Background and Aims:The incidence of intrahepatic cholangiocarcinoma(ICC)has been increasing in recent years.Due to its insidious onset and low rate of early diagnosis,radical resection remains the only potential curative treatment.Lymph node metastasis is a major adverse prognostic factor in ICC,but the scope and therapeutic value of lymphadenectomy remain controversial.Previous studies suggest that patients with central ICC may derive greater survival benefit from lymphadenectomy than those with peripheral ICC.Preoperative assessment of lymph node status mainly relies on imaging,but its accuracy is limited.This study aimed to investigate the prognostic impact of lymphadenectomy in ICC patients at different anatomical sites to inform surgical decision-making.Methods:A retrospective analysis was conducted on 220 ICC patients who underwent radical resection at the 904th Hospital of the Joint Logistic Support Force of the PLA from May 2016 to May 2021.The cohort included 126 males and 94 females,with a mean age of(56.76±13.15)years.Patients were categorized into peripheral ICC(n=144)and central ICC(n=76)groups.Clinical characteristics,albumin-bilirubin(ALBI)grade,preoperative risk of lymph node metastasis,number of lymph nodes dissected,lymph node metastasis status,and postoperative survival outcomes were compared.Subgroup analyses were conducted to assess the prognostic value of the number of lymph nodes dissected under different risk stratifications.Results:Significant differences were observed between peripheral and central ICC in ALBI grade(x2=9.952,P=0.002),preoperative lymph node metastasis risk(x2=6.166,P=0.014),number of lymph nodes dissected(x2=4.167,P=0.042),and lymph node metastasis rate(x2=7.331,P=0.007).The 3-year overall survival(OS)rate was higher in peripheral ICC(31.94％)than in central ICC(15.79％)(x2=13.890,P＜0.001).Among central ICC patients,those with ≥6 lymph nodes dissected had better 3-year OS than those with＜6(16.89％vs.13.04％,x2=3.894,P=0.048).In the high-risk subgroup of central ICC,≥6 lymph nodes dissected was also associated with improved 3-year OS compared with＜6(15.62％vs.11.11％,x2=3.962,P=0.047).In contrast,the number of lymph node dissections had no significant prognostic impact in peripheral ICC or in patients classified as low risk.Conclusion:Patients with peripheral ICC had a better prognosis than those with central ICC.Adequate lymphadenectomy(≥6 nodes)improved survival and enhanced staging accuracy in central ICC patients at high risk of lymph node metastasis,highlighting the importance of preoperative risk assessment for optimizing surgical strategies.

Background and Aims:Radical resection is the only potentially curative treatment for intrahepatic cholangiocarcinoma(ICC),yet the high recurrence rate results in poor prognosis.In recent years,"textbook outcome"(TO)has been proposed as a comprehensive quality metric,but its association with prognosis remains unclear.This study aimed to analyze the risk factors influencing the achievement of TO after radical resection of ICC and to explore the relationship between TO and survival.Methods:A retrospective analysis was conducted on the clinical data of 180 ICC patients who underwent radical resection at the 904th Hospital of the Joint Logistic Support Force of the PLA between February 2018 and February 2023.Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with TO,and survival analysis was carried out using the Kaplan-Meier method and Log-rank test.Results:Of the 180 patients,66 achieved TO.Multivariate Logistic regression analysis indicated that preoperative total bilirubin＞22 μmol/L,preoperative CA19-9＞35 U/mL,maximum tumor diameter＞5 cm,poor tumor differentiation,microvascular invasion(MVI),and lymph node metastasis were independent risk factors for failing to achieve TO(all P＜0.05).Survival analysis demonstrated that patients who achieved TO had a significantly longer median survival compared with those who did not(36 months vs.16 months,P＜0.001).Conclusion:Preoperative total bilirubin＞22 μmol/L,preoperative CA19-9＞35 U/mL,maximum tumor diameter＞5 cm,poor tumor differentiation,MVI,and lymph node metastasis are independent risk factors for not achieving TO after radical resection of ICC.Patients who achieved TO exhibited markedly longer survival,suggesting that TO not only reflects perioperative treatment quality but also serves as an important prognostic indicator.Greater attention to these risk factors and optimization of perioperative management may improve the likelihood of achieving TO and enhance long-term outcomes.

