Combined hepatocellular-cholangiocarcinoma (cHCC-CC) is a special type of primary liver cancer, which is characterized by dual phenotypic differentiation of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Due to the lack of specific diagnostic markers and therapeutic targets, the preoperative diagnosis is difficult, the treatment is not easy, and the prognosis is poor. Routine serology, imaging examination and histological biopsy are the main methods of preliminary screening and diagnosis of cHCC-CC. Patients with resectable cHCC-CC should be treated with surgical treatment if possible, but whether they should receive liver transplantation remains a careful choice. There is still no unified standard for local treatment and systemic treatment for advanced patients, and its efficacy is still controversial. Systemic treatment including platinum drugs can benefit some patients. The potential value of targeted therapy and immunotherapy in the treatment of advanced cHCC-CC patients has been highlighted. The introduction of multidisciplinary diagnosis and treatment model has provided a strong guarantee for the comprehensive treatment of patients, and the development of xenogenetic model and multi-omics technology has provided a considerable prospect for the realization of individualized treatment for patients. The present situation and progress of diagnosis and treatment of cHCC-CC are discussed in order to provide reference for clinical practice.

Tumor chemoprevention and treatment are two approaches aimed at improving the survival of patients with cancers. An ideal anti-tumor drug is that which not only kills tumor cells but also alleviates tumor-causing risk factors, such as precancerous lesions, and prevents tumor recurrence. Chinese herbal monomers are considered to be ideal treatment agents due to their multi-target effects. Astragaloside has been shown to possess tumor chemoprevention, direct anti-tumor, and chemotherapeutic drug sensitization effects. In this paper, we review the effects of astragaloside on tumor prevention and treatment and provide directions for further research.
Humans ; Chemoprevention ; Antineoplastic Agents ; Neoplasms/prevention & control* ; Saponins/pharmacology* ; Triterpenes/pharmacology*

Objective:To investigate the prognostic factors of combined hepatocellular-cholangiocarcinoma (CHC) based on Surveillance, Epidemiology, and End Results (SEER), and to construct and investigate the application value of a nomogram predictive model for CHC.Methods:The retrospective cohort study was conducted. The clinicopathological data of 208 patients with CHC entered into SEER database from January 2004 to December 2019 were analyzed. There were 150 males and 58 females, 121 cases with age ≥60 years, 87 cases with age <60 years. All the 208 patients with CHC were divided into a training set and a validation set in a 7∶3 ratio based on the random table method. The COX proportional hazard model was used to construct the nomogram predictive model, which was validated and compared the predictive performance with the eighth edition of the American Joint Committee on Cancer (AJCC). Observation indicators: (1) survival of patients with CHC; (2) prognostic factors analysis of patients with CHC; (3) construction and perfor-mance evaluation of the nomogram predictive model. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was analyzed using the chi-square test. Comparison of ordinal data was analyzed using the rank sum test. The COX regression model was used for univariate and multivariate analyses. The Kaplan-Meier method was used to calculate survival rate. The Log-Rank test was used for survival analysis. The prognostic efficacy of the predictive model was evaluated using the consistency index (C-index) and the area under curve (AUC) of receiver operating characteristic (ROC) curve. The calibration curve was used to validate the accuraly of predictive model and decision curve was used to evaluate the clinical utility of predictive model. Results:(1) Survival of patients with CHC. The overall survival time of 145 patients with CHC in the training set was 15.0(range, 1.0-166.0)months, with 1-year survival rate as 52.7%. The overall survival time of 63 patients with CHC in the validation set was 11.5(range, 1.0-176.0)months, with 1-year survival rate as 48.3%. (2) Prognostic factors analysis of patients with CHC. Results of multivariate analysis showed that T staging, surgery, degree of tumor differentiation and chemotherapy were independent factors for prognosis of patients with CHC ( P<0.05). (3) Cons-truction and performance evaluation of the nomogram model. The nomogram predictive model was constructed based on results of multiveriate analysis. The C-index of nomogram predictive model in the training set and the validation set was 0.758 and 0.742, respectively. The C-index of the AJCC predictive model in the training set and the validation set was 0.622 and 0.662, respectively. The AUC of ROC of the nomogram predictive model for 1-, 3-, 5-year overall survival rates was 0.830, 0.861, 0.881 for CHC patients in the training set and 0.798, 0.813, 0.844 for CHC patients in the validation set. The AUS of ROC of AJCC predictive model for 1-, 3-, 5-year overall survival rates was 0.668, 0.699, 0.747 for CHC patients in the training set and 0.719, 0.760, 0.796 for CHC patients in the validation set. Results of calibration curve showed that 1-year overall survival rate calibration curve fitted well with the ideal straight line with a slope of 1, and the predicted results of the two prediction models were highly consistent with the actual results. Results of decision curve showed that nomogram predictive model had a better prediction efficiency than the AJCC predictive model. Conclusion:T staging, surgery, degree of tumor differentiation, chemotherapy are independent factors for prognosis of patients with CHC, and the nomogram constructed based on SEER database can more accurately evaluate the prognosis of CHC patients.

