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Ma X, Qian X, Wang Q, Zhang Y, Zong R, Zhang J, Qian B, Yang C, Lu X, Shi Y. Radiomics nomogram based on optimal VOI of multi-sequence MRI for predicting microvascular invasion in intrahepatic cholangiocarcinoma. LA RADIOLOGIA MEDICA 2023; 128:1296-1309. [PMID: 37679641 PMCID: PMC10620280 DOI: 10.1007/s11547-023-01704-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Microvascular invasion (MVI) is a significant adverse prognostic indicator of intrahepatic cholangiocarcinoma (ICC) and affects the selection of individualized treatment regimens. This study sought to establish a radiomics nomogram based on the optimal VOI of multi-sequence MRI for predicting MVI in ICC tumors. METHODS 160 single ICC lesions with MRI scanning confirmed by postoperative pathology were randomly separated into training and validation cohorts (TC and VC). Multivariate analysis identified independent clinical and imaging MVI predictors. Radiomics features were obtained from images of 6 MRI sequences at 4 different VOIs. The least absolute shrinkage and selection operator algorithm was performed to enable the derivation of robust and effective radiomics features. Then, the best three sequences and the optimal VOI were obtained through comparison. The MVI prediction nomogram combined the independent predictors and optimal radiomics features, and its performance was evaluated via the receiver operating characteristics, calibration, and decision curves. RESULTS Tumor size and intrahepatic ductal dilatation are independent MVI predictors. Radiomics features extracted from the best three sequences (T1WI-D, T1WI, DWI) with VOI10mm (including tumor and 10 mm peritumoral region) showed the best predictive performance, with AUCTC = 0.987 and AUCVC = 0.859. The MVI prediction nomogram obtained excellent prediction efficacy in both TC (AUC = 0.995, 95%CI 0.987-1.000) and VC (AUC = 0.867, 95%CI 0.798-0.921) and its clinical significance was further confirmed by the decision curves. CONCLUSION A nomogram combining tumor size, intrahepatic ductal dilatation, and the radiomics model of MRI multi-sequence fusion at VOI10mm may be a predictor of preoperative MVI status in ICC patients.
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Affiliation(s)
- Xijuan Ma
- Department of Radiology, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, No. 199 Jiefang South Road, Quanshan District, Xuzhou, 221009, Jiangsu, People's Republic of China
| | - Xianling Qian
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Shanghai, 200032, People's Republic of China
- Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, People's Republic of China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Shanghai, 200032, People's Republic of China
| | - Qing Wang
- Graduate Department, Bengbu Medical College, Bengbu, 233000, Anhui, People's Republic of China
| | - Yunfei Zhang
- Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, People's Republic of China
- Central Research Institute, United Imaging Healthcare, No. 2258 Chengbei Rd, Shanghai, 201807, People's Republic of China
| | - Ruilong Zong
- Department of Radiology, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, No. 199 Jiefang South Road, Quanshan District, Xuzhou, 221009, Jiangsu, People's Republic of China
| | - Jia Zhang
- Department of Radiology, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, No. 199 Jiefang South Road, Quanshan District, Xuzhou, 221009, Jiangsu, People's Republic of China
| | - Baoxin Qian
- Huiying Medical Technology, Huiying Medical Technology Co., Ltd, Room A206, B2, Dongsheng Science and Technology Park, Haidian District, Beijing City, 100192, People's Republic of China
| | - Chun Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Shanghai, 200032, People's Republic of China
- Shanghai Institute of Medical Imaging, No. 180 Fenglin Rd, Shanghai, 200032, People's Republic of China
- Department of Cancer Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Shanghai, 200032, People's Republic of China
| | - Xin Lu
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Shanghai, 200032, People's Republic of China.
- Department of Cancer Center, Zhongshan Hospital, Fudan University, No. 180 Fenglin Rd, Shanghai, 200032, People's Republic of China.
- Department of Radiology, Shanghai Geriatric Medical Center, No. 2560 Chunshen Rd, Shanghai, 201104, People's Republic of China.
| | - Yibing Shi
- Department of Radiology, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, No. 199 Jiefang South Road, Quanshan District, Xuzhou, 221009, Jiangsu, People's Republic of China.
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Jiang JH, Fang DZ, Hu YT. Influence of surgical margin width on survival rate after resection of intrahepatic cholangiocarcinoma: a systematic review and meta-analysis. BMJ Open 2023; 13:e067222. [PMID: 37156579 PMCID: PMC10174020 DOI: 10.1136/bmjopen-2022-067222] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES Hepatectomy is the best treatment for patients with intrahepatic cholangiocarcinoma (ICC) at present, but there has been controversy about the width of surgical margins. In this study, we systematically investigated the effects of different surgical margin widths on the prognosis of patients with ICC undergoing hepatectomy. DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase and Web of Science databases were systematically searched from inception to June 2022. ELIGIBILITY CRITERIA Cohort studies reported in English with patients who underwent negative marginal (R0) resection were included. The effects of surgical margin width on overall survival (OS), disease-free survival (DFS) and recurrence-free survival (RFS) in patients with ICC were assessed. DATA EXTRACTION AND SYNTHESIS Two investigators independently conducted literature screening and data extraction. Risk of bias was assessed using funnel plots and quality was assessed by the Newcastle-Ottawa Scale. Forest plots of HRs and their 95% CIs for outcome indicators were plotted. Heterogeneity was assessed and determined quantitatively using I2, and the stability of the study results was evaluated using sensitivity analysis. Analyses were performed using Stata software. RESULTS Nine studies were included. With the wide margin group (≥10 mm) as the control, pooled HR of OS in the narrow margin group (<10 mm) was 1.54 (95% CI 1.34 to 1.77). HRs of OS in three subgroups where the margin was less than 5 mm ranged from 5 mm to 9 mm, or was less than 10 mm in length were 1.88 (1.45 to 2.42), 1.33 (1.03 to 1.72) and 1.49 (1.20 to 1.84), respectively. Pooled HR of DFS in the narrow margin group (<10 mm) was 1.51 (1.14 to 2.00). Pooled HR of RFS in the narrow margin group (<10 mm) was 1.35 (1.19 to 1.54). HRs of RFS in three subgroups where the margin was less than 5 mm ranged from 5 mm to 9 mm, or was less than 10 mm in length were 1.38 (1.07 to 1.78), 1.39 (1.11 to 1.74) and 1.30 (1.06 to 1.60), respectively. Neither lymph node lesions (HR 1.44, 95% CI 1.22 to 1.70) nor lymph node invasion (2.14, 1.39 to 3.28) was favourable for postoperative OS in patients with ICC. Lymph node metastasis (1.31, 1.09 to 1.57) was unfavourable for RFS in patients with ICC. CONCLUSION Patients with ICC who underwent curative hepatectomy with a negative margin ≥10 mm may have a long-term survival advantage, but lymph node dissection also needs to be considered. In addition, tumour-related pathological features need to be explored to see if they affect the surgical outcome of R0 margins.
