Objective: To investigate the impact of portal hypertention with hypersplenism of different severity and splenectomy on prognosis of hepatocellular carcinoma (HCC). Methods: We retrospectively analyzed the clinical data of 403 patients with HCC who met the Milan criteria and received radical treatment in Tianjin Third Central Hospital from January 2008 to January 2018. Cox propor-tional risk regression analysis was performed for parameters such as platelet levels (PLT), albumin-bilirubin (ALBI) grade, aspartate ami-notransferase-to-platelet ratio index (APRI), and post-sinusoidal resistance (PSR). HCC patients with severe hypersplenism were as-signed into two groups according to treatment method: radical treatment for HCC alone and radical treatment for HCC plus splenecto-my. Clinical data were compared, and the two groups were evaluated using the Kaplan-Meier survival analysis method. Results: Univar-iate and multivariate analyses showed that PLT was an independent risk factor for overall survival (OS) and disease-free survival (DFS) in patients with HCC. OS curves differed significantly with different PLT among patients with HCC (P=0.013). Furthermore, parameters of portal hypertension in cirrhosis, such as PSR, APRI, and ALBI grade, were risk factors for HCC prognosis. The degree of portal hyper-tension and hypersplenism, liver function, and tumor-node-metastasis stage did not differ between the two groups (P>0.05). Survival analysis showed significantly longer OS in the radical treatment plus splenectomy group (P=0.025). Following were the 1-, 3-, and 5-year survival rates: radical treatment alone group 100% , 98.2% , and 68.5% and radical treatment plus splenectomy group. 97.1% , 79.4%, and 56.8%, respectively. DFS did not differ between the two groups (P=0.326). Conclusions: Clinical parameters, such as PLT, PSR, APRI, and ALBI grade, are important prognostic factors in HCC patients with portal hypertension and hypersplenism. Radical treat-ment for HCC plus splenectomy can improve OS in HCC patients within the Milan criteria with severe hypersplenism.

Lung cancer is one of the most lethal malignancies in the world, with non-small cell lung cancer (NSCLC) accounting for approximately 80%-85% of all pathological types. Approximately 30%-55% of NSCLC patients develop brain metastases. It has been reported that 5%-6% of patients with brain metastases harbor anaplastic lymphoma kinase (ALK) fusion. ALK-positive NSCLC patients have shown significant therapeutic benefits after treatment with ALK inhibitors. Over the past decade, ALK inhibitors have rapidly evolved and now exist in three generations: first-generation drugs such as Crizotinib; second-generation drugs including Alectinib, Brigatinib, Ceritinib, and Ensartinib; and third-generation drugs like Lorlatinib. These drugs have exhibited varying efficacy in treating brain metastases in ALK-positive NSCLC patients. However, the numerous options available for ALK inhibition present a challenge for clinical decision-making. Therefore, this review aims to provide clinical guidance by summarizing the efficacy and safety of ALK inhibitors in treating NSCLC brain metastases.
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Humans ; Carcinoma, Non-Small-Cell Lung/drug therapy* ; Lung Neoplasms/drug therapy* ; Brain Neoplasms/drug therapy* ; Protein Kinase Inhibitors/adverse effects* ; Crizotinib