方法。其临床应用主要面临两大挑战:高质量的活性胰岛短缺与异种免疫排斥反应。合适的猪供体筛选(年龄、性别、品系、基因表型)是获取充足的高性能胰岛移植物的重要前提,并可有效地减轻胰岛异种抗原性及体内异种排斥反应,进而延长移植物的功能存活时间。在文中,我们总结了异种移植中猪胰岛的相关研究进展,为供体猪的筛选提供了依据;同时表明了无特殊病原体的成年转基因猪可能是目前最佳的异种胰岛供体,有望在未来的临床研究中大规模应用。

关键词：胰岛猪异种移植供体

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The value of the lymph node ratio and total number of lymph nodes examined for resected pancreatic signet ring cell carcinoma:a retrospective cohort study

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Journal of Pancreatology 2022年第2期5卷 87-95页

作者： Chao Ren Feng Xue Yinying Wu Zheng Wang department of hepatobiliary and Pancreatic surgery The Affiliated Jinhua Hospital of Zhejiang University School of MedicineJinhuaChina department of hepatobiliary surgery of the first affiliated hospital of xi’an jiaotong university Xi’anChina department of medical Oncology of the first affiliated hospital of xi’an jiaotong university Xi’anChina

Background:Pancreatic signet ring cell carcinoma(SRCC)is an exceedingly rare histological subtype of pancreatic cancer.Previous studies have focused on the trends of incidence and independent predictors of pancreatic SRCC.Our objectives of the study were to analyze the prognostic value of the lymph node ratio(LNR)and to explore the minimal number of lymph nodes examined to accurately evaluate the N stage in resected pancreatic SRCC.Method:We analyzed 120 patients diagnosed from January 1,1990,to December 31,2016,constituted the study cohort from the Surveillance,Epidemiology,and End Results(SEER)registry.We calculated the overall survival(OS)of these patients by using a Kaplan–Meier analysis.The Kaplan–Meier analysis was used to analyze the influence of various factors on the prognosis of patients in the univariate analysis.The multivariate Cox analysis were applied to find independent prognostic factors of patients with pancreatic SRCC.Receiver-operating characteristic curve(ROC)analysis to investigate the discriminatory ability of the total number of lymph nodes examined(TNLE)relative to whether lymph node metastasis was present.Results:The median number of lymph nodes examined among 120 patients with resected pancreatic SRCC was 14(interquartile range:6.25–20.0).According to the univariate analysis of OS,age,grade,chemotherapy,LNR,and TNLE were significantly different(P<.05).We demonstrated the prognostic benefit of chemotherapy in resected pancreatic SRCC,whereas radiotherapy was not associated with improved survival.The multivariate survival analysis showed that LNR and grade were independent prognostic indicators after pancreatic SRCC resection for OS.TNLE≥8 showed the highest discriminatory power for evaluating lymph node metastasis(Area under curve(AUC):0.656,95%confidence interval:0.564–0.741,Youden index:0.2533,sensitivity:78.67%,specificity:46.67%,P=.003).Conclusion:Our study indicated that the LNR was a valuable independent prognostic factor for resected pancreatic SRCC.Regional lymphadenectomy of at

关键词： Independent factor Lymph node ratio Pancreatic signet ring cell carcinoma SEER database Total number of lymph nodes examined

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Central obesity and nonalcoholic fatty liver disease risk after adjusting for body mass index

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World Journal of Gastroenterology 2015年第5期21卷 1650-1662页

作者： Qing Pang Jing-Yao Zhang Si-Dong Song Kai Qu xin-Sen Xu Su-Shun Liu Chang Liu department of hepatobiliary surgery the First Affiliated Hospital of Medical CollegeXi’an Jiaotong University

