Objective To investigate the correlation between thrombocytosis and the progress of gastric cancer. Methods The clinical data of 276 gastric cancer patients who had been admitted to Tianjin Cancer Hospital from August 2002 to January 2004 were retrospectively analyzed. Of all patients, 75 were with thrombocy-tosis and 201 were with normal level of platelet. Data were analyzed by chi-square test, and the prognostie factors for gastric cancer were analyzed by Cox regression model. The accumulative survival was determined by Kaplan-Meier method, and the difference in survival between patients with and without thrombocytosis was analyzed by Log-rank test. Results The 1-, 3-, 5-year survival rates of gastric cancer patients with normal level of platelet were 82.4%, 50.5% and 41.9%, and the 1-, 3-, 5-year survival rates of gastric cancer patients with thrombocy-tosis were 74.7%, 37.3% and 25.3%. There was a significant difference in 5-year survival rates between patients with or without thrombocytosis (χ~2= 7.358, P<0.05). Thrombocytosis was correlated with the depth of invasion, distal metastasis, TNM staging and the tumor size (χ~2=6.946, 5.625, 14. 925, 4.028, P<0.05). The result of multivariate analysis indicated that the content of platelet was not the independent factor of good prog-nosis in gastric cancer. Conclusions There is a close relationship between thromboeytosis and clinieopathological factors of gastric cancer. Thrombocytosis may be used as a reference indicator for the prognosis of gastric cancer.

Objective To evaluate the feasibility and clinical significance of magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of anatomic variants of the extrahepatic biliary tract. Methods The MRCP images of 535 patients who were admitted to The Second Affiliated Hospital of Suzhou University from March 2008 to March 2009 were retrospectively analyzed by two reviewers independently. The anatomic variants of the extrahepatic biliary tract were evaluated by studying the T2-weighted magnetic resonance images. Results The consistency between the two reviewers in the diagnosis of low choledochal joint, medial cystic duct insertion, aberrant hepatic duct, accessory hepatic duct and other anatomic variants was 98% , 99% , 89% , 90% and 100%, respectively (K = 0.86, 0.93, 0.81, 0.82, 1.00). The extrahepatic biliary system was clearly displayed by MRCP in 500 patients, and anatomic variants were observed in 240 patients, including low choledochal joint in 85, parallel cystic duct in 37, medial cystic duct insertion in 82, aberrant hepatic duct in nine, accessory hepatic duct in 10, choledochal cyst in three and high cystic duct in seven. A total of 259 patients underwent operation, and 168 patients had anatomic variants of the extrahepatic biliary tract. Conclusion MRCP imaging enables the accurate assessment of anatomic variants of the extrahepatic biliary system and avoids bile duct injury.

Objective To evaluate the application of 64-slice computed tomography (CT) and software-assisted image analysis in preoperative evaluation and surgical planning of hilar cholangiocarcinoma. Methods The clinical data of six patients with hilar cholangiocarcinoma who were admitted to The First Affiliated Hospital of Sun Yat-sen University from June to December, 2009 were retrospectively analyzed. All six patients underwent 64-slice CT scanning before the operation, and then three-dimensional (3D) reconstruction of the liver, tumor, blood vessels and bile ducts was achieved with the assistance of Myrian (R) XP-Hepatic software. The relationships of the tumor, blood vessels and bile ducts were illustrated in the 3D model. Virtual liver resection was carried out for surgical planning. Results The 3D models of the liver, tumor, blood vessels and bile ducts were successfully constructed . The 3D models were able to be rotated and magnified as necessary. Preoperative evaluation and surgical planning were in accordance with actual surgery. The relative accuracy of the software-assisted image analysis system for calculating the hepatic volume to be resected was 5%. Patients recovered well without occurrence of hepatic failure. Conclusion Sixty-four-slice CT scanning and software-assisted image analysis are important for preoperative evaluation and surgical planning of hilar cholangiocarcinoma.

Objective To investigate the prognostic factors of hilar cholangiocarcinoma. Methods The clinical data of 204 patients with hilar cholangiocarcinoma who were admitted to The First Affiliated Hospital of China Medical University from January 1996 to May 2007 were retrospectively analyzed. The survival rate was calculated using the Kaplan-Meier method and Log-rank test. Seventeen factors that may have influenced prognosis were analyzed by univariate analysis. Factors that were statistically significant were further analyzed by the Cox regression model. Results The median survival times of patients who received radical resection, palliative resec-tion, bile duct exploration and catheter drainage, exploratory laparotomy, and liver transplantation were 37, 18, 11,5 and 25 months, respectively, and there was a significant difference between the 5 groups (χ2 = 58. 300, P < 0. 05). The prognostic factors included tumor size, portal vein or hepatic artery invasion, local invasion, resection margin, tumor grading, lymph node metastasis and surgical procedure (χ2 =6. 541, 8. 159, 5. 837, 4. 365, 13.748, 5.346, 9.472, P <0.05). Multivariate analysis demonstrated that surgical procedure and tumor grading were independent prognostic factors (6=0.287, 0. 320, P <0.05). Conclusions Radical resection is the most important prognostic factor of hilar cholangiocarcinoma. Appropriate perioperative care can improve the survival rate.