Background and Aims:The incidence of intrahepatic cholangiocarcinoma(ICC)has been increasing in recent years.Due to its insidious onset and low rate of early diagnosis,radical resection remains the only potential curative treatment.Lymph node metastasis is a major adverse prognostic factor in ICC,but the scope and therapeutic value of lymphadenectomy remain controversial.Previous studies suggest that patients with central ICC may derive greater survival benefit from lymphadenectomy than those with peripheral ICC.Preoperative assessment of lymph node status mainly relies on imaging,but its accuracy is limited.This study aimed to investigate the prognostic impact of lymphadenectomy in ICC patients at different anatomical sites to inform surgical decision-making.Methods:A retrospective analysis was conducted on 220 ICC patients who underwent radical resection at the 904th Hospital of the Joint Logistic Support Force of the PLA from May 2016 to May 2021.The cohort included 126 males and 94 females,with a mean age of(56.76±13.15)years.Patients were categorized into peripheral ICC(n=144)and central ICC(n=76)groups.Clinical characteristics,albumin-bilirubin(ALBI)grade,preoperative risk of lymph node metastasis,number of lymph nodes dissected,lymph node metastasis status,and postoperative survival outcomes were compared.Subgroup analyses were conducted to assess the prognostic value of the number of lymph nodes dissected under different risk stratifications.Results:Significant differences were observed between peripheral and central ICC in ALBI grade(x2=9.952,P=0.002),preoperative lymph node metastasis risk(x2=6.166,P=0.014),number of lymph nodes dissected(x2=4.167,P=0.042),and lymph node metastasis rate(x2=7.331,P=0.007).The 3-year overall survival(OS)rate was higher in peripheral ICC(31.94％)than in central ICC(15.79％)(x2=13.890,P＜0.001).Among central ICC patients,those with ≥6 lymph nodes dissected had better 3-year OS than those with＜6(16.89％vs.13.04％,x2=3.894,P=0.048).In the high-risk subgroup of central ICC,≥6 lymph nodes dissected was also associated with improved 3-year OS compared with＜6(15.62％vs.11.11％,x2=3.962,P=0.047).In contrast,the number of lymph node dissections had no significant prognostic impact in peripheral ICC or in patients classified as low risk.Conclusion:Patients with peripheral ICC had a better prognosis than those with central ICC.Adequate lymphadenectomy(≥6 nodes)improved survival and enhanced staging accuracy in central ICC patients at high risk of lymph node metastasis,highlighting the importance of preoperative risk assessment for optimizing surgical strategies.

Background and Aims:Radical resection is the only potentially curative treatment for intrahepatic cholangiocarcinoma(ICC),yet the high recurrence rate results in poor prognosis.In recent years,"textbook outcome"(TO)has been proposed as a comprehensive quality metric,but its association with prognosis remains unclear.This study aimed to analyze the risk factors influencing the achievement of TO after radical resection of ICC and to explore the relationship between TO and survival.Methods:A retrospective analysis was conducted on the clinical data of 180 ICC patients who underwent radical resection at the 904th Hospital of the Joint Logistic Support Force of the PLA between February 2018 and February 2023.Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with TO,and survival analysis was carried out using the Kaplan-Meier method and Log-rank test.Results:Of the 180 patients,66 achieved TO.Multivariate Logistic regression analysis indicated that preoperative total bilirubin＞22 μmol/L,preoperative CA19-9＞35 U/mL,maximum tumor diameter＞5 cm,poor tumor differentiation,microvascular invasion(MVI),and lymph node metastasis were independent risk factors for failing to achieve TO(all P＜0.05).Survival analysis demonstrated that patients who achieved TO had a significantly longer median survival compared with those who did not(36 months vs.16 months,P＜0.001).Conclusion:Preoperative total bilirubin＞22 μmol/L,preoperative CA19-9＞35 U/mL,maximum tumor diameter＞5 cm,poor tumor differentiation,MVI,and lymph node metastasis are independent risk factors for not achieving TO after radical resection of ICC.Patients who achieved TO exhibited markedly longer survival,suggesting that TO not only reflects perioperative treatment quality but also serves as an important prognostic indicator.Greater attention to these risk factors and optimization of perioperative management may improve the likelihood of achieving TO and enhance long-term outcomes.