AIM:To investigate whether central obesity is associated with nonalcoholic fatty liver disease(NAFLD) formation after adjusting for general obesity.METHODS:The online databases Pub Med,EMBASE,and ISI Web of Science were searched for studies estimating the influence of central obesity on NAFLD occurrence published through April 2014.Studies that did not adjust for body mass index(BMI) were excluded.In addition,the independent effect of BMI was also assessed with the included studies.The pooled effect sizes and 95% confidence intervals(CIs) were calculated using random- or fixed-effects models based on the degree of heterogeneity.Furthermore,subgroup analyses,meta-regression,sensitivity analyses,and publication bias were performed.RESULTS:Twenty eligible studies were identified.The summary odds ratio(OR) values per-unit increase in waist circumference(WC) and BMI for NAFLD formation were 1.07(95%CI:1.03-1.10,I2 = 73.9%,n = 11 studies) and 1.25(95%CI:1.13-1.38,I2 = 88.7%,n = 11 studies),respectively.When the indices were expressed as binary variables(with the non-obesity group as reference),the pooled OR in WC,waist-tohip ratio,and BMI were 2.34(95%CI:1.83-3.00,I2 = 41.8%,n = 7 studies),4.06(95%CI:1.53-10.79,I2 = 65.7%,n = 3 studies),and 2.85(95%CI:1.60-5.08,I2 = 57.8%,n = 5 studies),respectively.Using the same studies as the latter(n = 5),pooled OR in WC was 3.14(95%CI:2.07-4.77),which is greater than that in BMI.CONCLUSION:Central obesity may pose a greater threat to national health than general obesity,although both are independently associated with increased risk of NAFLD.

关键词： Central obesity General obesity Nonalcoholic fatty

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Platelet to lymphocyte ratio as a novel prognostic tool for gallbladder carcinoma

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World Journal of Gastroenterology 2015年第21期21卷 6675-6683页

作者： Qing Pang Ling-Qiang Zhang Rui-Tao Wang Jian-Bin Bi Jing-Yao Zhang Kai Qu Su-Shun Liu Si-Dong Song xin-Sen Xu Zhi-xin Wang Chang Liu department of hepatobiliary surgery the First Affiliated Hospital of Medical CollegeXi’an Jiaotong University

AIM:To preliminarily investigate the prognostic significance of the platelet to lymphocyte ratio(PLR) in patients with gallbladder carcinoma(GBC).METHODS:Clinical data of 316 surgical GBC patients were analyzed retrospectively,and preoperative serum platelet and lymphocyte counts were used to calculate the PLR.The optimal cut-off value of the PLR for detecting death was determined by the receiver operating characteristic(ROC) curve.The primary outcome was overall survival,which was estimated by the Kaplan-Meier method.The log-rank test was used to compare the differences in survival.Then,we conducted multivariate Cox analysis to assess the independent effect of the PLR on the survival of GBC patients.RESULTS:For the PLR,the area under the ROC curve was 0.620(95%CI:0.542-0.698,P = 0.040) in detecting death.The cut-off value for the PLR was determined to be 117.7,with 73.6% sensitivity and 53.2% specificity.The PLR was found to be significantlypositively correlated with CA125 serum level,tumornode-metastasis(TNM) stage,and tumor differentiation.Univariate analysis identified carcinoembryonic antigen(CEA),CA125 and CA199 levels,PLR,TNM stage,and the degree of differentiation as significant prognostic factors for GBC when they were expressed as binary data.Multivariate analysis showed that CA125 > 35 U/mL,CA199 > 39 U/mL,PLR ≥ 117.7,and TNM stage Ⅳ were independently associated with poor survival in GBC.When expressed as a continuous variable,the PLR was still an independent predictor for survival,with a hazard ratio of 1.018(95%CI:1.001-1.037 per 10-unit increase,P = 0.043).CONCLUSION:The PLR could be used as a simple,inexpensive,and valuable tool for predicting the prognosis of GBC patients.

关键词： Platelets Lymphocyte Gallbladder carcinoma Prognosis Survival

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Highlights for α-fetoprotein in determining prognosis and treatment monitoring for hepatocellular carcinoma

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World Journal of Gastroenterology 2012年第48期18卷 7242-7250页

作者： xin-Sen Xu Kai Qu Chang Liu Yue-Lang Zhang Jun Liu Yan-Zhou Song Peng Zhang Si-Nan Liu Hu-Lin Chang department of hepatobiliary surgery The First Affiliated Hospital of Medical CollegeXi'an Jiaotong University department of Radiology The First Affiliated Hospital of Medical CollegeXi'an Jiaotong University

