Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related death worldwide.Increase in incidence has been shown in HCC over the last few years and more than half of the cases were reported in China,where hepatitis B virus (HBV) infection is the main etiologic factor.Heterogeneity in HCC's distribution worldwide and difference in etiology may result in a more complicated issue about prognosis-estimation and choosing of treatment options for HCC patients.In the past decade,there have been several clinical staging systems developed in terms of relevant prognostic factors.Among them,the Barcelona Clinic Liver Cancer (BCLC) and the Hong Kong Liver Cancer (HKLC) staging system are the only two classifications that link prognostic classification to treatment indications.In this review,we mainly focus on the application of BCLC and HKLC staging systems in guiding decision making for HCC,the respective advantages and disadvantages of each classification,and the future perspective of our own prediction model in which some new clinical factors will be integrated.

Curative resection can offer a better chance for long-term survival than any other therapeutic modalities for hilar cholangiocarcinoma.This review highlights recent improvements in hilar cholangiocarcinoma management,with special attention to the new staging system for hilar cholangiocarcinoma,the perioperative management and the accurate dissection approach to achieve more adequate tumor-free resection margin.Overall,the precise surgical strategy and appropriate surgical techniques may provide an increased chance to cure patients with hilar cholangiocarcinoma.

Objective To evaluate the clinical diagnosis of gastric stromal tumors and the safety and feasibility with laparoscopic wedge resection.Methods The clinical data of diagnosis and treatment were retrospectively analyzed in 43 cases diagnosed as gastric stromal tumors by endoscopyic ultrasonography.Results Thirty-six cases were successful by laparoscopic surgery success rate being 83.7%.Endoscopic ultrasonography diagnosis rate was 69.0%.The positive rate of CD117 and CD34 in postoperative diagnosis of gastrointestinal stromal tumor wasl00%.The mean post-operative hospital stay was 5 days.Conclusion Endoscopyic ultrasonography can be selected as a main method for clinical diagnosis of gastric stromal tumors and laparoscopic resection was safe and feasible.

Objective To study the classification, its incidence and some related factors of neurological complications after liver transplantation.Methods 166 cases of orthotopic liver transplantation were retrospectively studied. The classification and the incidence of the neurological complications were analyzed. In addition, the patients were divided into two groups, according to whether they suffered from neurological complications or not, to study the difference of related factors, which included gender, age, primary disease, type of operation procedure, operation time, non-hepatic time, ischemia time of donor liver, blood loss, blood infusion and immunosuppressive regimen.Results Neurological complications occurred in 28 cases (32 times), which included encephalopathy, seizure, stroke, infection of central nervous system, serious para-pyramidal syndrome and peripheral neuropathy. The total incidence was 16.9 %. Between the neurological complication group and non-neurological-complication group, no difference was found in gender, age, type of operation procedure, operation time, non-hepatic time, ischemia time of donor liver, blood loss, blood infusion and immunosuppressive regimen, but the neurological complications were closely related with primary diseases. The incidence of neurological complications was 30 % in acute liver failure, followed by post-hepatitis B liver cirrhosis (21 %), primary liver carcinoma (17.8 %), Wilson disease (16.7 %) and primary biliary liver cirrhosis (12.5 %). Interestingly as a sole complication disease, the incidence of encephalopathy in acute liver failure was 15 %, that was much higher than that in other primary disease. So was the peripheral neuropathy, which was 10 % in primary liver carcinoma.Conclusions The neurological complication is a kind of serious disease with high incidence after liver transplantation. Its onset may have some relationships with the primary liver disease.

Cholangiolocellular carcinoma (CLC) is a rare type of primary liver cancer,which is thought to originate from hepatic progenitor cells.CLC is categorized as a different tumor type from the conventional intrahepatic cholangiocarcinoma (cICC) due to its unique histological and embryological features.This review summarizes the clinical,radiological and pathological characteristics and surgical outcomes of cICC and CLC.This pathological classification may provide important clinical implications for the treatment and outcome evaluation of this disease.

Cancer cells can secrete programmed death ligand 1 (PD-L1) to bind with inhibitory regulatory protein of programmed death 1 (PD-1) which lies on T-cell lymphocyte.Consequently,the activity of the T cells reduces,and the apoptosis cells increase.It's one of the pathways of newly discovered tumor immune escape.Primary hepatic cancer is one of the common malignant tumors of digestive system and closely related to viral hepatitis B in China.PD-1/PD-L1 pathway plays an important role in tumorigenesis and development of primary liver cancer.In this paper,the research updates of PD-1/PD-L1 in primary hepatic carcinoma were summarized.

Objective To explore the effect of multiplex methylation specific PCR for early diagnosis of nasopharyngeal carcinoma. Methods The methylation status of 18 genes were verified by MSP from 35 early nasopharyngeal carcinoma andmultiplex-MSP was established through the optimized working condition for rapid detection of several genes′ methylation status. Results The methylation rate of 12 genes exceeds 50%. The methylation specific products in only one group (Segment U) did reach the expected results while those from the other three groups were consistent with the MSP′s. Conclusion Multiplex-MSP is an efficient and low-cost method, and it can produce ideal experimental results similar to those by the MSP and DNA microarrays.