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Affiliation(s)
- Jing-Hua Jiang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Da-Zhang Fang
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Yi-Ting Hu
- Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Zhejiang Shuren University, Shulan International Medical College, Hangzhou, China
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Rebhun J, Shin CM, Siddiqui UD, Villa E. Endoscopic biliary treatment of unresectable cholangiocarcinoma: A meta-analysis of survival outcomes and systematic review. World J Gastrointest Endosc 2023; 15:177-190. [PMID: 37034966 PMCID: PMC10080560 DOI: 10.4253/wjge.v15.i3.177] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/12/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Endoscopic radiofrequency ablation (ERFA), percutaneous radiofrequency ablation (PRFA), and photodynamic therapy (PDT), when used in conjunction with conventional biliary stenting, have demonstrated a survival benefit in patients with unresectable cholangiocarcinoma.
AIM To compare pooled survival outcomes, adverse event rates, and mean stent patency for those undergoing these procedures.
METHODS A comprehensive literature review of published studies and abstracts from January 2011 to December 2020 was performed comparing survival outcomes in patients undergoing ERFA with stenting, biliary stenting alone, PRFA with stenting, and PDT with stenting for unresectable cholangiocarcinoma (CCA).
RESULTS Data from four studies demonstrated a pooled mean survival favoring ERFA as compared to biliary stenting alone (12.0 ± 0.9 mo vs 6.8 ± 0.3 mo, P < 0.001) as well as statistically improved median survival time (13 mo vs 8 mo, P < 0.001). Both ERFA with stenting and PRFA with stenting groups demonstrated statistical superiority to biliary stenting alone (P < 0.001 and P = 0.004, respectively). However, when comparing ERFA to PRFA, pooled data demonstrated overall higher mean survival in the ERFA with stenting cohort as compared to PRFA with stent cohort (12.0 + 0.9 mo vs 8.1 + 2.1 mo, P < 0.0001). Data from two studies demonstrated a pooled median survival favoring ERFA with stenting as compared to PDT with stenting (11.3 mo vs 8.5 mo, P = 0.02).
CONCLUSION While further prospective, randomized studies are needed to assess efficacy of ERFA, our meta-analysis demonstrated that this technique offers endoscopists a reasonable palliative method by which to treat patients with unresectable CCA that results in longer survival as compared to biliary stenting alone, percutaneous radiofrequency ablation with biliary stenting, and PDT with biliary stenting as well as an acceptable adverse event profile based on available published data.
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Affiliation(s)
- Jeffrey Rebhun
- Department of Gastroenterology, Oregon Health and Sciences University, Portland, OR 97239, United States
| | - Claire M Shin
- Department of Medicine, University of Illinois at Chicago, Chicago, IL 60612, United States
| | - Uzma D Siddiqui
- Center for Endoscopic Research and Therapeutics, University of Chicago, University of Chicago Medicine, Chicago, IL 60637, United States
| | - Edward Villa
- Department of Gastroenterology and Hepatology, Northshore University Health System, Evanston, IL 60201, United States
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Qian X, Zhou C, Wang F, Lu X, Zhang Y, Chen L, Zeng M. Development and validation of combined Ki67 status prediction model for intrahepatic cholangiocarcinoma based on clinicoradiological features and MRI radiomics. LA RADIOLOGIA MEDICA 2023; 128:274-288. [PMID: 36773271 PMCID: PMC10020304 DOI: 10.1007/s11547-023-01597-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 01/10/2023] [Indexed: 02/12/2023]
Abstract
PURPOSE Incidence and mortality of intrahepatic cholangiocarcinoma (ICC) have been increasing over the past few decades, and Ki67 is an adverse prognostic predictor and an attractive therapeutic target for ICC patients. Thus, we aim to develop and validate a combined Ki67 prediction model for ICC patients. MATERIALS AND METHODS Preoperative contrast-enhanced MR images were collected from 178 patients with postoperative pathologically confirmed ICC, and randomly divided into training and validation cohorts in a ratio of 7:3 (124:54). A time-independent test cohort of 49 ICC patients was used for validation. Independent clinicoradiological features of Ki67 status were determined by multivariate analysis. Optimal radiomics features were selected by least absolute shrinkage and selection operator logistic regression and linear discriminant analysis was used to construct combined models. The prediction efficacy of combined model was assessed by receiver operating characteristics curve, and verified by its calibration, decision and clinical impact curves. RESULTS HBV (p = 0.022), arterial rim enhancement (p = 0.006) and enhancement pattern (p = 0.012) are independent clinicoradiological features. The radiomics model achieves good prediction efficacy in the training cohort (AUC = 0.860) and validation cohort (AUC = 0.843). The combined Ki67 prediction model incorporates clinicoradiological and radiomics features, and it yields desirable predictive efficiency in test cohort (AUC = 0.815). Decision curves and clinical impact curves further validate that the combined Ki67 prediction model can achieve net benefits in clinical work. CONCLUSION The combined Ki67 model incorporating HBV, arterial rim enhancement, enhancement pattern and radiomics features is a potential biomarker in Ki67 prediction and stratification.