Hepatocellular carcinoma (HCC) is the most common type of primary hepatocellular carcinoma (PHC). Early diagnosis of HCC remains the key to improve the prognosis. In recent years, with the promotion of the concept of precision medicine and more in-depth analysis of the biological mechanism underlying HCC, new diagnostic methods, including emerging serum markers, liquid biopsies, molecular diagnosis, and advances in imaging (novel contrast agents and radiomics), have emerged one after another. Herein, we reviewed and analyzed scientific advances in the early diagnosis of HCC and discussed their application and shortcomings. This review aimed to provide a reference for scientific research and clinical practice of HCC.
Humans ; Carcinoma, Hepatocellular/pathology* ; Liver Neoplasms/pathology* ; Prognosis ; Early Diagnosis ; Precision Medicine

As the most complicated and challenging operation in general surgery, pancreaticoduodenectomy is also a classic operation for the treatment of pancreatic head and periampullary tumors. With the continuous improvement of medical technology and medical instruments, minimally invasive technology is increasingly widely used in pancreaticoduodenectomy, but there are many controversies. In this paper, the clinical application and research progress of open, laparoscopic and robotic pancreaticoduodenectomy were reviewed based on the experience of author′s team and domestic and foreign literatures, so as to provide reference for grasping surgical indications and formulating individualized treatment strategies.

In recent years, the existence of the Laennec′s capsule has been histologically confirmed and contributes to the Laennec′s approach based on Laennec′s capsule for anatomic hepatectomy. With the deep understanding of liver surgery, the importance of Laennec′s approach based on Laennec′s capsule could be recognized. Better use of Laennec′s capsule would be beneficial to the standardization of surgical technique, facilitate safe and precise anatomical liver resection.The application of Laennec′s capsule in hepatic inflow occlusion and intrahepatic segmentation was summarized in this study. The natural gap between Laennec′s capsule, the liver pedicle and hepatic veins can reduce the destruction of liver parenchyma and intraoperative hemorrhage, simplify surgical steps, shorten the time of Hilar occlusion and surgery.

Pancreatic cancer has a poor prognosis, systemic comprehensive therapy including chemotherapeutic and molecular targeted therapy is the key to improve the postoperative prognosis of pancreatic cancer, as well as to prolong the survival time of advanced pancreatic cancer. However, due to the drug resistance and heterogeneity of pancreatic cancer cells, systemic comprehensive treatment still does not reach the ideal effect, and personalized therapy will be an important approach to solve this problem. The personalized therapy for pancreatic cancer will become possible with the application of patient-derived tumor xenograft (PDX) models. Here, this article will review the progress of the application of PDX models in comprehensive therapy of pancreatic cancer based on reviewing the methods of establishing pancreatic cancer PDX models, aiming to provide new ideas for personalized therapy of pancreatic cancer.

With the deep integration of medicine, science and technology, remarkable progress has been made in the field of surgery. The new technologies represented by artificial intelligence, 5th generation mobile communication technology, precision surgery and surgical robot have been deeply explored and widely applied in the diagnosis and treatment of surgical diseases, which has played an important role in promoting the development of "surgery 4.0" . In the future, with the continuous development, improvement and promotion of surgery 4.0, the traditional working mode of surgeons will be greatly changed, and the diagnosis and treatment process of surgical diseases will be optimized.

Intrahepatic cholangiocarcinoma (ICC) has a poor prognosis. Surgical treatment combined with adjuvant therapy including chemotherapy, radiotherapy, molecular targeted drug therapy, local liver damage therapy, interventional therapy, antiviral therapy can have complementary effects to prevent its recurrence after surgery. We will review the latest advances in surgery and adjuvant therapy for ICC, and provide new ideas for the comprehensive treatment and clinical research of ICC.

The fifth generation wireless systems (5G technology) has the characteristics of high system capacity, high data transmission rate, massive device connectivity, extremely low latency, and ultra-reliability. With the advent of 5G technology, modern surgery has made new progress in telesurgery, tele-consultation, remote instruction and teaching, remote monitoring and ambulance. "5G+ surgery" is still in its infancy, and with the gradual improvement of 5G technology, its application in the surgical field will continuously deepen and expand.