Objective To research the effect of γ-ray released from 103Pd radioactive stent on the expression of Fas gene and its relation with apoptosis of cholangiocarcinoma cell and the significances through the establishment of human cholangiocarcinoma model. Methods The model of nude mouse with implanted human cholangiocarcinoma was established. The mice were divided into study group and control group, 37 MBq 103Pd biliary stent was implanted in the study group and the ordinary metal biliary stent was implanted in the control group. The volume of tumor was measured, the cell apoptosis was detected by the TUNEL method and the expression of Fas gene of the cell apoptosis of the induced human cholangiocarcinoma was checked out by immunohistochemistry staining 10 d after the implantation. Results Compared with the control group, the growing speed of the volume of tumor in study group was significantly reduced (Plt;0.05), the expression positive rate of Fas gene was significantly higher (Plt;0.05), and the apoptotic rate of cancer cells was also higher (Plt;0.01). Conclusions The 103Pd radioactive stent can induce the cell apoptosis in nude mouse model with implanted human cholangiocarcinoma inhibit the cell growth of bile duct cancer and may promote the apoptosis of cancer cells by increasing the expression of Fas gene. It may be helpful for the further study of treatment for bile duct cancer using 103Pd radioactive stent.
ObjectiveTo investigate the expression of proapoptosis gene bad in intrahepatic cholangiocarcinoma (ICC) and its relationship to differentiation of the tumor.MethodsThe immunohistochemistry technique by Dako Envision system and rabbit antihuman bad polyclonal antibodies were adopted. The expression of bad was detected in 48 cases of ICC and 25 cases of control tissues.ResultsBad immunoreactivity in 48 cases of ICC was higher than that of bile duct epithelium in 25 cases of control tissues. And contrasted with 21 cases of well differentiated ICC, bad immunoreactivity was higher in 27 cases of middle and poor differentiated ICC.ConclusionThe expression of bad gene may be related to the differentiation of ICC.
ObjectiveTo summarize the surgical treatment and explore factors which influencing prognosis of hilar cholangiocarcinoma. MethodsClinical data of 189 cases of hilar cholangiocarcinoma who treated in our hospital from Jan. 2000 to Dec. 2010 and clinicopathological factors that might influence survival were analyzed retrospectively. A multivariate factor analysis was performed through Cox proportional hazard model. ResultsOf 189 cases, 62 cases received radical resection, 54 cases received palliative surgery, and 73 cases received non-resection surgery. Operative procedure (RR=0.165), differentiated degree (RR=2.692), lymph node metastasis (RR=3.014), neural infiltration (RR=2.857), and vascular infiltration (RR=2.365) were found to be the statistically significant factors that influenced survival by multivariate factor analysis through the Cox proportional hazard model. ConclusionsRadical resection is the best treatment for hilar cholangiocarcinoma. Skeletonized hepatoduodenal ligament, complete excision of infiltrated nerve and blood vessel are important influence factors to improve the prognosis of hilar cholangiocarcinoma.
ObjectiveTo explore the treatment and prognostic factors of typeⅢhilar cholangiocarcinoma. MethodsThe data of 170 cases of typeⅢhilar cholangiocarcinoma treated in our hospital from Jan. 2002 to Dec. 2011 were retrospectively analyzed. ResultsAmong these 170 patients of typeⅢhilar cholangiocarcinoma, 109 patients underwent surgical exploration in which 60 patients underwent resection and the remaining 49 patients were found unresectable and underwent U-tube or metallic stent drainage. Sixty one patients were preoperatively assessed as unresectable in which 14 patients underwent percutaneous transhepatic cholangial drainage and the remaining 47 patients refused any surgical intervention. Results of Cox proportional hazard model showed that residual tumor status (HR=4.621, 95% CI:1.907-11.199, P=0.001), lymph node metastasis (HR=2.792, 95% CI:1.393-5.598, P=0.004), and hepatectomy (HR=3.003, 95% CI:1.373-6.569, P=0.006) were independent prognostic factors which associated with patients in resection group. Besides, treatmentR0 resection (HR=0.177, 95% CI:0.081-0.035, P < 0.001), no treatment (HR=5.568, 95% CI:2.733-11.342, P < 0.001)] and vascular invasion (HR=1.667, 95% CI:1.152-2.412, P=0.007) were prognostic factors associated with all patients. ConclusionsTreatment and vascular invasion are the most important predictors of prolonging survival associated with typeⅢhilar cholangiocarcinoma. Besides, R0 resection including hepatectomy without lymph nodes metastasis is feasible in the majority of patients with resectable hilar cholangiocarcinoma.
