Abstract Background Intrahepatic cholangiocarcinoma (ICC) is a highly aggressive malignancy characterized by a poor prognosis and closely linked to tumor stemness. However, the key molecules that regulate ICC stemness remain elusive. Although Y‐box binding protein 1 (YBX1) negatively affects prognosis in various cancers by enhancing stemness and chemoresistance, its effect on stemness and cisplatin sensitivity in ICC remains unclear. Methods Three bulk and single‐cell RNA‐seq datasets were analyzed to investigate YBX1 expression in ICC and its association with stemness. Clinical samples and colony/sphere formation assays validated the role of YBX1 in stemness and sensitivity to cisplatin. AZD5363 and KYA1979K explored the interaction of YBX1 with the phosphatidylinositol 3‐kinase (PI3K)/protein kinase B (PKB/AKT) and WNT/ β ‐catenin pathways. Results YBX1 was significantly upregulated in ICC, correlated with worse overall survival and shorter postoperative recurrence time, and was higher in chemotherapy‐non‐responsive ICC tissues. The YBX1‐high group exhibited significantly elevated stemness scores, and genes linked to YBX1 upregulation were enriched in multiple stemness‐related pathways. Moreover, YBX1 expression is significantly correlated with several stemness‐related genes ( SOX9 , OCT4 , CD133 , CD44 and EPCAM ). Additionally, YBX1 overexpression significantly enhanced the colony‐ and spheroid‐forming abilities of ICC cells, accelerated tumor growth in vivo and reduced their sensitivity to cisplatin. Conversely, the downregulation of YBX1 exerted the opposite effect. The transcriptomic analysis highlighted the link between YBX1 and the PI3K/AKT and WNT/ β ‐catenin pathways. Further, AZD5363 and KYA1979K were used to clarify that YBX1 promoted ICC stemness through the regulation of the AKT/ β ‐catenin axis. Conclusions YBX1 is upregulated in ICC and promotes stemness and cisplatin insensitivity via the AKT/ β ‐catenin axis. Our study describes a novel potential therapeutic target for improving ICC prognosis.
Objective Evaluation of video-assisted thoracoscopic surgery(VATS) in the solitary pulmonary nodule(SPN) diagnosis and treatment.Methods To review 55 solitary pulmonary nodule patients with underwent wedge resection followed by frozen section diagnosis after thoracoscopic exploration.Pulmonary wedge resection was performed.Whether or not an open pulmonary lobectomy and mediastinal lymph node resection was required was determined according to pathological findings of intraoperative frozen section biopsy.Results There were 31 benign nodules and 24 malignant nodules in all 55 cases.Singe wedge resections under thoracoscopy were done in 30 cases,the other 25 cases accompanied by small incision lobectomy plus mediastinal lymph nodes dissections.Conclusions VATS for the SPN patients can make accurate diagnosis and standard treatment and have outstanding advantages.VATS should be the main methods of diagnosis and treatment or standard for the SPN patients.
Objective : To investigate the clinical efficacy and value of uniportal video-assisted thoracoscopic bronchial sleeve lobectomy (BSL) in the treatment of central lung cancer. Methods : The clinical data of five patients who underwent uniportal video-assisted thoracoscopic BSL at our hospital from October 2014 to September 2016 were retrospectively analyzed. Results : The BSL procedure was successful in all five cases. The average operation time was 254 min, and the mean time to complete the anastomosis was 168 min. The average blood loss was 116 ml, and the mean number of lymph node dissections was 16.6/case. The average intubation time was 5 d, and the total postoperative drainage volume was 732 ml. The mean VAS score was 2.86, and the average postoperative hospital stay was 9.2 d. All patients were followed up for 3–19 months, and all of them survived without recurrence or metastasis. Conclusion : Uniportal video-assisted thoracoscopic BSL was found to be safe, reliable, and minimally invasive. Keywords : lung cancer; bronchial sleeve lobectomy; video-assisted thoracoscopic surgery; anastomosis
Oesophageal schwannomas is a rare tumour and most commonly found incidentally or from diagnostic workup of dysphagia or dyspnoea. Most oesophageal schwannomas are benign and more frequently occurs in female than in the male. To date, <40 cases have been described in the English literature. In this study, we reported the case of a 57-year-old woman visited our hospital with the symptom of long-time dysphagia. A thoracic computed tomography demonstrated an upper oesophageal well marginated and homogeneous mass that adhered to the right wall of the oesophagus. Oesophageal endoscopy showed an extrinsic bulge 21 cm distal to the incisors with normal overlying mucosa. Strictly on a clinical and radiologic basis, this entity is impossible to definitively diagnose, the final diagnosis was based on histopathology and immunohistochemistry. Tumour cells stain positive for S100, a characteristic marker of Schwann cell. A minimally invasive thoracoscopic surgery was performed. The post-operative period was uneventful.
