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BMC Cancer May 2024Tumor morphology, immune function, inflammatory levels, and nutritional status play critical roles in the progression of intrahepatic cholangiocarcinoma (ICC). This...
BACKGROUND
Tumor morphology, immune function, inflammatory levels, and nutritional status play critical roles in the progression of intrahepatic cholangiocarcinoma (ICC). This multicenter study aimed to investigate the association between markers related to tumor morphology, immune function, inflammatory levels, and nutritional status with the prognosis of ICC patients. Additionally, a novel tumor morphology immune inflammatory nutritional score (TIIN score), integrating these factors was constructed.
METHODS
A retrospective analysis was performed on 418 patients who underwent radical surgical resection and had postoperative pathological confirmation of ICC between January 2016 and January 2020 at three medical centers. The cohort was divided into a training set (n = 272) and a validation set (n = 146). The prognostic significance of 16 relevant markers was assessed, and the TIIN score was derived using LASSO regression. Subsequently, the TIIN-nomogram models for OS and RFS were developed based on the TIIN score and the results of multivariate analysis. The predictive performance of the TIIN-nomogram models was evaluated using ROC survival curves, calibration curves, and clinical decision curve analysis (DCA).
RESULTS
The TIIN score, derived from albumin-to-alkaline phosphatase ratio (AAPR), albumin-globulin ratio (AGR), monocyte-to-lymphocyte ratio (MLR), and tumor burden score (TBS), effectively categorized patients into high-risk and low-risk groups using the optimal cutoff value. Compared to individual metrics, the TIIN score demonstrated superior predictive value for both OS and RFS. Furthermore, the TIIN score exhibited strong associations with clinical indicators including obstructive jaundice, CEA, CA19-9, Child-pugh grade, perineural invasion, and 8th edition AJCC N stage. Univariate and multivariate analysis confirmed the TIIN score as an independent risk factor for postoperative OS and RFS in ICC patients (p < 0.05). Notably, the TIIN-nomogram models for OS and RFS, constructed based on the multivariate analysis and incorporating the TIIN score, demonstrated excellent predictive ability for postoperative survival in ICC patients.
CONCLUSION
The development and validation of the TIIN score, a comprehensive composite index incorporating tumor morphology, immune function, inflammatory level, and nutritional status, significantly contribute to the prognostic assessment of ICC patients. Furthermore, the successful application of the TIIN-nomogram prediction model underscores its potential as a valuable tool in guiding individualized treatment strategies for ICC patients. These findings emphasize the importance of personalized approaches in improving the clinical management and outcomes of ICC.
Topics: Humans; Cholangiocarcinoma; Male; Female; Retrospective Studies; Bile Duct Neoplasms; Middle Aged; Nutritional Status; Prognosis; Aged; Nomograms; Inflammation; Biomarkers, Tumor; Alkaline Phosphatase; Tumor Burden; Nutrition Assessment; Serum Albumin; ROC Curve; Monocytes
PubMed: 38783240
DOI: 10.1186/s12885-024-12375-7 -
Cirugia Y Cirujanos 2024This study aimed to compare the intestinal and pancreatobiliary subtypes of ampullary adenocarcinoma in a large patient group due to limited data on survival and risk... (Comparative Study)
Comparative Study
OBJECTIVES
This study aimed to compare the intestinal and pancreatobiliary subtypes of ampullary adenocarcinoma in a large patient group due to limited data on survival and risk factors.
METHODS
A retrospective analysis of the clinical and pathological findings and the survival of 184 patients with ampullary adenocarcinoma who underwent curative operation between 2007 and 2018 was performed.
RESULTS
Pancreatobiliary subtype had a higher prevalence of jaundice before operation than the intestinal subtype (p < 0.05). Pancreatobiliary subtype had a larger tumor size (> 2 mm) (p < 0.01) and poorer differentiation (p < 0.05) than the intestinal subtype. Perineural invasion more frequently occurred in pancreatobiliary subtype than the intestinal subtype (p < 0.01) and pancreatobiliary subtype had a higher prevalence of positive dissected lymph nodes (p < 0.05) with an advanced disease stage (p < 0.01) than the intestinal subtype. Patients of the pancreatobiliary subtype had poorer disease-free and overall survival than patients of the intestinal subtype. No survival benefit of adjuvant chemotherapy was found in either patients of the intestinal subtype or pancreatobiliary subtype. No significant difference was found in any subtypes regarding the recurrent regions.
CONCLUSIONS
Pancreatobiliary subtype exhibited a higher recurrence rate and a poorer overall survival rate with more unfavorable pathological characteristics than the intestinal subtype.