AIM:To explore the prognostic value in the monitoring of treatment efficacy of serial α-fetoprotein(AFP) in hepatocellular carcinoma(HCC) patients.METHODS:We searched MEDLINE,EMBASE and COCHRANE LIBRARY through April 21,2012,to find qualifying articles.Our overall search strategy included terms for HCC,AFP,treatment response,and prognosis.Literature was limited to English-language,human studies.Studies reporting cumulative survival rates were summa-rized qualitatively.For the prognostic meta-analysis,we undertook a series of meta-analyses that summarised the Cox proportional hazard ratios(HRs) by assuming a random effects model.With regards to the correlation of AFP change with radiologic response,the categorical dichotomous variables were assessed using Poisson relative risks(RRs),which were incorporated into the random effects model meta-analysis of accuracy prediction.Between-study heterogeneity was estimated by use of the I2 statistic.Publication bias was evaluated using the Begg funnel plot and Egger plot.Sensitivity analyses were conducted first by separating systemic treatment estimates from locoregional therapy estimates,evaluating different AFP response cut-off point effects,and exploring the impact of different study sizes.RESULTS:Of 142 titles identified in our original search,11 articles(12 clinical studies) met our criteria.Six studies investigated outcome in a total of 464 cases who underwent systemic treatment,and six studies investigated outcome in a total of 510 patients who received locoregional therapy.A random-effects model metaanalysis showed that AFP response was associated with an mortality HR of 0.55(95%CI,0.47-0.65) across HCC in overall survival(OS) and 0.50(95%CI,0.38-0.65) in progression-free survival.Restricting analysis to the six eligible analyses of systemic treatment,the pooled HRs were 0.64(95%CI,0.53-0.77) for OS.Limiting analysis to the six analyses of locoregional therapy,the pooled HRs for OS was 0.39(95%CI,0.29-0.53).We showed a larger pooled HR in the 50% definition studies

关键词：治疗效果甲胎蛋白肝癌预后监测随机效应模型 MEDLINE 疾病控制

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Magnetic-assisted laparoscopic liver transplantation in swine

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hepatobiliary & Pancreatic Diseases International 2022年第4期21卷 340-346页

作者： Zhe Feng Shan-Pei Wang Hao-Hua Wang Qiang Lu Wei Qiao Kai-Ling Wang Hong-Fan Ding Yue Wang Rong-Feng Wang Ai-Hua Shi Bing-Yi Ren Yu-Nan Jiang Bin He Jia-Wei Yu Rong-Qian Wu Yi Lv department of hepatobiliary surgery the First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061China National Local Joint Engineering Research Center for Precision surgery&Regenerative Medicine Shaanxi Provincial Center for Regenerative Medicine and Surgical EngineeringInstitute of Advanced Surgical Technology and Engineeringthe First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061China department of Geriatric surgery the First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an 710061China department of hepatobiliary surgery Shaanxi Provincial People’s HospitalXi’an 710000China Zonglian college Xi’an Jiaotong UniversityXi’an 710000China

Background:Although laparoscopic technology has achieved rapid development in the surgical field,it has not been applied to liver transplantation,primarily because of difficulties associated with laparoscopic vascular anastomosis.In this study,we introduced a new magnetic-assisted vascular anastomosis technique and explored its application in laparoscopic liver transplantation in pigs.Methods:Two sets of magnetic vascular anastomosis rings(MVARs)with different diameters were developed.One set was used for anastomosis of the suprahepatic vena cava(SHVC)and the other set was used for anastomosis of the infrahepatic vena cava(IHVC)and portal vein(PV).Six laparoscopic orthotopic liver transplantations were performed in pigs.Donor liver was obtained via open surgery.Hepatectomy was performed in the recipients through laparoscopic surgery.Anastomosis of the SHVC was performed using hand-assisted magnetic anastomosis,and the anastomosis of the IHVC and PV was performed by magnetic anastomosis with or without hand assistance.Results:Liver transplants were successfully performed in five of the six cases.Postoperative ultrasonographic examination showed that the portal inflow was smooth.However,PV bending and blood flow obstruction occurred in one case because the MVARs were attached to each other.The durations of loading of MVAR in the laparoscope group and manual assistance group for IHVC and PV were 13±5 vs.5±1 min(P<0.01)and 10±2 vs.4±1 min(P<0.05),respectively.The durations of MVAR anastomosis in the laparoscope group and manual assistance group for IHVC and PV were 5±1 vs.1±1 min(P<0.01),and 5±1 vs.1±1 min(P<0.01),respectively.The anhepatic phase was 43±4 min in the laparoscope group and 23±2 min in the manual assistance group(P<0.01).Conclusions:Our study showed that magnetic-assisted laparoscopic liver transplantation can be successfully carried out in pigs.