Abstract Aims Few studies have investigated differences in sequential transarterial chemoembolization (TACE), radiofrequency ablation (RFA), and simultaneous RFA‐TACE for the treatment of hepatocellular carcinoma (HCC) using the Milan criteria. This study explored the differences in safety and prognosis between sequential TACE‐RFA and simultaneous RFA‐TACE. Methods This retrospective real‐world study included 109 patients with HCC within the Milan criteria who underwent sequential TACE‐RFA ( n = 75) or simultaneous RFA‐TACE ( n = 34) at the Eastern Hepatobiliary Surgery Hospital between January 2017 and 2021. Postoperative complications, length of hospital stay, and long‐term prognosis were compared. The median follow‐up duration of these patients was 39.1 months. Overall survival (OS) and time to tumor recurrence (TTR) curves were plotted using the Kaplan−Meier method and were compared using the logarithmic rank test. Independent risk factors for OS and tumor recurrence (TR) were analyzed using the Cox risk regression model. Results Multivariate analysis showed that tumor diameter >3 cm (hazard ratio [HR]: 2.201, 95% confidence interval [CI]: 1.106–4.378, p = 0.025; HR: 2.236, 95% CI: 1.271–3.934, p = 0.005, respectively) and alpha‐fetoprotein (AFP) > 400 μg/L (HR: 2.362, 95% CI: 1.195–4.668, p = 0.013; HR: 1.798, 95% CI: 1.048–3.086, p = 0.033, respectively) were independent risk factors for OS and TTR, whereas the presence of multiple tumors (HR: 2.352, 95% CI: 1.127–4.907, p = 0.023) was an independent risk factor for TTR. Simultaneous RFA‐TACE did not have an effect on OS or TTR. After propensity score‐matched, comparable results were obtained and RFA‐TACE still had no effect on OS or TTR. No significant differences were observed in grade III/IV complications (2/75 [2.7%] vs. 1/34 [2.9%], p = 1.000) between the two groups. However, the RFA‐TACE group had fewer complications than the TACE‐RFA group (24/34 [70.6%] vs. 66/75 [88.0%], p = 0.026). The RFA‐TACE group had a shorter hospital stay and less total cost during hospitalization compared with the TACE‐RFA group (6.0 vs. 10.0 days, p < 0.001; 30,000 vs. 35,000 CNY, p < 0.001). Conclusions For HCC within the Milan criteria, there was no significant difference in OS and TTR between RFA‐TACE and TACE‐RFA. However, RFA‐TACE could reduce all‐grade complications and shorten the length of hospital stay compared with TACE‐RFA. Therefore, simultaneous RFA‐TACE may be considered for patients with HCC and good liver function falling within the Milan criteria.
The objective of this study was to investigate the impact of surgical margin and hepatic resection on prognosis and compare their importance on prognosis in patients with hepatocellular carcinoma (HCC).The clinical data of 906 patients with HCC who underwent hepatic resection in our hospital from January 2013 to January 2015 were collected retrospectively. All patients were divided into anatomical resection (AR) (n = 234) and nonanatomical resection (NAR) group (n = 672) according to type of hepatic resection. The effects of AR and NAR and wide and narrow margins on overall survival (OS) and time to recurrence (TTR) were analyzed.In all patients, narrow margin (1.560, 1.278-1.904; 1.387, 1.174-1.639) is an independent risk factor for OS and TTR, and NAR is not. Subgroup analysis showed that narrow margins (2.307, 1.699-3.132; 1.884, 1.439-2.468), and NAR (1.481, 1.047-2.095; 1.372, 1.012-1.860) are independent risk factors for OS and TTR in patients with microvascular invasion (MVI)-positive. Further analysis showed that for patients with MVI-positive HCC, NAR with wide margins was a protective factor for OS and TTR compared to AR with narrow margins (0.618, 0.396-0.965; 0.662, 0.448-0.978). The 1, 3, and 5 years OS and TTR rate of the two group were 81%, 49%, 29% versus 89%, 64%, 49% (P = .008) and 42%, 79%, 89% versus 32%, 58%, 74% (P = .024), respectively.For patients with MVI-positive HCC, AR and wide margins were protective factors for prognosis. However, wide margins are more important than AR on prognosis. In the clinical setting, if the wide margins and AR cannot be ensured at the same time, the wide margins should be ensured first.
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