Topics: Humans; Retrospective Studies; Ampulla of Vater; Male; Female; Adenocarcinoma; Common Bile Duct Neoplasms; Middle Aged; Aged; Chemotherapy, Adjuvant; Adult; Neoplasm Invasiveness; Aged, 80 and over; Neoplasm Recurrence, Local; Lymphatic Metastasis; Tumor Burden; Disease-Free Survival
PubMed: 38782386
DOI: 10.24875/CIRU.23000021 -
BMC Gastroenterology May 2024Endoscopic biliary stenting (EBS) is commonly used for preoperative drainage of localized perihilar cholangiocarcinoma (LPHC). This study retrospectively compared the... (Comparative Study)
Comparative Study
BACKGROUND/PURPOSE
Endoscopic biliary stenting (EBS) is commonly used for preoperative drainage of localized perihilar cholangiocarcinoma (LPHC). This study retrospectively compared the utility of inside stent (IS) and conventional stent (CS) for preoperative EBS in patients with LPHC.
METHODS
EBS was performed in 56 patients with LPHC. EBS involved the placement of a CS (n = 32) or IS (n = 24). Treatment outcomes were compared between these two groups.
RESULTS
Preoperative recurrent biliary obstruction (RBO) occurred in 23 patients (71.9%) in the CS group and 7 (29.2%) in the IS group, with a significant difference (p = 0.002). The time to RBO (TRBO) was significantly longer in IS than in CS (log-rank: p < 0.001). The number of stent replacements was significantly lower in IS than CS [0.38 (0-3) vs. 1.88 (0-8), respectively; p < 0.001]. Gemcitabine-based neoadjuvant chemotherapy (NAC) was administered to 26 patients (46.4%). Among patients who received NAC, TRBO was longer in IS than in CS group (log-rank: p < 0.001). The IS group had a significantly shorter preoperative and postoperative hospital stay than the CS group (20.0 vs. 37.0 days; p = 0.024, and 33.5 vs. 41.5 days; p = 0.016). Both the preoperative and the postoperative costs were significantly lower in the IS group than in the CS group (p = 0.049 and p = 0.0034, respectively).
CONCLUSION
Compared with CS, IS for preoperative EBS in LPHC patients resulted in fewer complications and lower re-intervention rates. The fact that the IS group had shorter preoperative and postoperative hospital stays and lower costs both preoperatively and postoperatively compared to the CS group may suggest that the use of IS has the potential to benefit not only the patient but also the healthcare system.
Topics: Humans; Male; Stents; Female; Drainage; Bile Duct Neoplasms; Retrospective Studies; Middle Aged; Aged; Klatskin Tumor; Preoperative Care; Cholestasis; Neoadjuvant Therapy; Deoxycytidine; Gemcitabine; Recurrence; Treatment Outcome; Aged, 80 and over; Adult
PubMed: 38769494
DOI: 10.1186/s12876-024-03266-z -
VideoGIE : An Official Video Journal of... May 2024Video 1Pancreatic cannulation via the uneven method.
Video 1Pancreatic cannulation via the uneven method.
PubMed: 38766399
DOI: 10.1016/j.vgie.2024.02.003 -
World Journal of Clinical Cases May 2024Diagnosing early-stage pancreatic cancer (PC) remains a clinical challenge. Hence, studying novel imaging aspects that could enhance the diagnostic accuracy of malignant...
Diagnosing early-stage pancreatic cancer (PC) remains a clinical challenge. Hence, studying novel imaging aspects that could enhance the diagnostic accuracy of malignant pancreatic precursor lesions is imperative. This article aims to underscore the promising role of emerging imaging aspects that may facilitate the earlier diagnosis of PC, thereby improving its management and prognosis.
PubMed: 38765749
DOI: 10.12998/wjcc.v12.i14.2463 -
Frontiers in Immunology 2024This study aimed to analyze active compounds and signaling pathways of CH applying network pharmacology methods, and to additionally verify the molecular mechanism of CH...
Material basis and molecular mechanisms of Chaihuang Qingyi Huoxue Granule in the treatment of acute pancreatitis based on network pharmacology and molecular docking-based strategy.
OBJECTIVES
This study aimed to analyze active compounds and signaling pathways of CH applying network pharmacology methods, and to additionally verify the molecular mechanism of CH in treating AP.
