Objective:To study the expression of forkhead box P1 (FOXP1) in intrahepatic cholangiocarcinoma (ICC), and its clinicopathological and prognostic significance.Methods:The clinical data of ICC patients treated with radical resection at Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine from January 1, 2013 to December 12, 2019 were retrospectively analysed. Of 48 ICC patients, there were 24 males and 24 females, with age of (59.1±10.1) years old (range 42 to 83 years old). Their clinicopathological data, including age, gender, tumor size, degree of differentiation, and staging were recorded. Immunohistochemical method was used to detect the expression of FOXP1 protein in ICC cancer tissues and the corresponding adjacent normal tissues. Kaplan-Meier method was used to calculate survival rates and to construct survival curves of patients. Cox regression model was used to analyze factors affecting prognosis of patients.Results:Forty-eight ICC cancer tissues and 40 corresponding paracancerous tissues were collected. The positive rates of FOXP1 proteins in ICC were significantly lower than the adjacent normal tissues [54.2%(26/48) vs. 92.5%(37/40), χ 2=15.76, P<0.05]. The degrees of tumor differentiation, lymph node metastasis, organ invasion and TNM staging were related to expression of FOXP1 ( P<0.05). Forty-two patients were followed-up with a median follow-up time of 11.5 (7.75, 19.25) months. Cox multivariate analysis revealed that invasion to adjacent organs, lymph node metastasis, high TNM staging (stage Ⅲ) and negative expression of FOXP1 were independent risk factors affecting overall survival of ICC patients. The overall survival and recurrence-free survival of FOXP1-positive ICC patients were 17.5 months and 15.5 months, which were significantly higher than the 14.0 months and 11.1 months, respectively, in FOXP1-negative patients. Conclusion:Negative FOXP1 expression was closely correlated with aggressive biological behavior and poor prognosis of ICC. FOXP1 may be used as new diagnostic and therapeutic targets.

Biliary tract cancer is found in the middle and advanced stages mostly and patients will deprive surgical indications. Conversion therapy can make the stage of some patients down and thus make radical resection feasible. Biliary tract cancer is highly heterogeneous in clinical features, cell origin, histology, molecular biology and other aspects, resulting in a lack of specific and effective conversion therapy strategies. Currently, it is the important development direction to evaluate and classify different individual conditions and select individualized conversion therapy regimens. With the deepening of the research on the pathogenesis and the improvement of treatment protocols, the future conversion therapy will undoubtedly develop towards the direction of individualization and precision.

Laparoscopic cholecystectomy (LC) is the first preferred treatment of benign gallbladder diseases such as gallbladder stones and gallbladder polyps, however bile duct injury is a serious complication of LC. Although bile duct injury is a rare complication, improper treatments will seriously affect the quality of life or even threaten life. Therefore, the prevention and correct treatments of bile duct injury in LC are crucial. Based on domestic and overseas researches, the authors investigate risk factors for bile duct injury in LC, share experiences of timely detection, diagnosis and treatment, so as to provide references for hepatic and biliary surgeons.

Biliary tract cancer is found in the middle and advanced stages mostly and patients will deprive surgical indications. Conversion therapy can make the stage of some patients down and thus make radical resection feasible. Biliary tract cancer is highly heterogeneous in clinical features, cell origin, histology, molecular biology and other aspects, resulting in a lack of specific and effective conversion therapy strategies. Currently, it is the important development direction to evaluate and classify different individual conditions and select individualized conversion therapy regimens. With the deepening of the research on the pathogenesis and the improvement of treatment protocols, the future conversion therapy will undoubtedly develop towards the direction of individualization and precision.

Hepatitis B is a common and multiplex disease in China. Recently, epidemiological studies have shown that hepatitis B virus(HBV) infection is a high-risk factor for the development of intrahepatic cholangiocarcinoma(ICC). Based on a retrospective analysis of relevant literature of recent years, this article concludes that HBV-associated ICC is very different from other ICC regarding clinicopathological characteristics and treatment. Distinctive features of patients with HBV-associated ICC included younger age, preponderance of male patients, frequent elevation of alpha fetoprotein, decrease of CA19-9, frequent appearance of cirrhosis, infrequent lymph node metastasis and better prognosis. Because these clinicopathological features are similar to those of HBV-associated hepatocellular carcinoma(HCC), we speculate that the cell origin of HBV-associated ICC and HBV-associated HCC are consistent. In addition, this article also discusses that HBV-associated ICC should be treated with surgery-based comprehensive treatment in order to improve prognosis.

Hepatitis B is a common and multiplex disease in China. Recently, epidemiological studies have shown that hepatitis B virus(HBV) infection is a high-risk factor for the development of intrahepatic cholangiocarcinoma(ICC). Based on a retrospective analysis of relevant literature of recent years, this article concludes that HBV-associated ICC is very different from other ICC regarding clinicopathological characteristics and treatment. Distinctive features of patients with HBV-associated ICC included younger age, preponderance of male patients, frequent elevation of alpha fetoprotein, decrease of CA19-9, frequent appearance of cirrhosis, infrequent lymph node metastasis and better prognosis. Because these clinicopathological features are similar to those of HBV-associated hepatocellular carcinoma(HCC), we speculate that the cell origin of HBV-associated ICC and HBV-associated HCC are consistent. In addition, this article also discusses that HBV-associated ICC should be treated with surgery-based comprehensive treatment in order to improve prognosis.

Intrahepatic cholangiocarcinoma(ICC)is characterized by highly malignant behavior,being difficult to make an early detection,and frequent lymph node metastasis,vascular invasion and intrahepatic dissemination,which lead to the poor prognosis of the patients.At present,radical operation is still the only therapy for providing a chance of long-term survival,but it faces many problems such as low radical-resection rate and high postoperative recurrence rate,as well as many controversies such as determinations for the scope of liver resection and the width of the surgical margin and whether the lymph node dissection should be done.Adjuvant therapy is a critical component of the multimodality treatment,but there are no standard directions and effective protocols for its chemoradiotherapy,and the targeted therapy and immunotherapy are at the stage of exploration.With the development of molecular biological techniques,high degree of heterogeneity has been found in ICC in terms of gene mutation,signal transduction and clinicopathologic features.Here,the authors from the heterogeneity of the biological characteristics and clinical features of ICC in combination with the treatment strategies and the new concept of integrated therapy for ICC,provide new insights and research directions for its individualized treatment.

Intrahepatic cholangiocarcinoma(ICC)is characterized by highly malignant behavior,being difficult to make an early detection,and frequent lymph node metastasis,vascular invasion and intrahepatic dissemination,which lead to the poor prognosis of the patients.At present,radical operation is still the only therapy for providing a chance of long-term survival,but it faces many problems such as low radical-resection rate and high postoperative recurrence rate,as well as many controversies such as determinations for the scope of liver resection and the width of the surgical margin and whether the lymph node dissection should be done.Adjuvant therapy is a critical component of the multimodality treatment,but there are no standard directions and effective protocols for its chemoradiotherapy,and the targeted therapy and immunotherapy are at the stage of exploration.With the development of molecular biological techniques,high degree of heterogeneity has been found in ICC in terms of gene mutation,signal transduction and clinicopathologic features.Here,the authors from the heterogeneity of the biological characteristics and clinical features of ICC in combination with the treatment strategies and the new concept of integrated therapy for ICC,provide new insights and research directions for its individualized treatment.