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Affiliation(s)
- Xianling Qian
- grid.413087.90000 0004 1755 3939Department of Radiology, Zhongshan Hospital, Fudan University, No.180 Fenglin Rd, Shanghai, 200032 China
- grid.413087.90000 0004 1755 3939Shanghai Institute of Medical Imaging, No.180 Fenglin Rd, Shanghai, 200032 China
- grid.413087.90000 0004 1755 3939Department of Cancer Center, Zhongshan Hospital, Fudan University, No.180 Fenglin Rd, Shanghai, 200032 China
| | - Changwu Zhou
- grid.413087.90000 0004 1755 3939Department of Radiology, Zhongshan Hospital, Fudan University, No.180 Fenglin Rd, Shanghai, 200032 China
- grid.413087.90000 0004 1755 3939Shanghai Institute of Medical Imaging, No.180 Fenglin Rd, Shanghai, 200032 China
- grid.413087.90000 0004 1755 3939Department of Cancer Center, Zhongshan Hospital, Fudan University, No.180 Fenglin Rd, Shanghai, 200032 China
| | - Fang Wang
- Shanghai United Imaging Intelligence Co., Ltd, No.701 Yunjin Rd, Shanghai, 200232 China
| | - Xin Lu
- grid.413087.90000 0004 1755 3939Department of Radiology, Zhongshan Hospital, Fudan University, No.180 Fenglin Rd, Shanghai, 200032 China
- grid.413087.90000 0004 1755 3939Shanghai Institute of Medical Imaging, No.180 Fenglin Rd, Shanghai, 200032 China
- grid.413087.90000 0004 1755 3939Department of Cancer Center, Zhongshan Hospital, Fudan University, No.180 Fenglin Rd, Shanghai, 200032 China
| | - Yunfei Zhang
- grid.413087.90000 0004 1755 3939Shanghai Institute of Medical Imaging, No.180 Fenglin Rd, Shanghai, 200032 China
- grid.497849.fCentral Research Institute, United Imaging Healthcare, No.2258 Chengbei Rd, Shanghai, 201807 China
| | - Lei Chen
- Shanghai United Imaging Intelligence Co., Ltd, No.701 Yunjin Rd, Shanghai, 200232 China
| | - Mengsu Zeng
- grid.413087.90000 0004 1755 3939Department of Radiology, Zhongshan Hospital, Fudan University, No.180 Fenglin Rd, Shanghai, 200032 China
- grid.413087.90000 0004 1755 3939Shanghai Institute of Medical Imaging, No.180 Fenglin Rd, Shanghai, 200032 China
- grid.413087.90000 0004 1755 3939Department of Cancer Center, Zhongshan Hospital, Fudan University, No.180 Fenglin Rd, Shanghai, 200032 China
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Endo Y, Moazzam Z, Alaimo L, Lima HA, Munir MM, Shaikh CF, Guglielmi A, Aldrighetti L, Weiss M, Bauer TW, Alexandrescu S, Poultsides GA, Kitago M, Maithel SK, Marques HP, Martel G, Pulitano C, Shen F, Cauchy F, Koerkamp BG, Endo I, Pawlik TM. Predictive risk-score model to select patients with intrahepatic cholangiocarcinoma for adjuvant chemotherapy. HPB (Oxford) 2023; 25:229-238. [PMID: 36396550 DOI: 10.1016/j.hpb.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 10/19/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The aim of this study was to develop a predictive model to identify individuals most likely to derive overall survival (OS) benefit from adjuvant chemotherapy (AC) after hepatic resection of intrahepatic cholangiocarcinoma (ICC). METHODS Patients who underwent hepatic resection of ICC between 1990 and 2020 were identified from a multi-institutional database. Factors associated with worse OS were identified and incorporated into an online predictive model to identify patients most likely to benefit from AC. RESULTS Among 726 patients, 189 (26.0%) individuals received AC. Factors associated with OS on multivariable analysis included CA19-9 (Hazard Ratio [HR]1.17, 95%CI 1.04-1.31), tumor burden score (HR1.09, 95%CI 1.04-1.15), T-category (T2/3/4, HR1.73, 95%CI 1.73-2.64), nodal disease (N1, HR3.80, 95%CI 2.02-7.15), tumor grade (HR1.88, 95%CI 1.00-3.55), and morphological subtype (HR2.19, 95%CI 1.08-4.46). A weighted predictive score was devised and made available online (https://yutaka-endo.shinyapps.io/ICCrisk_model_for_AC/). Receipt of AC was associated with a survival benefit among patients at high/medium-risk (high: no AC, 0% vs. AC, 20.6%; medium: no AC, 36.4% vs. 40.8%; both p < 0.05) but not low-risk (low: no AC, 65.1% vs. AC, 65.1%; p = 0.73) tumors. CONCLUSION An online predictive model based on tumor characteristics may help identify which patients may benefit the most from AC following resection of ICC.
