Objective:To investigate the impact of the number of examined lymph nodes (ELN) on survival outcomes in gastric cancer patients with postoperative pathological stage pN3b.Methods:This retrospective cohort study included 279 pN3b gastric cancer patients who underwent D2 gastrectomy at Nanfang Hospital, Southern Medical University (September 2008 to April 2023), with 35 patients receiving combination chemotherapy and anti-PD-1 therapy (immunotherapy group) and 244 receiving adjuvant chemotherapy alone (nonimmunotherapy group). Additionally, 422 patients with pN3b from the SEER database (2005 to 2020) were collected as an external validation cohort to determine the optimal cutoff value for the number of lymph nodes examined in the nonimmunotherapy group. The primary endpoints were overall survival (OS) and recurrence-free survival (RFS) in the nonimmunotherapy group of the Nanfang Hospital cohort, stratified by whether the number of examined lymph nodes was above or below the ELN optimal cutoff value. These findings were subsequently validated in the SEER cohort.Results:The optimal ELN cutoff value (34 nodes) was determined using X-tile software and by constructing an ELN-HR fitting model with inflection point identification. In the nonimmunotherapy group, patients with ELN >34 exhibited significantly prolonged survival compared to ELN ≤34 (median OS: 25.0 (95%CI:20.5-29.5) to 17.0 (95%CI:12.7-21.3) months, P=0.004; median RFS: 19.0 (95%CI:15.6-22.4) to 13.0 (95%CI:9.5-16.5) months, P=0.048). Multivariate Cox analysis also showed ELN >34 to be an independent protective factor for both OS (HR=0.576, 95%CI: 0.397-0.836) and RFS (HR=0.701, 95%CI: 0.492-0.998). In the SEER cohort, ELN >34 was associated with a 5-month OS extension (19 to 14 months, P=0.065), with multivariate analysis supporting its independent prognostic significance (HR=0.729, 95%CI: 0.580-0.915, P=0.006). Notably, in the immunotherapy group, patients with ELN >34 ( n=30) achieved a median OS of 41 months, but the median OS had not been reached in the ELN ≤34 group ( n=5) (1 death at 48 months). Conclusion:Higher ELN (>34) correlates with improved survival in nonimmunotherapy-treated pN3b gastric cancer patients. However, in pN3b gastric cancer patients treated with immunotherapy, the optimal ELN threshold requires further exploration to determine.

Objective:To investigate the impact of the number of examined lymph nodes (ELN) on survival outcomes in gastric cancer patients with postoperative pathological stage pN3b.Methods:This retrospective cohort study included 279 pN3b gastric cancer patients who underwent D2 gastrectomy at Nanfang Hospital, Southern Medical University (September 2008 to April 2023), with 35 patients receiving combination chemotherapy and anti-PD-1 therapy (immunotherapy group) and 244 receiving adjuvant chemotherapy alone (nonimmunotherapy group). Additionally, 422 patients with pN3b from the SEER database (2005 to 2020) were collected as an external validation cohort to determine the optimal cutoff value for the number of lymph nodes examined in the nonimmunotherapy group. The primary endpoints were overall survival (OS) and recurrence-free survival (RFS) in the nonimmunotherapy group of the Nanfang Hospital cohort, stratified by whether the number of examined lymph nodes was above or below the ELN optimal cutoff value. These findings were subsequently validated in the SEER cohort.Results:The optimal ELN cutoff value (34 nodes) was determined using X-tile software and by constructing an ELN-HR fitting model with inflection point identification. In the nonimmunotherapy group, patients with ELN >34 exhibited significantly prolonged survival compared to ELN ≤34 (median OS: 25.0 (95%CI:20.5-29.5) to 17.0 (95%CI:12.7-21.3) months, P=0.004; median RFS: 19.0 (95%CI:15.6-22.4) to 13.0 (95%CI:9.5-16.5) months, P=0.048). Multivariate Cox analysis also showed ELN >34 to be an independent protective factor for both OS (HR=0.576, 95%CI: 0.397-0.836) and RFS (HR=0.701, 95%CI: 0.492-0.998). In the SEER cohort, ELN >34 was associated with a 5-month OS extension (19 to 14 months, P=0.065), with multivariate analysis supporting its independent prognostic significance (HR=0.729, 95%CI: 0.580-0.915, P=0.006). Notably, in the immunotherapy group, patients with ELN >34 ( n=30) achieved a median OS of 41 months, but the median OS had not been reached in the ELN ≤34 group ( n=5) (1 death at 48 months). Conclusion:Higher ELN (>34) correlates with improved survival in nonimmunotherapy-treated pN3b gastric cancer patients. However, in pN3b gastric cancer patients treated with immunotherapy, the optimal ELN threshold requires further exploration to determine.