Objective To discuss the relationship between the efficiency of bile duct drainage and the postoperative liver functional recovery and the prognosis of hilar cholangiocarcinoma. Methods We studied retrospectively 58 cases of hilar cholangiocarcinoma which entered our department between June 1987 and October 1998. The postoperative liver functional recovery and mortality and morbidity between unilateral (n＝27) and bilateral (n＝31) bile duct drainage groups were compared. Results The liver function in bilateral drainage group was nearly normal within 6 weeks after operation. The ALb level of unilateral drainaged patients recovered gradually to normal after operation, and the TBIL and ALT decrease nearly to the normal range within 6 weeks after operation. The AKP decreased within 2 postoperative weeks, then steadily increased. The differences of perioperative complication rate and mortality of the two groups showed no significance. Conclusion The data showed that the liver function can recover to some extent by unilateral bile duct drainage, and unilateral drainage operations are the choice for hilar cholangiocarcinoma that can not be excised now.
ObjectiveTo summarize the incidence, patterns and laws of perineural invasion, and explore the path and the influencing factors of perineural invasion in hilar cholangiocarcinoma. MethodsA clinicopathologic study was conducted on sections from 52 patients with hilar cholangiocarcinoma to summarize the incidence and patterns of perineural invasion. The relationship of perineural invasion to lymph node metastasis, serum CA19-9, CEA, total bilirubin (TBIL) level, Bismuth-Corllet classification, or tumor penetration depth of bile duct walls was analyzed by association analysis. ResultsThe overall incidence of perineural invasion was 90.38% (47/52). However, the incidences of perineural invasion had no significant differences among various differentiated adenocarcinoma groups (P > 0.05). The incidences of perineural invasion were not correlated with the lymph node metastasis, serum CA19-9, CEA, TBIL level, and Bismuth-Corlette classification (P > 0.05), which was correlated with the tumor penetration depth of bile duct walls (P < 0.01). There were four patterns of perineural invasion, sequenced them according their incidences from high to low as follows: typeⅡ> typeⅢ> typeⅣ> typeⅠ. The pattern of perineural invasion was correlated with the degree of tumor differentiation (χ2=31.04, P < 0.01). ConclusionsThe incidence of perineural invasion is very high in hilar cholangiocarcinoma. The patterns of perineural invasion are similar in the same patient, and a variety of invasion patterns might coexist. While the pattern of perineural invasion is correlated with the degree of tumor differentiation. The incidence of perineural invasion is correlated with the tumor penetration depth of bile duct walls.