MATERIALS AND METHODS
Network pharmacology and molecular docking were firstly used to identify the active components of CH and its potential targets in the treatment of AP. The pancreaticobiliary duct was retrogradely injected with sodium taurocholate (3.5%) to create an acute pancreatitis (AP) model in rats. Histological examination, enzyme-linked immunosorbent assay, Western blot and TUNEL staining were used to determine the pathway and mechanism of action of CH in AP.
RESULTS
Network pharmacological analysis identified 168 active compounds and 276 target proteins. In addition, there were 2060 targets associated with AP, and CH had 177 targets in common with AP. These shared targets, including STAT3, IL6, MYC, CDKN1A, AKT1, MAPK1, MAPK3, MAPK14, HSP90AA1, HIF1A, ESR1, TP53, FOS, and RELA, were recognized as core targets. Furthermore, we filtered out 5252 entries from the Gene Ontology(GO) and 186 signaling pathways from the Kyoto Encyclopedia of Genes and Genomes(KEGG). Enrichment and network analyses of protein-protein interactions predicted that CH significantly affected the PI3K/AKT signaling pathway, which played a critical role in programmed cell death. The core components and key targets showed strong binding activity based on molecular docking results. Subsequently, experimental validation demonstrated that CH inhibited the phosphorylation of PI3K and AKT in pancreatic tissues, promoted the apoptosis of pancreatic acinar cells, and further alleviated inflammation and histopathological damage to the pancreas in AP rats.
CONCLUSION
Apoptosis of pancreatic acinar cells can be enhanced and the inflammatory response can be reduced through the modulation of the PI3K/AKT signaling pathway, resulting in the amelioration of pancreatic disease.
Topics: Animals; Molecular Docking Simulation; Pancreatitis; Drugs, Chinese Herbal; Rats; Network Pharmacology; Signal Transduction; Male; Disease Models, Animal; Apoptosis; Rats, Sprague-Dawley; Protein Interaction Maps
PubMed: 38765004
DOI: 10.3389/fimmu.2024.1353695 -
International Journal of Surgery Case... Jun 2024Pancreaticopleural fistula is a rare complication most associated with alcohol-induced chronic pancreatitis. This usually presents with chest symptoms instead of...
INTRODUCTION
Pancreaticopleural fistula is a rare complication most associated with alcohol-induced chronic pancreatitis. This usually presents with chest symptoms instead of abdominal ones. Diagnosis requires a high index of suspicion in patients with pancreatitis and persistent pleural effusions.
PRESENTATION OF CASE
We present a case of an 81-years-old man admitted in the emergency department with a one week complaints of productive cough, fever, dyspnea and left-side chest pain. The chest X-ray revealed a moderated-volume left-side pleural effusion. The pleural fluid analysis was consistent with an exsudative pleural effusion with high levels of amylase. The thoracoabdominal CT raised the suspicion of a pancreaticopleural fistula, confirmed by ERCP. A pancreatic main duct stenting was performed with good results. The patient was discharged asymptomatic after 18 days of hospitalization.
DISCUSSION
Because of PPF insidious presentation it poses a great number of differential diagnosis, so pleural fluid analysis is of paramount importance with high levels of amylase confirming the diagnosis. MRCP and ERCP may establish the fistulous tract between the pancreatic duct and the pleural cavity, with the latter being also therapeutic.
CONCLUSION
The rarity of this complication related to pancreatitis and the seldomly presence of abdominal pain in contrast with chest symptoms poses a diagnostic challenge.
PubMed: 38761693
DOI: 10.1016/j.ijscr.2024.109755 -
Endoscopy Dec 2024
Topics: Humans; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Pancreatic Neoplasms; Male; Aged; Hemorrhage
PubMed: 38759965
DOI: 10.1055/a-2313-3991 -
Endoscopy Dec 2024
Topics: Humans; Female; Infant; Foreign Bodies; Appendix; Pancreatic Ducts
PubMed: 38759964
DOI: 10.1055/a-2308-2975 -
JPGN Reports May 2024Jaundice is an important physiologic manifestation of both benign and insidious diseases. We report on the case of an 11-year-old male who presented with diffuse...
Jaundice is an important physiologic manifestation of both benign and insidious diseases. We report on the case of an 11-year-old male who presented with diffuse pruritis, jaundice, and later abdominal pain. Initial work-up revealed an obstructive cholestatic pattern, warranting investigation for structural anomalies. Extensive imaging revealed a lesion on the pancreatic head, and biopsy of the lesion confirmed the diagnosis of idiopathic fibrosing pancreatitis (IFP). Temporary stenting of the common bile duct successfully treated our patient's symptomatic IFP.
PubMed: 38756122
DOI: 10.1002/jpr3.12018