Objective China has the biggest population of commonly encountered liver diseases , so hepatology resear-ches are of great importance to human health .In order to comprehensively collect/organize and effectively share/display liv-er physiopathology knowledge scattered around databases and literature , a Human Liver Disease Ontology ( HuLDO ) is built and applied in many ways .Methods HuLDO systematically classified and annotated various human liver diseases based on extensive cross mapping and integration of several authoritative nomenclatures of diseases and two monographs of hepatology .Results In the present version , HuLDO encompassed knowledge of 227 human liver diseases and was enriched by plenty of synonyms,definitions, descriptions, references, and logical or pathological relations between different disea-ses.Compared with other existing nomenclatures , HuLDO extended far beyond them in the scope of liver diseases .Several applications of HuLDO in database construction , knowledge collection and text mining were also described .Conclusion HuLDO offers a sound basis for knowledge mining , data integration and data analysis in the field of hepatology .HuLDO is publicly available at ftp://liveratlas.hupo.org.cn/5.liver 5.liver%20Disease%20Ontology/.

Objective To investigate the pathological characteristics of bile duct tumor thrombi (BDTT) and its inlfuence on the prognosis of patients with hepatocellular carcinoma (HCC) after surgical treatments. Methods Clinical data of 26 patients with HCC and BDTT (23 males, 3 females, age ranging from 23 to 78 years old and the median age of 52 years old) who underwent hepatectomy in Department of Hepatopancreatobiliary Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University from June 2007 to June 2012 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. The surgical procedures included regular hepatectomy (n=12), irregular hepatectomy (n=14). The treatments for BDTT included bile duct thrombectomy (n=13), extrahepatic bile duct resection (n=8), combined resection of BDTT and tumor (n=5). The pathological characteristics of BDTT were observed and its correlation with tumor recurrence was analyzed. The comparison of rates was conducted by Fisher's exact probability test. Results Two cases of pure small microscopic BDTT and 24 cases of big macroscopic BDTT (14 cases were combined with pure small microscopic BDTT) were observed. According to the Satoh's BDTT clinical classiifcation, there were 3 cases of typeⅠ, and 21 cases of type Ⅱin 24 cases of big macroscopic BDTT. In all 26 cases of BDTT, sub-epithelium spreading along the bile duct wall was observed in 23 cases, most of which were small microscopic BDTT or big macroscopic BDTT. Intraductal spreading was rare and was observed mostly at the end part of big macroscopic BDTT. During the follow-up, intrahepatic tumor recurrence was observed in 10 cases, in which 8 cases were combined with BDTT recurrence. The intrahepatic tumor recurrence rate was 3/9 in patients after regular hepatectomy, and was 58%(7/12) in patients after irregular hepatectomy. In the 13 cases receiving bile duct thrombectomy, 7 cases suffered from BDTT recurrence with the recurrence rate of 54%(7/13). In the 8 cases receiving extrahepatic bile duct resection, 1 case suffered from BDTT recurrence with the recurrence rate of 1/8, where signiifcant difference was observed (P<0.05). Conclusions BDTT of HCC includes macroscopic BDTT and microscopic BDTT. BDTT spreads mostly in sub-epithelium along the bile duct wall. Tumor recurrence rate may be reduced and the outcome may be improved by surgical treatments of regular hepatectomy combined with extrahepatic bile duct resection.