Objective: To investigate the correlation between Ishak inflammation score and the clinicopathological characteristics and recurrence of patients with hepatocellular carcinoma (HCC) after curative resection, and then set up a recurrence nomogram for HCC. Methods: A total of 326 patients with HCC after curative resection from January 2006 to December 2009 were studied retrospectively as training cohort and 110 HCC patients after surgery from January 2010 to December 2012 were used as validation cohort.Clinical follow-up data and peritumoral Ishak inflammation score in training cohort were used to set up a nomogram predicting recurrence of HCC, which was verified by validation cohort. Kaplan-Meier and Cox proportional hazard regression model were used to analyzed accuracy of model prediction. Results: According to Ishak inflammation score, patients were divided into four subgroups: Grade Ⅰ(1-4 scores), Grade Ⅱ(5-8 scores), Grade Ⅲ (9-12 scores) and Grade Ⅳ(13-18 scores). Ishak inflammation score were associated with aspartate transaminase(median 36.0 U/L, P=0.011), γ-glutamyl transpeptidase(median 54.5 U/L, P=0.005), HBV-DNA load(20.5%>10⁶ copies/ml, P=0.015) and microvascular invasion(26.7% positive, P=0.021). Multivariate analysis showed that Ishak inflammation score(P=0.007), HBV-DNA load(P<0.01), tumor size(P=0.001) and microvascular invasion(P=0.001) were related with the recurrence of HCC patients.These four risk factors were incorporated into the nomogram.Calibration curves of the nomogram had good agreement between prediction and observation in the probability of recurrence.Both C-indexes and receiver operating characteristic curve analyses revealed that this nomogram had better predictive abilities than those of the AJCC and Barcelona Clinic Liver Cancer (BCLC) stage systems.These results were verified by the validation cohort. Conclusion A nomogram based on Ishak inflammation score could accurately predict the recurrence of HCC and contribute to HCC relapse surveillance after curative hepatectomy.

The tumor microenvironment of hepatocellular carcinoma (HCC) is complex, leading to the high heterogeneity, occurrence and development of HCC. Exosomes are one of the most important components of HCC tumor microenvironment. Exosomes are membranous vesicles with the diameter about 40~160 nm, consisting with protein, nucleic acid and other substances, and can carry out signal transmission between cells. The information regulation of HCC-derived exosomes in the tumor microenvironment has a significant impact on the malignant biological behavior of HCC. In recent years, studies on the role of exosomes in the detection, treatment and prognosis of HCC have been made in-depth. This review focused on the role of exosomes in the biological process of HCC microenvironment, and discusses the research progress of exosomes in the HCC angiogenesis, metastasis, epithelial-mesenchymal transformation and immune regulation and so on.

Objective To study the association between ratio of peritumoral hepatic stellate cells to γδ T cells ratio (SGR) and prognosis of patients with hepatocellular carcinoma (HCC) after curative resection.Methods From January 2011 to December 2013,the clinical data of 320 patients with HCC who underwent curative resection at the Department of Hepatobiliary Surgery,the First Affiliated Hospital of Chongqing Medical University were collected and analyzed retrospectively.Immunohistochemistry was used to calculate the SGR in adjacent cancer tissues.Survival was estimated by Kaplan-Meier method.Prognosis of HCC patients was analyzed by univariate and multivariate analyses.Results Multivariate analysis revealed multiple tumors (HR =1.895,95％ CI:1.155-3.108),microvascular invasion (HR =1.665,95％ CI:1.104-2.512),tumor size ＞ 5 cm (HR =2.400,95％ CI:1.603-3.594) and peritumoral SGR ＞ 18 (HR =1.880,95％ CI:1.257-2.810) were independent risk factors of the overall survival rate in HCC patients.Preoperative AFP ＞ 20 μg/L (HR =1.631,95％ CI:1.151-2.311),microvascular invasion (HR =2.145,95％ CI:1.536-2.994),tumor size ＞ 5 cm (HR =1.866,95％ CI:1.342-2.592) and peritumoral SGR ＞ 18 (HR =1.517,95％ CI:1.084-2.122) were independent risk factors of the tumor-free survival rate in HCC patients.Patients were then divided into the low SGR (ratio≤ 18,n =222) and high SGR groups (ratio ＞ 18,n =98) using SGR in adjacent cancer tissues.The overall survival and tumor-free survival rates of the low SGR group were significantly better than the high SGR group (P ＜ 0.05).Conclusion Peritumoral SGR was an independent prognostic factor of patients with HCC following radical resection.The prognosis of patients with low SGR was better.