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Affiliation(s)
- Yutaka Endo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Zorays Moazzam
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Laura Alaimo
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA; Department of Surgery, University of Verona, Verona, Italy
| | - Henrique A Lima
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Muhammad M Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | - Chanza F Shaikh
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA
| | | | | | - Matthew Weiss
- Department of Surgery, John Hopkins Hospital, Baltimore, MD, USA
| | - Todd W Bauer
- Department of Surgery, University of Virginia, Charlottesville, VA, USA
| | | | | | - Minoru Kitago
- Department of Surgery, Keio University, Tokyo, Japan
| | | | - Hugo P Marques
- Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal
| | | | - Carlo Pulitano
- Department of Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Feng Shen
- Department of Surgery, Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | - François Cauchy
- Department of Hepatobiliopancreatic Surgery, APHP, Beaujon Hospital, Clichy, France
| | - Bas G Koerkamp
- Department of Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City, University School of Medicine, Yokohama, Japan
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
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Yang SH, Hu S, Kang Q, Liu LX, Wei Q, Song ZM, Chen YH, Liao ZJ, Huan YF, Wang XJ, Zou H, Zhang XW. EIF5A2 promotes proliferation and invasion of intrahepatic cholangiocarcinoma cells. Clin Res Hepatol Gastroenterol 2022; 46:101991. [PMID: 35792239 DOI: 10.1016/j.clinre.2022.101991] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/09/2022] [Accepted: 07/01/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Intrahepatic cholangiocarcinoma (ICC) can invade and metastasize. EIF5A2 is involved in the invasive metastatic process of several digestive malignancies. However, its role in ICC is yet to be elucidated. METHODS Immunohistochemistry (IHC) and Western blot (WB) were used to detect the level of EIF5A2 in the tumor specimens of ICC patients and evaluate the correlation between its expression and clinicopathological characteristics. The significance of EIF5A2 in the prognosis of ICC patients was further evaluated by Kaplan-Meier and Cox regression analysis. In addition, CCK-8, EdU, Transwell invasion, and scratch assays were utilized to detect tumor cell proliferation, invasion, and metastasis. Furthermore, the role of EIF5A2 in ICC cells was evaluated after modification of EIF5A2 expression. RESULTS The level of EIF5A2 protein was significantly higher in ICC than in adjacent tissues. This high expression in the tumor samples was significantly associated with malignant phenotypes, such as lymph node metastasis (LNM), microvascular or bile duct invasion, and poor differentiation. ICC patients with high expression of EIF5A2 had short overall survival and a high cumulative recurrence rate. The multifactorial analysis showed that EIF5A2 is an independent prognostic marker. Furthermore, high levels of EIF5A2 may activate the PI3K/AKT/mTOR signaling pathway and upregulate Cyclin D1, Cyclin D3, MMP2, and MMP9 to promote ICC cell proliferation, migration, and invasion. CONCLUSION The current study found that EIF5A2 promotes ICC progression and is a prognostic biomarker and candidate therapeutic target for ICC patients.
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Affiliation(s)
- Shao-Hua Yang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, China
| | - Sheng Hu
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, China
| | - Qiang Kang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, China
| | - Li-Xin Liu
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, China
| | - Qun Wei
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, China
| | - Zhi-Mei Song
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, China
| | - Yi-Hui Chen
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, China
| | - Zhou-Jun Liao
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, China
| | - Yun-Feng Huan
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, China
| | - Xue-Jun Wang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, China
| | - Hao Zou
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, China
| | - Xiao-Wen Zhang
- Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650101, China.
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Meng Z, Xue H, Wang T, Chen B, Dong X, Yang L, Dai J, Lou X, Xia F. Aggregation-induced emission photosensitizer-based photodynamic therapy in cancer: from chemical to clinical. J Nanobiotechnology 2022; 20:344. [PMID: 35883086 PMCID: PMC9327335 DOI: 10.1186/s12951-022-01553-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/08/2022] [Indexed: 12/24/2022] Open
Abstract
Cancer remains a serious threat to human health owing to the lack of effective treatments. Photodynamic therapy (PDT) has emerged as a promising non-invasive cancer treatment that consists of three main elements: photosensitizers (PSs), light and oxygen. However, some traditional PSs are prone to aggregation-caused quenching (ACQ), leading to reduced reactive oxygen species (ROS) generation capacity. Aggregation-induced emission (AIE)-PSs, due to their distorted structure, suppress the strong molecular interactions, making them more photosensitive in the aggregated state instead. Activated by light, they can efficiently produce ROS and induce cell death. PS is one of the core factors of efficient PDT, so proceeding from the design and preparation of AIE-PSs, including how to manipulate the electron donor (D) and receptor (A) in the PSs configuration, introduce heavy atoms or metal complexes, design of Type I AIE-PSs, polymerization-enhanced photosensitization and nano-engineering approaches. Then, the preclinical experiments of AIE-PSs in treating different types of tumors, such as ovarian cancer, cervical cancer, lung cancer, breast cancer, and its great potential clinical applications are discussed. In addition, some perspectives on the further development of AIE-PSs are presented. This review hopes to stimulate the interest of researchers in different fields such as chemistry, materials science, biology, and medicine, and promote the clinical translation of AIE-PSs.
