Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal tract.Extensive het-erogeneity exists in the clinical course and prognosis of GISTs due to multiple genetic mutations.Since the advent of tyrosine kinase inhibit-ors(TKIs),such as imatinib,the survival of patients with GISTs has substsntially improved.However,progression or metastasis often occurs in these patients.For advanced and metastatic GISTs,drug selection and surgical indications have been studied and debated in recent years.With further research in etiology and TKI resistance,novel target agents such as ripretinib,avapritinib,and other pathway inhibitors have been introduced into clinical practice,enabling a more individualized and accurate treatment modality for advanced and metastatic GISTs.This review provides an update on the current therapeutic development landscape in advanced and metastatic GISTs.

Objective:To evaluate the prognostic value of tumor burden score(TBS)combined with serum tumor markers in patients with resectable colorectal liver metastasis(CRLM)after curative hepatectomy.Methods:We retrospectively retrieved and analyzed clinicalpatho-logical data of patients with CRLM who underwent curative hepatectomy between Jan 2012 to Dec 2023 in The First Affiliated Hospital of Chongqing Medical University.Serological tumor markers and TBS were utilized to generate prediction model,where the serological index was derived from the sum of carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9)levels,and TBS was calculated from preoperative radiological images.The cutoff values were determined as the sum of CEA and CA19-9 levels and preoperative TBS.The pa-tients were then categorized based on prediction parameters into low-risk(lacking any high-level index),medium-risk(with one high-level in-dex)and high-risk(with two high-level indices)groups.Overall survival(OS)and disease-free survival(DFS)were compared using Kaplan-Meier curves,and multivariate Cox regression analysis was performed to determine possible prognostic risk factors.The receiver operating characteristic curve(ROC)and C-index were employed to assess the discriminatory power of the prediction model.Results:Median follow-up time was 43(4-112)months.Kaplan-Meier survival analysis suggested that the median OS time and 5-year OS of low-,median-,and high-risk groups were 64,54,and 30 months and 55%,38%,and 23%respectively(P=0.001 9).The median DFS time and 3-year DFS were 36,22,and 11 months,and 47%,35%,and 16%respectively(P<0.001).Multivariate Cox regression analysis revealed that in-dependent prognostic risk factors for postoperative OS were the sum of CEA and CA19-9 level(hazard rstio[HR]=1.81,95%confidence inter-val[CI]:1.09-3.01,P=0.021),TBS(HR=1.42,95%CI:1.02-2.84,P=0.032),bilobar metastasis(HR=1.99,95%CI:1.25-3.16,P=0.004),and primary tumor nodal invasion(HR=1.51,95%CI:1.37-3.34,P=0.028).Multivariate Logistic regression analysis showed that the sum of CEA and CA19-9 levels(odds ratio[OR]=2.44,95%CI 1.26-4.71,P=0.008)and TBS(OR=2.95,95%CI:1.50-5.78,P=0.002)associated significantly with postoper-ative recurrence.The ROC curve and C-index revealed that serum tumor markers combined with TBS(area under the curve=0.630,95%CI:0.552-0.707,P<0.05;C-index=0.627)were more effective in predicting the prognosis of patients with CRLM than either CEA or TBS alone.Conclusions:The prediction model based on serum tumor markers combined with TBS demonstrated better efficacy than any single serolo-gical or radiological index and may provide new insights aiding individualized and accurate clinical decision-making for patients with CRLM.

Malignant biliary obstruction is often in an advanced stage at the time of diagnosis, and palliative relief of obstruction has become the main treatment option. Biliary stent implantation is currently the most widely used treatment for the relief of biliary obstruction, but stent reobstruction has become a common problem in clinical practice. Endoscopic retrograde cholangiopancreatography (ERCP) combined with intraductal radiofrequency ablation can solve the problem of direct obstruction in malignant biliary obstruction and improve stent patency rate, survival time, and survival rate, with few complications and a low surgery-related mortality rate, and therefore, it can be used as a safe and feasible palliative treatment method for malignant biliary obstruction.