Objective:To study and compare the impact of lymph node metastasis and dissection on the prognosis of intrahepatic cholangiocarcinoma (ICC) patients at different anatomical locations, as well as the effect on prognosis.Methods:A retrospective analysis was conducted on the clinical data of 150 ICC patients who underwent radical surgical resection at the 904th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from September 2017 to September 2020. Among them, 86 were males and 64 were females, with the age of (56.2±12.9) years. Differences in albumin-bilirubin (ALBI) grade, preoperative lymph node metastasis risk, number of lymph nodes dissected, lymph node metastasis, and postoperative survival between peripheral and central ICC patients were compared to analyze the impact of lymph node dissection on the prognosis of ICC patients at different locations.Results:There were statistically significant differences in ALBI grade, preoperative lymph node metastasis risk, the number of lymph nodes dissected, and lymph node metastasis between 98 cases of peripheral ICC and 52 cases of central ICC (all P<0.05). The 3-year overall survival rates for peripheral and central ICC patients were 30.6% and 15.4%, respectively, with a statistically significant difference ( χ2=8.46, P=0.004). Among central ICC patients, the 3-year overall survival rates for those with ≥6 lymph nodes dissected and <6 lymph nodes dissected were 16.7% and 12.5%, respectively, with a statistically significant difference ( χ2=3.96, P=0.046). In the high-risk central ICC patients with preoperative lymph node metastasis, the 3-year overall survival rate of ≥6 lymph nodes dissection ( n=22) and <6 lymph nodes dissection ( n=12) were 13.6% and 8.3%, respectively, with statistical significance ( χ2=5.55, P=0.019). Conclusions:The prognosis of peripheral ICC patients is better than that of central ICC patients. For central ICC patients with a high preoperative lymph node metastasis risk, adequate lymph node dissection can lead to a better prognosis.

Objective To investigate the expressions and the significance among the three markers TGF β1,Survivin and Caspase-3 in intrahepatic bile duct tissues in patients with intrahepatic bile duct stones.Method Total of 130 paraffin section of intrahepatic bile duct tissue were collected at Department of Pathology,The 904th Hospital of Joint Logistic Support Force of PLA from 2013 to 2018.Total of 50 patients with intrahepatic bile duct stones complicated with bile duct strictures (the stenosis group),40 patients with intrahepatic bile duct stones with chronic inflammation (the inflammation group),and 40 patients with normal liver tissues (the normal control group) were included in this study.The expressions of TGF β1,Survivin and Caspase-3 in liver tissues were detected by immunohistochemistry and compared among the 3 groups to find their correlations with the clinicopathological features of the disease of the patients.Results TGF β1 was expressed in 72.0％ of the patients in the stenosis group,37.5％ in the inflammatory group,and 15.0％ in the normal control group.The differences among the groups were significant (P ＜ 0.05);Survivin was expressed in 78.0％ of the patients in the stenosis group,47.5％ in the inflammatory group,and 25.0％ in the normal control group.The differences among the groups were significant (P ＜ 0.05);Caspase-3 was expressed in 10.0％ of the patients in the stenosis group,42.5％ in the inflammatory group,and 75.0％ in the normal control group.The differences among the groups were significant (P ＜ 0.05).Within the stenosis group,TGF β1 was negatively correlated with Caspase-3 (r =-0.882,P ＜ 0.05),and positively correlated with Survivin (r =0.889,P ＜ 0.05).Survivin and Caspase-3 were also negatively correlated (r=-0.923,P＜0.05).Conclusion Abnormal expressions of TGF β1,Survivin and Caspase-3 were involved in the formation of intrahepatic bile duct stones associated with bile duct strictures.