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Affiliation(s)
- Zijuan Meng
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan, 430074, China
| | - Huiying Xue
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan, 430074, China
| | - Tingting Wang
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan, 430074, China
| | - Biao Chen
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430034, China
| | - Xiyuan Dong
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430034, China
| | - Lili Yang
- Institute of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430034, China.
| | - Jun Dai
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430034, China.
| | - Xiaoding Lou
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan, 430074, China
| | - Fan Xia
- State Key Laboratory of Biogeology and Environmental Geology, Faculty of Materials Science and Chemistry, China University of Geosciences, Wuhan, 430074, China
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Qian X, Lu X, Ma X, Zhang Y, Zhou C, Wang F, Shi Y, Zeng M. A Multi-Parametric Radiomics Nomogram for Preoperative Prediction of Microvascular Invasion Status in Intrahepatic Cholangiocarcinoma. Front Oncol 2022; 12:838701. [PMID: 35280821 PMCID: PMC8907475 DOI: 10.3389/fonc.2022.838701] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 01/24/2022] [Indexed: 02/06/2023] Open
Abstract
Background Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer with increasing incidence in the last decades. Microvascular invasion (MVI) is a poor prognostic factor for patients with ICC, which correlates early recurrence and poor prognosis, and it can affect the selection of personalized therapeutic regime. Purpose This study aimed to develop and validate a radiomics-based nomogram for predicting MVI in ICC patients preoperatively. Methods A total of 163 pathologically confirmed ICC patients (training cohort: n = 130; validation cohort: n = 33) with postoperative Ga-DTPA-enhanced MR examination were enrolled, and a time-independent test cohort (n = 24) was collected for external validation. Univariate and multivariate analyses were used to determine the independent predictors of MVI status, which were then incorporated into the MVI prediction nomogram. Least absolute shrinkage and selection operator logistic regression was performed to select optimal features and construct radiomics models. The prediction performances of models were assessed by receiver operating characteristic (ROC) curve analysis. The performance of the MVI prediction nomogram was evaluated by its calibration, discrimination, and clinical utility. Results Larger tumor size (p = 0.003) and intrahepatic duct dilatation (p = 0.002) are independent predictors of MVI. The final radiomics model shows desirable and stable prediction performance in the training cohort (AUC = 0.950), validation cohort (AUC = 0.883), and test cohort (AUC = 0.812). The MVI prediction nomogram incorporates tumor size, intrahepatic duct dilatation, and the final radiomics model and achieves excellent predictive efficacy in training cohort (AUC = 0.953), validation cohort (AUC = 0.861), and test cohort (AUC = 0.819), fitting well in calibration curves (p > 0.05). Decision curve and clinical impact curve further confirm the clinical usefulness of the nomogram. Conclusion The nomogram incorporating tumor size, intrahepatic duct dilatation, and the final radiomics model is a potential biomarker for preoperative prediction of the MVI status in ICC patients.
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Affiliation(s)
- Xianling Qian
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xin Lu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xijuan Ma
- Department of Radiology, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Ying Zhang
- Department of Radiology, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Changwu Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fang Wang
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Yibing Shi
- Department of Radiology, Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Mengsu Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.,Shanghai Institute of Medical Imaging, Shanghai, China.,Department of Cancer Center, Zhongshan Hospital, Fudan University, Shanghai, China
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9
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Sahu R, Sharma P, Kumar A. An Insight into Cholangiocarcinoma and Recent Advances in its Treatment. J Gastrointest Cancer 2022; 54:213-226. [PMID: 35023010 DOI: 10.1007/s12029-021-00728-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cholangiocarcinoma (CCA) is a malignant disease of the epithelial cells of the intrahepatic and extrahepatic bile ducts. This review focuses on various aspects of cholangiocarcinoma such as its associated causes, treatment criteria, and more. METHODS Although it remains a rare malignancy and is the second most common primary malignancy of the liver, the incidence is increasing, especially the incidence of intrahepatic CCA. Several studies suggested that surgery is not only solution; recently, reported targeted drugs may have the potential to become an alternative option. RESULTS This review provides an overview of the current scenario of targeted therapies for CCA, which were tabulated with their current status and it also included its associated causes and its treatment criteria. CONCLUSION Because of its rarity and complexity, surgery remains the preferred treatment in resectable patients. Howerver, the studies suggested that the recently reported drugs may have the potential to be an alternative option for the treatment of CCA and related complications. In addition, this review will certainly benefit the community and researcher for further investigation.
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Affiliation(s)
- Rakesh Sahu
- Department of Pharmacy, School of Medical & Allied Sciences, Galgotias University, Greater Noida, 201310, Uttar Pradesh, India
- Department of Pharmaceutical Chemistry, Institute of Pharmaceutical Research, GLA University, Mathura, 281406, India
| | - Praveen Sharma
- Department of Pharmacy, School of Medical & Allied Sciences, Galgotias University, Greater Noida, 201310, Uttar Pradesh, India
| | - Ajay Kumar
- Department of Pharmaceutical Chemistry, Institute of Pharmaceutical Research, GLA University, Mathura, 281406, India
- Department of Pharmaceutical Chemistry, Noida Institute of Engineering and Technology (Pharmacy Institute), Knowledge Park-II, 201306, Greater Noida, India
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10
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Yan X, Zhuang LP, Ning ZY, Wang P, Meng ZQ. Addition of thermal ablation to systemic chemotherapy for the treatment of unresectable intrahepatic cholangiocarcinoma: a propensity score matching analysis. Expert Rev Gastroenterol Hepatol 2022; 16:81-88. [PMID: 34937481 DOI: 10.1080/17474124.2022.2021067] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To retrospectively compare the survival outcomes of thermal ablation plus chemotherapy to those of chemotherapy alone in patients with unresectable intrahepatic cholangiocarcinoma (ICC). METHODS 189 patients with unresectable ICC who received thermal ablation plus chemotherapy or chemotherapy alone as the initial treatment were identified . To avoid potential bias, 1:1 matching between groups was performed through propensity score matching. Overall survival (OS) was the primary endpoint. Clinical and tumor factors related to OS were analyzed through univariate and multivariate analyses. RESULTS Of the enrolled patients, 55 received ablation plus chemotherapy, and 134 received chemotherapy alone. The median OS was 16.267 months for patients treated with combined therapy and 6.067 months for patients treated with chemotherapy alone (p = 0.000). The benefit of ablation plus chemotherapy was also preserved in the matched cohort, with a median OS of 15.233 months in the combined treatment group and 7.967 months in the chemotherapy group (p = 0.009). Univariate and multivariate analyses indicated that the type of treatment was an independent factor of OS (p < 0.05). CONCLUSIONS The combination of thermal ablation and systemic chemotherapy provides an opportunity to improve the prognosis of patients with unresectable ICC.