Objective To systematically evaluate the clinical efficacy of ABO-incompatible living donor liver transplantation (ABO-I LDLT) and compare with ABO-compatible LDLT (ABO-C LDLT). Methods A systematic search of multiple databases at home and abroad was conducted to retrieve the literatures related to the statistical comparison of clinical efficacy between ABO-I LDLT and ABO-C LDLT. The literature screening was conducted, the quality of literatures was evaluated and data extraction was performed. Using Rev Man 5.3 software, a Meta-analysis was performed by random effect model or fixed effect model. Results A total of 432 articles were searched, and 6 articles published in English were eventually included according to the inclusion criteria. The Meta-analysis demonstrated that there was no significant difference in the postoperative 1-, 3- and 5-year survival rate of the recipients and grafts and the incidence of rejection responses between the ABO-I LDLT and ABO-C LDLT groups (all P≥0.05). The incidence of postoperative biliary complications and hepatic artery embolization in the ABO-I LDLT group was significantly higher than that in the ABO-C LDLT group [odds ratio (OR)=2.08, 95% confidence interval (CI) 1.25-3.45, P=0.005; OR=2.24, 95%CI 1.03-4.89, P=0.04]. Conclusions Compared with the ABO-C LDLT, ABO-I LDLT yields lower clinical efficacy, whereas it is still an effective method for the treatment of end-stage liver disease.

Objective To evaluate the role of emergency and staged hepatectomy in peritoneal metastasis associated with ruptured hemorrhage of resectable hepatocellular carcinoma (HCC) patients,and investigate the impact of surgery timing-selecting on peritoneal metastasis of postoperative HCC patients.Methods A retrospective analysis was conduct on the pooled data from 38 HCC patients with spontaneously ruptured hemorrhage treated in our hospital from August 2011 to January 2016.These patients were divided into emergency group who underwent hepatectomy within 24 hours at admission,and staged group who underwent the procedure one week after admission.Perioperative events,overall survival (OS) and disease-freesurvival (DFS) rates,incidence of recurrent and metastatic disease were compared between the two groups.Results The perioperative blood loss and transfusion were much more in emergency group than staged group (both P ＜ 0.05).Nevertheless,the incidence of postoperative mortality was not significantly different (6.0％ vs 0％,P ＞ 0.05).The median survival was 22.5 months in emergency group versus 14.2 months in staged group.The 6-month,1-year,3-year OS rates in emergency group were 88.2％,82.4％ and 30.3％ respectively,and 6-month,1-year,3-year DFS rates were 81.3％,54.7％ and 27.3％.The 1-year OS and 6-month DFS rates were higher than those of staged group (both P ＜ 0.05).The incidence of peritoneal metastasis in staged group was higher than that in emergency group,but it was not significantly different (38.1％ vs 29.4％,P ＞ 0.05).Univariate and multivariate analysis indicated that tumor diameter ≥ 10 cm and AFP ＞ 10 000 μg/L were the risk factors for peritoneal metastasis after hepatectomy for HCC patients with spontaneously ruptured hemorrhage.Conclusions Emergency hepatectomy would warrant a better short-term prognosis compared with staged hepatectomy for the HCC patients with spontaneously ruptured hemorrhage.Staged hepatectomy would not raise the possibility of postoperative peritoneal metastasis.The predictors of tumor diameter ≥ 10 cm and AFP ＞ 10 000 μg/L were risk factors for peritoneal metastasis after hepatectomy for spontaneously ruptured HCC patients.

Neuroendocrine carcinoma of the pancreas is uncommon in clinic,which has a low malignancy,maintains indolent patterns of growth,and has a good long-term prognosis.However,because of its atypical clinical manifestation,its delayed presentation often results in distant metastasis,in which the liver is the most common site.Currently,the treatment of pancreatic neuroendocrine liver metastasis is limited and requires a diverse and multidisciplinary combination of therapy.This manuscript will discuss the current status of treating pancreatic neuroendocrine carcinoma liver metastasis.

Teacher's career development in British medical school has experienced a very long process from establish to gradually mature.So far,it has already set up its system and its own characters in strategy and teacher's self-development.By analyzing characters of teacher's career development in British medical school including teacher development center,teacher's self-development and assessment for medical educators,we aimed to raise enlightenments on teacher's career development in China.