关键词： Liver transplantation Laparoscopy Magnetic surgery Vascular anastomosis

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Traditional Chinese medicine as supportive care for the management of liver cancer: Past, present, and future

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Genes & Diseases 2020年第3期7卷 370-379页

作者： xia Liao Yang Bu Qingan Jia department of Nutrition First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an710061China department of hepatobiliary surgery General HospitalNingxia Medical UniversityYinchuan750001China department of hepatobiliary surgery First Affiliated Hospital of Xi’an Jiaotong UniversityXi’an710061China

Liver cancer is the sixth most commonly diagnosed cancer and the fourth leading cause of cancer death worldwide.Western medicine and therapies are the primary treatment strategies of hepatocellular carcinoma(HCC),but the general prognosis for HCC patients is still dismal.Under these circumstances,HCC prevention is particularly important.Traditional Chinese medicine(TCM)encompasses a wealth of documented therapeutic resources,and“preventative treatment”is the principle of TCM.In China,TCM has been used for HCC prevention for thousands of years,and has also been demonstrated to be effective for the treatment of HCC in modern China.However,the TCM theory for prevention and treatment of HCC is more widely accepted in China than abroad.In this review,we first summarize the herbs and ancient formulas with therapeutic effects on HCC.We also review the research status of TCM in modern medicine as well as the current obstacles in its development.Finally,we discuss the future of TCM in the context of precision and integrated medicine.After reviewing the literature,we believe that TCM,through ancient development,is an advanced method of cancer treatment with positive curative effects,despite its surrounding controversy.Furthermore,precise analyses and systematic research methods provides novel approaches to modernize TCM for the future.

关键词： Chinese herbal medicine Hepatocellular carcinoma Molecular mechanism Network pharmacology Traditional Chinese medicine

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Survival Analysis of Hepatocellular Carcinoma： A Comparison Between Young Patients and Aged Patients

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Chinese medical Journal 2015年第13期128卷 1793-1800页

作者： xin-Sen Xu Wei Chen Run-Chen Miao Yan-Yan Zhou Zhi-xin Wang Ling-Qiang Zhang Kai Qu Qing Pang Rui-Tao Wang Chang Liu department of hepatobiliary surgery The First Affiliated Hospital of Medical College Xi'an Jiaotong University Xi'an Shannxi 710061 China

Background： To compare the clinicopathological features and prognosis between younger and aged patients with hepatocellular carcinoma （HCC）. Methods： We analyzed the outcome of 451 HCC patients underwent liver resection, transcatheter arterial chemoembolization and radiofrequency ablation, respectively. Then risk factors for aged and younger patients＇ survival were evaluated by multivariate analysis, respectively. Results： The patients who were older lhan 55 years old were defined as the older group. The overall survival for aged patients was significantly worse than those younger patients. The younger patients had similar liver fhnctional reserve but more aggressive tumor Paclors than aged patients. Cox regression analysis showed that tile elevated levels ofaspartate aminotransferase （AST）（Waldx2= 3.963, P = 0.047, hazard ratio [HR] -1.453, 95% confidence interval [CI]： 1.006-2.098）, lower albumin （Wald X2 = 12.213, P 〈 0.001, HR 1.982, q5% CI： 1.351 2.910）, tumor size （Wald X2 = 8.179, P- 0,004, HR - 1.841,95% CI： 1.212-2.797）, and higher alpha-fetoprotein level （Wald X2=4.044, P = 0.044, HR = 1,465, 95% （CI： 1.010 2.126） were independent prognostic factors for aged patients, while only elevated levelsofAST（WaldZ= 14.491,P〈0.001,HR 2.285, 95%CI： 1.493-3.496）andtumorsize（WaldX2= 21.662, P〈0.001,HR= 2.928, 95% CI： 1.863-4.604） were independent prognostic factors for younger patients. Conclusions： Age is a risk factor to determine the prognosis of patients with HCC. Aged patients who have good liver lhnctional reserve are still encouraged to receive curative therapy.

关键词： Age Hepatocellular Carcinoma： Multivariate Analysis： Prognosis

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