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Affiliation(s)
- Xia Yan
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Cancer minimally invasive treatment center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Li-Ping Zhuang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Cancer minimally invasive treatment center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhou-Yu Ning
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Cancer minimally invasive treatment center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Peng Wang
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Cancer minimally invasive treatment center, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Zhi-Qiang Meng
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.,Cancer minimally invasive treatment center, Fudan University Shanghai Cancer Center, Shanghai, China
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11
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Rizzo A, Ricci AD, Gadaleta-Caldarola G, Brandi G. Toward personalized therapy for cholangiocarcinoma: new insights and challenges. Expert Rev Gastroenterol Hepatol 2021; 15:1241-1243. [PMID: 34553646 DOI: 10.1080/17474124.2021.1984879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Alessandro Rizzo
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Medical Oncology Unit, "Mons. R. Dimiccoli" Hospital, Barletta, Italy
| | - Angela Dalia Ricci
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Medical Oncology Unit, "Mons. R. Dimiccoli" Hospital, Barletta, Italy
| | | | - Giovanni Brandi
- Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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12
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Solitary 18F-fluorodeoxyglucose avid spinous process cholangiocarcinoma metastasis proven on CT guided percutaneous needle bone biopsy. Radiol Case Rep 2021; 16:3798-3801. [PMID: 34691343 PMCID: PMC8511690 DOI: 10.1016/j.radcr.2021.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/10/2021] [Indexed: 11/22/2022] Open
Abstract
A 65-year-old female with newly diagnosed cholangiocarcinoma was referred for a FDG PET/CT for initial staging. There was a region of moderate FDG avidity localizing to the hepatic hilum representing the primary site of malignancy. An unexpected moderately FDG avid focus was demonstrated in the spinous process of the T11 vertebra with no corresponding mass lesion seen on low dose CT and no evidence of distant metastatic disease elsewhere. A percutaneous CT guided needle bone biopsy was performed which confirmed a solitary T11 spinous process metastasis on histopathology.
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13
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Kam AE, Masood A, Shroff RT. Current and emerging therapies for advanced biliary tract cancers. Lancet Gastroenterol Hepatol 2021; 6:956-969. [PMID: 34626563 DOI: 10.1016/s2468-1253(21)00171-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/30/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023]
Abstract
Biliary tract cancers (cholangiocarcinomas and gallbladder cancers) are increasing in incidence and have a poor prognosis. Most patients present with advanced disease, for which the treatment is palliative chemotherapy. Over the past few years, the genomic landscape of biliary tract cancers has been examined and several targeted therapies have been developed. Molecular targets with clinically meaningful activity include fibroblast growth factor receptor (FGFR), isocitrate dehydrogenase (IDH), RAS-RAF-MEK (MAP2K1)-ERK (MAPK3), HER2 (also known as ERBB2), DNA mismatch repair, and NTRK. Pemigatinib, a FGFR1-3 inhibitor, showed encouraging response rates and survival data as second-line treatment and received US Food and Drug Administration (FDA) approval in April, 2020, for previously treated advanced or metastatic cholangiocarcinoma with FGFR2 gene fusion or rearrangements. Ivosidenib, an IDH1 inhibitor, showed improved progression-free survival versus placebo in second-line treatment in the phase 3 ClarIDHy trial. Early phase trials of dabrafenib plus trametinib (BRAF and MEK inhibition) and zanidatamab (a bispecific HER2-antibody) have yielded encouraging response rates. Immunotherapy has mainly produced responses in tumours with deficient mismatch repair or high microsatellite instability (also known as dMMR or MSI-H) or higher PD-L1 score, or both. However, early phase trials of immunotherapy plus chemotherapy in unselected patient populations appear promising. NTRK inhibitors have also shown promise in early phase trials of NTRK-fusion positive solid tumours, including cholangiocarcinoma. In this Review, we discuss current and emerging therapies for advanced biliary tract cancers, with a focus on molecularly targeted therapy.
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Affiliation(s)
- Audrey E Kam
- Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA.
| | - Ashiq Masood
- Division of Hematology, Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL, USA
| | - Rachna T Shroff
- Division of Hematology and Oncology, University of Arizona Cancer Center, Tucson, AZ, USA
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14
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Ampullary Carcinoma: An Overview of a Rare Entity and Discussion of Current and Future Therapeutic Challenges. Curr Oncol 2021; 28:3393-3402. [PMID: 34590592 PMCID: PMC8482111 DOI: 10.3390/curroncol28050293] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 12/29/2022] Open
Abstract
Ampullary carcinomas (ACs) represent a rare entity, accounting for approximately 0.2% of all gastrointestinal solid tumors and 20% of all periampullary cancers (PACs). Unfortunately, few data are available regarding the optimal therapeutic strategy for ACs due to their rarity, and physicians frequently encounter significant difficulties in the management of these malignancies. In this review, we will provide an overview of current evidence on AC, especially focusing on biological features, histological characteristics, and available data guiding present and future therapeutic strategies for these rare, and still barely known, tumors.