ObjectiveTo detect expression of FXYD6 protein in hilar cholangiocarcinoma tissues and explore its significances. MethodsThe expressions of FXYD6 protein in the 58 hilar cholangiocarcinoma tissues and 30 normal bile duct tissues adjacent to cancer were detected by strept avidin-biotin complex (SABC) immunohistochemistry. The relation between FXYD6 protein expression and biological characteristics of patient with hilar cholangiocarcinoma was analyzed. ResultsThe positive rate of FXYD6 protein expression in the hilar cholangiocarcinoma tissues was significantly higher than that in the normal bile duct tissues adjacent to cancer[75.9% (44/58) versus 33.3% (10/30), χ2=15.084, P=0.000]. Furthermore, the positive rate of FXYD6 protein expression in the well and moderately differentiated hilar cholangiocar-cinoma tissue was significantly higher than that in the poorly differentiated hilar cholangiocarcinoma [85.4% (35/41) versus 52.9% (9/17), χ2=5.243, P=0.022], which was not related to the gender (χ2=0.000, P=1.000), age (χ2=1.248, P=0.264), T stage (χ2=0.466, P=0.495), lymph node metastasis (χ2=0.357, P=0.550), pathological stage (χ2=0.005, P=0.944), and perineural invasion (χ2=3.016, P=0.082). Conclustion The positive rate of FXYD6 protein expression is associated with differentiation of hilar cholangiocarcinoma, which might be a new biomarker of it.
Objective To explore favorable factors of reducing incidence of postoperative liver failure after radical resection of Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma in condition of hyperbilirubinemia. Methods All the clinical data of one patient with Bismuth-Corlette type Ⅳ hilar cholangiocarcinoma underwent radical resection in June 2017 in the West China Hospital of Sichuan University were collected. The preoperative total bilirubin level of this patient was 470.3 μmol/L, the patient didn’t receive preoperative biliary drainage. The preoperative jaundice time and cholangitis were calculated accurately. A 3D imaging system for quantitative evaluation of the liver was used to reconstruct the images with contrast-enhanced CT images of this patient. And the total liver volume and the future liver remnant volume (FLRV) were calculated. Finally, 6 months of follow-up were conducted after surgery. Results The exact jaundice time was 20 d and there was no preoperative cholangitis. The postoperative FLRV accounted for about 70%. No postoperative liver failure occurred. No recurrence of tumor and death of patient occurred after 6 months of follow-up. Conclusions Radical resection of hilar cholangiocarcinoma in condition of hyperbilirubinemia is not an absolute contraindication for surgery, but indications should be strictly controlled. For special patient whose jaundice with short duration, no preoperative cholangitis and a high FLRV may be treated with directly radical surgery to prevent for losting the best time of surgery.
ObjectiveTo explore the association between viral hepatitis and extrahepatic cholangiocarcinoma (ECC). MethodsDatabase of Medline, Embase, PubMed, CNKI, and Wanfang were searched for the articles which were related to the relationship between viral hepatitis and ECC. After the quality evaluation and the data extraction of the literatures, statistical software of RevMan 5.0 was used to perform Meta analysis. ResultsAccording to the inclusion criteria and exclusion criteria, 9 articles were enrolled, 8 articles of them were related to hepatitis B virus(HBV) and 6 articles of them were related to hepatitis C virus(HCV). Meta analysis results showed that the HBV infection may be the risk factor for ECC(OR=1.69, 95% CI:1.32-2.17, P<0.000 1). In the United States, HCV infection may be the risk factor for ECC(OR=5.53, 95% CI:2.21-13.82, P=0.000 3), but the relationship was not found in China(OR=0.82, 95% CI:0.44-1.52, P=0.520 0). ConclusionsThe present studies suggest that HBV infection may be a high risk factor for ECC. HCV in the United States can increase the incidence of ECC, but the situation can not be found in China.
ObjectiveTo understand the current progress in the application of artificial intelligence (AI) technology in intrahepatic cholangiocarcinoma (ICC). MethodA systematic review was conducted on recent domestic and international research literature regarding AI applications in ICC, with a focus on radiomics and deep learning (DL). ResultsICC is a critical subtype of primary liver cancer characterized by high malignancy and mortality. We systematically reviewed the current status and prospects of AI-based approaches in preoperative diagnosis, treatment guidance, and prognosis prediction for ICC. ConclusionsDespite the progress made by AI in the field of ICC, it still faces challenges such as model accuracy, data integration, and clinical application. With technological advancements and deeper research, AI is expected to play a more significant role in ICC prevention and treatment. Interdisciplinary collaboration will also drive sustainable progress in this domain.