Objective To compare the primary treatment efficacy of radiofrequency ablation and surgical resection in patients with solitary hepatocellular carcinoma (HCC) which the diameter is ≤5 cm.Methods Databases were searched for comparative studies on radiofrequency ablatiom vs surgical resection published from 2005 to 2012.A Meta-analysis was performed using a randomized or fixed effect model to compare the treatment efficacy between radiofrequency ablatiom and surgical resection.Results Five studies fulfilled the criteria and were included.For HCC patients whose single tumors' diameter is ≤5 cm,radiofrequency ablation was equivalent to surgical resection for 1-,3-and 5-year overall survivals (P ＞ 0.05).However,surgical resection was superior to radiofrequency ablation in 1-,3-and 5-year disease-free survivals and there' s significant difference (P ＜ 0.05).Higher local recurrence rate was associated with radiofrequency ablation than surgical resection.Conclusions For HCC patients whose single tumors' diameter is ≤5 cm,radiofrequency ablation can achieve comparable overall survival as surgical resection,though with higher recurrence rate and lower disease-free survival.

Objective To invcstigate the value of preoperative imaging morphologic classification in solitary small hepatocellular carcinoma treated by RFA.Methods The clinical data of 73 patients with small hepatocellular carcinoma who rcccivcd radiofrequency ablation at the Affiliated Drum Tower Hospital of Medical School of Nanjing University from January 2008 to December 2012 were analyzed retrospectively.The lesions were classified into three types according to gross appearance in preoperative contrast-enhanced computed tomography (CT):single nodular type (type 1);single nodular with extranodular growth type or confluent multinodular type (type 2);infiltrating type (type 3).Thc clinicopathological features of patients with 3 types of tumors were compared by statistical methods.Patients were followed up via outpatient examination and telephone interview up to August 2014 or death.Results There were 24 cases of type 1,35 cases of type 2,14 cases of type 3,and the proportion were 20.2％,32.9％,47.9％,19.2％,respectively.The preoperative alpha-fetoprotein of type 3 was significantly higher than othcr types.The disease-free survival time of the three types were (37.2 ± 3.3) months,(20.9 ± 4.0) months,(14.4 ±4.9) months.The prognosis of the irregular types (type 2,type 3) is poor than the regular types (type 1).The overall survival time were (72.5 ± 4.7) months,(66.2 ± 7.3) months,(31.2 ± 5.3) months.The type 3 was the worst.The results of univariate analysis showed that morphologic classification,preoperative AFP,tumor size were related factors affecting the prognosis of patients (P ＜ 0.05).The results of multivariate analysis showed that morphologic classification was the independent risk factors affecting the prognosis of patients (P ＜ 0.05).Conclusion The preoperative imaging morphologic classification is the independent risk factors affecting the prognoses of patients with small HCC,which is help to choose the best treatment for patients with small hepatocellular.

Objective To investigate the correlation between immediate postoperative platelet count with liver failure after partial hepatectomy in patients with hepatocellular carcinoma.Methods The clinical data of 71 patients with hepatocellular carcinoma who underwent liver resection at the Hepatopancreatobiliary Surgery Department of Nanjing Drum Tower Hospital from July 2013 to August 2015 were retrospectively analyzed.The clinical diagnosis was confirmed by pathology of the resected specimens.Based on postoperative platelet count within 2 h,the patients were divided into the low platelet count (PLT ＜ 100 × 109/L) group (n =24,33.8％) and the normal platelet count (PLT ≥ 100 × 109/L) group (n =47,66.2％).The correlations between immediate postoperative platelet count with serum indexes including serum alanine aminotransferase (ALT),aspartate aminotransferase (AST),total bilirubin (TBil) and direct bilirubin (DBil) were analyzed,and the incidences of posthepatectomy liver failure was also evaluated in these two groups.Results There was no re-operation and perioperative death in this study.Among the 71 patients,25 patients (35.2％) developed postoperative complications (grade Ⅰ to Ⅲ),and 8 patients (11.3％) suffered from postoperative liver failure (grade A).When compared with the normal platelet count group,the low platelet count group had significantly increased risks of postoperative liver failure (29.2％ vs 2.1％,X2 =11.618,P ＜ 0.05),increased postoperative peaks of ALT,AST,TBil and DBil levels [(462.5 ±135.7)U/L vs (307.9 ± 192.6) U/L,(440.0 ± 163.3) U/L vs (265.8 ± 155.8) U/L,(29.5 ±9.1) μmol/L vs (17.9 ±8.8) μ mol/L,t =3.507,4.385,5.129,P ＜0.05,respectively] and longer normalization time of liver function.Multiple Logistic regression analyses revealed that an immediate postoperative low platelet count was an independent risk factor of posthepatectomy liver failure.Conclusions The platelet count was associated with the incidence of postoperative liver failure after partial liver resection in patients with hepatocellular carcinoma.Patients with an immediate postoperative low platelet count suffered from a high incidence of posthepatectomy liver failure and delayed liver function recovery.