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15
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Li H, Li J, Xiao W, Zhang Y, Lv Y, Yu X, Zheng J. The Therapeutic Potential of Galectin-3 in the Treatment of Intrahepatic Cholangiocarcinoma Patients and Those Compromised With COVID-19. Front Mol Biosci 2021; 8:666054. [PMID: 34109213 PMCID: PMC8180910 DOI: 10.3389/fmolb.2021.666054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/07/2021] [Indexed: 11/13/2022] Open
Abstract
The novel coronavirus pneumonia COVID-19 is characterized by all age susceptibility, which imposes a dramatic threat to the human species all over the world. According to current available data, the cytokine storm appears to be the most life-threatening symptom of severe COVID-19 cases accompanied with lung fibrosis. Galectin-3 (Gal-3), a member of soluble β-galactoside-binding lectin families, has been implicated as a key regulator in various inflammation conditions in addition to its well-documented roles in cancer. The pro-inflammatory activity of Gal-3 in the inflammatory response and lung fibrosis of COVID-19 has been proposed by emerging studies, which suggested that inhibition of Gal-3 may represent a novel treatment approach for COVID-19 patients. Intrahepatic cholangiocarcinoma (ICC) is an aggressive malignancy with poor prognosis. ICC accounts for 10-25% of primary liver cancers with limited therapeutic options, which has higher incidence in Asian countries, particularly in China. Cancer patients, including ICC patients, are highly vulnerable to COVID-19 due to their impaired immune system. It is thus undoubtedly a challenge for our oncology department to establish effective treatment strategies under the influence of the COVID-19 crisis. According to our management procedures in the COVID-19 era, emergency treatment will be applied to ICC patients who are under life-threatening conditions, despite the COVID-19 infection. To the best of our knowledge, the modulatory function of Gal-3 in ICC is still barely explored to date. In order to evaluate the therapeutic potential of Gal-3 for ICC patients or those comprised with COVID-19, we herein report our preliminary investigation into roles of Gal-3 in ICC. Our results exhibited that the expression of Gal-3 was significantly up-regulated in ICC tissues, and a significant correlation was observed between its overexpression and malignant progression of ICC cells. We further discussed the activity and possible molecular mechanisms of Gal-3 in ICC, which may pave the ways for further exploring the possibility of Gal-3 as a potential therapeutic target for treating ICC patients or those with COVID-19-related conditions.
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Affiliation(s)
- Hao Li
- Biliary Tract Surgery Laboratory, Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, the First Affiliated Hospital of Hunan Normal University, Changsha, China.,Hunan Research Center of Biliary Disease, the First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Jianmin Li
- Department of Pulmonary and Critical Care Medicine, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Wei Xiao
- Department of Medical Administration, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Yujing Zhang
- The Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Yuan Lv
- The Key Laboratory of Molecular Epidemiology in Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Xing Yu
- The Key Laboratory of Model Animals and Stem Cell Biology in Hunan Province, School of Medicine, Hunan Normal University, Changsha, China
| | - Jiao Zheng
- Department of Drug Clinical Trial, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
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16
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Cai Z, He C, Zhao C, Lin X. Survival Comparisons of Hepatic Arterial Infusion Chemotherapy With mFOLFOX and Transarterial Chemoembolization in Patients With Unresectable Intrahepatic Cholangiocarcinoma. Front Oncol 2021; 11:611118. [PMID: 33868997 PMCID: PMC8047640 DOI: 10.3389/fonc.2021.611118] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 03/18/2021] [Indexed: 12/30/2022] Open
Abstract
Background Intrahepatic cholangiocarcinoma (ICC) has a poor prognosis and 40%-60% of patients present with advanced disease at the time of diagnosis. Transarterial chemoembolization (TACE) and hepatic arterial infusion chemotherapy (HAIC) have recently been used in unresectable ICC. The aim of this study was to compare the survival differences of unresectable ICC patients after TACE and HAIC treatment. Methods Between March 2011 and October 2019, a total of 126 patients with unresectable ICC, as evident from biopsies and imaging, and who had received TACE or HAIC were enrolled in this study. Baseline characteristics and survival differences were compared between the TACE and HAIC treatment groups. Results ICC Patients had significantly higher survival rates after the HAIC treatment, compared with those after TACE treatment [1-year overall survival (OS) rates: 60.2% vs. 42.9%, 2-year OS rates: 38.7% vs. 29.4%, P=0.028; 1-year progression-free survival (PFS) rates: 15.0% vs. 20.0%, 2-year PFS rates: 0% vs. 0%, P=0.641; 1-year only intrahepatic PFS (OIPFS) rates: 35.0% vs. 24.4%, 2-year OIPFS rates: 13.1% vs. 14.6%, P = 0.026]. Multivariate Cox regression analysis showed that HAIC was a significant and independent factor for OS and OIPFS in the study cohort. Conclusions HAIC is superior to TACE for treatment of unresectable ICC. A new tumor response evaluation procedure for HAIC treatment in unresectable ICC patients is needed to provide better therapeutic strategies. A randomized clinical trial comparing the survival benefits of HAIC and TACE is therefore being considered.