Objective To summarize the experiences of a single treatment group in surgical treatment of hilar cholangiocarcinoma during the past 10 years. Methods From January 2000 to December 2009, 1572 patients with hilar cholangiocarcinoma were admitted to the Eastern Hepatobiliary Surgery Hospital, and the clini-cal data of 462 patients in our treatment group were retrospectively analyzed. Among the patients, 314 received surgical treatment, and the remaining 148 received conservative interventions or refused any therapy. Factors that may have influenced the prognosis were analyzed by the Kaplan-Meier method, Log-rank test and Cox proportional hazards model. The correlation of different factors was analyzed by the chi-square test. Results A total of 314 patients underwent surgical treatment and tumor resection was performed in 237 patients, including 174 with R0 resection, 17 with R1 resection, and 46 with R2 resection. There were 91 patients with postoperative complications and 10 in-hospital deaths. A total of 260 patients had been followed up for 5-113 months, and the overall 1-, 3-, and 5-year survival rates were 71.7% , 32.6% and 10.9% , respectively; the 1-, 3-, and 5-year survival rates of patients with R0 resection were 76. 9% , 48. 6% and 32. 7% , respectively, with a median survival time of 35 months. R0 resection, TNM staging, regional lymph node involvement and tumor differentiation were the independent prognostic factors (RR = 2. 1, 1.9,2.2, 1.7, P<0.05). Conclusions Curative resection is the treatment of choice for hilar cholangiocarcinoma. Preoperative systematic evaluation and preparation can improve the radical resection rate and reduce postoperative morbidity.

Objective To investigate the expression and clinical significance of ABCG2 protein in hepato-cellular carcinoma (HCC). Methods Specimens of HCC were collected at The First Aifiliated Hospital of Sun Yat-sen University from January 2005 to December 2006. The expression of ABCG2 protein in 165 samples of HCC tissue, 25 samples of normal liver tissue and 40 samples of cirrhotic liver tissue was detected using immunohisto-chemistry. The correlation between the expression of ABCG2 protein and clinicopathological characters was then analyzed. Enumeration data, survival rate and the difference between groups were analyzed with a chi-square test, the Kaplan-Meier method and Log-rank test, respectively. Results ABCG2 protein expression was weakly posi-tive in all normal and cirrhotic liver tissues. In HCC tissues, the expression of ABCG2 protein was strongly positive in 66 cases and weakly positive in 99 cases. The expression of ABCG2 protein was related to tumor diameter, tumor number, adjacent organ invasion and TNM stages (χ2 =8. 130, 14. 279, 4. 820, 21. 179, P <0. 05). Kaplan-Meier survival analysis revealed that patients with strongly positive ABCG2 protein had a significantly lower 3-year overall survival (24. 1%) compared with those with weakly positive ABCG2 protein (39. 4%) (χ2 = 15.716, P<0.05). Conclusions The expression level of ABCG2 protein is related to tumor invasiveness, TNM stage and prognosis. ABCG2 has the potential to become a new target for HCC treatment.

Objective To investigate the therapeutic effectiveness of endoscopic self-expandable metal stent implantation for hilar cholangiocarcinoma. Methods The clinical data of 73 patients with hilar cholangiocar-cinoma who had received endoscopic metal stent implantation at the General Hospital of PLA Chengdu Command from July 2004 to July 2009 were retrospectively analyzed. The success rate of stent implantation, effective rate of jaundice release, duration of patency of the stent, survival time and postoperative complications were analyzed. Results Among the patients, 70 were successfully implanted with the stents. Unilateral metal stents were implan-ted in 62 patients, bilateral metal stents in three patients, and metal + plastic stents in five patients. The effective rate of jaundice release was 87% (61/70), the median duration of patency of the stent was 190 days, and the median survival time was 246 hours. Seven patients had complications of cholangitis, three had pancreatitis and two had bleeding. Conclusions The advantages of endoscopic metal stent implantation include minimal trauma and good efficacy in alleviating jaundice. It is the option of choice for the treatment of malignant biliary obstruction in patients with inoperable hilar cholangiocarcinoma.