Hepatolithiasis is a very common hepatobiliary disease in Asia. Recurrent hepatolithiasis frequently lead to incidence of intrahepatic cholangiocarcinoma. The associated intrahepatic cholangiocarci-noma is generally hidden and often covered up by the related clinical symptoms caused by stones, which can easily lead to missed the best time of diagnosisand treatment. This paper mainly showed the diseases of intra-hepatic cholangiocarcinoma associated with intrahepatic cholelithiasis, and expounded the changes of local microenvironment of bile duct tissue from intrahepatic cholelithiasis to intrahepatic cholangiocarcinoma. The purpose of this study is to look for the risk factors related to the development of intrahepatic cholelithiasis to intrahepatic cholangiocarcinoma and to provide a new research direction for the clinical treatment of intrahe-patic cholangiocarcinoma.

Objective:To investigate the expressions of TGF-β1,survivin and caspase-3 in hepatolithiasis-associated intrahepatic cholangiocarcinoma(ICC)tissue and their clinical significance.Methods:The expressions of TGF-β1,survivin and caspase-3 in intrahepatic bile duct specimens from 52 patients with intrahepatic stones and concomitant ICC(tumor group)and 30 patients with intrahepatic stones and chronic inflammation(inflammation group)as well as 30 specimens of normal intrahepatic bile duct were determined by immunohistochemical staining.The relations of the three factors with the clinicopathologic characteristics and prognosis of ICC patients were analyzed.Results:In tumor group,inflammation group and normal group,the positive expression rates TGF-β1 and survivin presented a successively decreasing order,while the positive expression rates of caspase-3 showed a successively increasing order(all P<0.05);in ICC tissue,the expressions of TGF-β1 and survivin showed a positive correlation(r=0.917,P<0.01),and both had a negative correlation with that of caspase-3(r=-0.890,P<0.01;r=-0.894,P<0.01).the results of univariate and multivariate analyses showed that TGF-β1,survivin and caspase-3 were independent influential factors for the prognosis of patients with hepatolithiasis-associated ICC(all P<0.05);the survival rates of patients with positive TGF-β1 or survivin expression were significantly reduced compared with respective negative ones(χ2=13.192,P=0.001;χ2=10.536,P=0.002),and the survival rate of patients with positive caspase-3 expression was significantly higher than those with its negative expression(χ2=5.469,P=0.023).Conclusion:The expressions of TGF-β1,survivin and caspase-3 are abnormal in hepatolithiasis-associated ICC tissue,and they may probably be jointly involved in the occurrence and development of this condition.

Objective:To investigate the expressions of TGF-β1,survivin and caspase-3 in hepatolithiasis-associated intrahepatic cholangiocarcinoma(ICC)tissue and their clinical significance.Methods:The expressions of TGF-β1,survivin and caspase-3 in intrahepatic bile duct specimens from 52 patients with intrahepatic stones and concomitant ICC(tumor group)and 30 patients with intrahepatic stones and chronic inflammation(inflammation group)as well as 30 specimens of normal intrahepatic bile duct were determined by immunohistochemical staining.The relations of the three factors with the clinicopathologic characteristics and prognosis of ICC patients were analyzed.Results:In tumor group,inflammation group and normal group,the positive expression rates TGF-β1 and survivin presented a successively decreasing order,while the positive expression rates of caspase-3 showed a successively increasing order(all P<0.05);in ICC tissue,the expressions of TGF-β1 and survivin showed a positive correlation(r=0.917,P<0.01),and both had a negative correlation with that of caspase-3(r=-0.890,P<0.01;r=-0.894,P<0.01).the results of univariate and multivariate analyses showed that TGF-β1,survivin and caspase-3 were independent influential factors for the prognosis of patients with hepatolithiasis-associated ICC(all P<0.05);the survival rates of patients with positive TGF-β1 or survivin expression were significantly reduced compared with respective negative ones(χ2=13.192,P=0.001;χ2=10.536,P=0.002),and the survival rate of patients with positive caspase-3 expression was significantly higher than those with its negative expression(χ2=5.469,P=0.023).Conclusion:The expressions of TGF-β1,survivin and caspase-3 are abnormal in hepatolithiasis-associated ICC tissue,and they may probably be jointly involved in the occurrence and development of this condition.