A female patient aged 61 years was diag-nosed with metastatic liver cancer from colorectal cancer. Com-puted tomography (CT) scanning showed that the mass was located at the confluence of 3 hepatic venous trunks and had a diameter of 7 cm. The patient's standard liver volume was 1087 ml, and the volume in the right lobe was 634 mL and the right posterior lobe was 279 ml. We attempted to resect the left and caudate lobes with the middle hepatic vein (MHV) and to reconstruct tributaries of the MHV from segment V using a cryo-preserved autologous iliac artery. The operation time was 280 minutes and blood loss was 300 mL, and no postoperative com-plications were observed. The length of hospital stay was six days. Two weeks after the operation, imaging examinations by ultrasound and CT indicated that the graft vessel was patent. Three months after the operation, ultrasound examination demonstrated that the bypass was blocked, while no atrophy in hepatic segment V was detected, which indicated that communi-cating branches between the hepatic veins of segment V and the right hepatic veins had formed. Hepatectomy combined with hepatic venous reconstruction is safe and feasible for hepatoma at the confluence of three hepatic venous trunks.

Objective To construct a RhoA-siRNA expression vector and determine its role on the malig-nant behavior of HepG2 cells.Methods A RhoA-siRNA DNA fragment was synthesized and cloned into the expression vector of pGenesil-1.The constructed Rhon-siRNA DNA plasmid was stably transfected into HerG2 cells by lipofectamine,and then HepG2 cells were divided into the HepG2/RhoA-siRNA group (HepG2 cells were transfected with pGenesil-1-RhoA-siRNA),HepG2/control group(HepG2 cells were transfected with control plasmid) and HepG2 group (without plasmid transfection).The inbibitory effect of RhoA-siRNA on RhoA protein expression was shown by Western blot.The proliferation,migration,growth potentiality and cell cycle of transfected HepG2 cells were evaluated by MTT assay,wounded healing,the plate cloning formation test and flow cytometry,respectively.All data were analyzed by one-way analysis of variance (ANOVA) and chi-square test.Results The expression of RhoA protein in the HepG2/RhoA-siRNA group was,significantly decreased compared with that in the other two groups (F=178.19,P<0.05).Scratched cells were healed within 48 hours in the HepG2/control group and HepG2 group,but not in the HepG2/RhoA-siRNA group.The clone formation rates in the HepG2/RhoA-siRNA group,HepG2 group and HepG2/control group were 39%±3%,67%±5%and 70%±6%,respectively,with a significant difference among the three groups(χ2=33.34,38.69,P<0.05).Flow cytometry showed that the number of cells transfected with RhoA-siRNA was highest in the G0/G1 phase and lowest in the S phase(F=70.46,76.57.P<0.05).Conclusion The RhoA-siRNA expression vector can effectively suppress the proliferation and migration of HepG2 cells,which may provide a novel gene therapy for hepatocellular carcinoma.

Objective To investigate the typing, staging and therapeutic outcome of intrahepatic cholan-giocarcinoma (ICC). Methods The clinical data of 60 ICC patients who were admitted to the Renji Hospital of Shanghai Jiaotong University from January 2000 to December 2008 were retrospectively analyzed. ICC was classi-fied according to the type and TNM staging proposed by the Liver Cancer Study Group of Japan (LCSGJ). The relationships between typing, staging, surgical procedures and therapeutic outcome were investigated, as well as the relationship between the LCSGJ staging system and UICC staging system. Results The 1-, 3-, and 5-year survivals of the 60 ICC patients were 44% (23/52), 19% (10/52) and 10% (5/52), respectively. The median survival time for patients with radical resection (n =30) , liver transplantation (n = 10), palliative surgery (n = 11) and exploratory laparotomy (n=9) were 13, 3, 3 and 1 months, respectively. The radical resection rates for mass-forming type, periductal-infiltrating type, intraductal growth type and mixed type were 23/31, 9/15, 5/6 and 3/8, respectively. There were significant relationships between tumor type, degree of differentiation and prog-nosis (χ2 = 8. 308, 10. 009, P < 0. 05), and between tumor type and lymph node metastasis (χ2 = 13. 261, 5.702, P <0.05). There was no significant difference in survival time between patients with different pathological types, but the prognosis of patients with mucinous adenocarcinoma was better than that in the other types, with a median survival time of 20months. The median survival time of patients in LCSGJ stage Ⅳ was 3. 0 months, which was significantly longer than that in UICC stage Ⅳ (χ2 =3. 877, P <0. 05). Tumor staging was intimately related to the macroscopic type χ2 =8.288, P <0. 05). Conclusions The prognosis of ICC is poor. The typing and staging of LCSGJ is concise and practical, which is helpful in guiding treatment and evaluating progno-sis. Surgical treatment should be applied to mucinous ICC, and liver transplantation is not recommended for the treatment of ICC.