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Affiliation(s)
- Zhiyuan Cai
- Department of Pancreatobiliary Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China.,Guangdong Provincial Engineering Research Center of Molecular Imaging, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
| | - Chaobin He
- Department of Pancreatobiliary Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Chongyu Zhao
- Department of Pancreatobiliary Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaojun Lin
- Department of Pancreatobiliary Surgery, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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17
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Rizzo A, Brandi G. Neoadjuvant therapy for cholangiocarcinoma: A comprehensive literature review. Cancer Treat Res Commun 2021; 27:100354. [PMID: 33756174 DOI: 10.1016/j.ctarc.2021.100354] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 02/07/2023]
Abstract
Biliary tract cancers (BTCs) comprise a heterogenous group of aggressive and rare malignancies arising in the bile duct outside or within the liver. BTCs include cholangiocarcinoma (CCA), gallbladder cancer (GBC) and ampulla of Vater cancer (AVC); according to the "historical" anatomical classification, CCAs are further subdivided into extrahepatic cholangiocarcinomas (eCCAs) - including distal (dCCA) and perihilar (pCCA) - and intrahepatic cholangiocarcinomas (iCCA). Notably enough, these subtypes reflect distinct features in terms of biology, epidemiology, prognosis and therapeutic strategies. Although surgical resection remains the only potentially curative treatment option for CCA patients, radical surgery is possible for only a small proportion of cases. Moreover, it has been observed that up to 50% of patients deemed resectable at diagnosis are found to be unresectable during exploratory laparotomy. Additionally, even following radical surgery, recurrence rates are high. Neoadjuvant therapy represents an appealing approach in this setting, where this therapeutic strategy has the potential to improve local and distant control, to achieve R0 resection and to prevent distant metastasis. However, few data are currently available supporting neoadjuvant therapy in CCA and several questions remains unanswered, including the activity of systemic therapy in early stages of the disease, the optimal start time of treatment, patient selection and the length of neoadjuvant therapy. In this review, we will discuss available data on neoadjuvant systemic therapy in CCA, highlighting future directions in this setting, with a particular focus on recently published data and ongoing and recruiting trials.
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Affiliation(s)
- Alessandro Rizzo
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy; Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni, 15 Bologna, Italy.
| | - Giovanni Brandi
- Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, Italy; Oncologia Medica, Azienda Ospedaliero-Universitaria di Bologna, via Albertoni, 15 Bologna, Italy
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18
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Zhao J, Chen Y, Wang J, Wang J, Wang Y, Chai S, Zhang Y, Chen X, Zhang W. Preoperative risk grade predicts the long-term prognosis of intrahepatic cholangiocarcinoma: a retrospective cohort analysis. BMC Surg 2021; 21:113. [PMID: 33676467 PMCID: PMC7936481 DOI: 10.1186/s12893-020-00954-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 11/12/2020] [Indexed: 02/08/2023] Open
Abstract
Background Cumulating evidence indicates that the systemic inflammatory response (SIR) plays a crucial role in the prognosis of various cancers. We aimed to generate a preoperative risk grade (PRG) by integrating SIR markers to preoperatively predict the long-term prognosis of intrahepatic cholangiocarcinoma (ICC). Methods 468 consecutive ICC patients who underwent hepatectomy between 2010 and 2017 were enrolled. The PRG and a nomogram were generated and their predictive accuracy was evaluated. Results The PRG consisted of two non-tumor-specific SIR markers platelet-to-lymphocyte ratio (PLR) and albumin (ALB), which were both the independent predictors of overall survival (OS). Multivariate analysis showed that the PRG was significantly associated with OS (PRG = 1: hazard ratio (HR) = 3.800, p < 0.001; PRG = 2: HR = 7.585, p < 0.001). The C-index of the PRG for predicting survival was 0.685 (95% CI 0.655 to 0.716), which was statistically higher than that of the following systems: American Joint Committee on Cancer (AJCC) 8th edition (C-index 0.645), Liver Cancer Study Group of Japan (LCSGJ) (C-index 0.644) and Okabayashi (C-index 0.633) (p < 0.05). Besides, the C-index of the nomogram only consisting of the tumor-specific factors (serum carcinoembryonic antigen, carbohydrate antigen 19-9, tumor number) could be improved to 0.737 (95% CI 0.062–0.768) from 0.625 (95% CI 0.585–0.665) when the PRG was incorporated (p < 0.001). Conclusions The PRG integrating two non-tumor-specific SIR markers PLR and ALB was a novel method to preoperative predicting the prognosis of ICC.
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Affiliation(s)
- Jianping Zhao
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Yao Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Jingjing Wang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Wang
- Department of Hepatopancreatobiliary Surgery Treatment Center, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Ying Wang
- Department of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Songshan Chai
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Yuxin Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Xiaoping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
| | - Wanguang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
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19
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Su M, Qiao KY, Xie XL, Zhu XY, Gao FL, Li CJ, Zhao DQ. Development of a Prognostic Signature Based on Single-Cell RNA Sequencing Data of Immune Cells in Intrahepatic Cholangiocarcinoma. Front Genet 2021; 11:615680. [PMID: 33613623 PMCID: PMC7890365 DOI: 10.3389/fgene.2020.615680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/30/2020] [Indexed: 12/19/2022] Open
Abstract
Analysis of single-cell RNA sequencing (scRNA-seq) data of immune cells from the tumor microenvironment (TME) may identify tumor progression biomarkers. This study was designed to investigate the prognostic value of differentially expressed genes (DEGs) in intrahepatic cholangiocarcinoma (ICC) using scRNA-seq. We downloaded the scRNA-seq data of 33,991 cell samples, including 17,090 ICC cell samples and 16,901 ICC adjacent tissue cell samples regarded as normal cells. scRNA-seq data were processed and classified into 20 clusters. The immune cell clusters were extracted and processed again in the same way, and each type of immune cells was divided into several subclusters. In total, 337 marker genes of macrophages and 427 marker genes of B cells were identified by comparing ICC subclusters with normal subclusters. Finally, 659 DEGs were obtained by merging B cell and macrophage marker genes. ICC sample clinical information and gene expression data were downloaded. A nine-prognosis-related-gene (PRG) signature was established by analyzing the correlation between DEGs and overall survival in ICC. The robustness and validity of the signature were verified. Functional enrichment analysis revealed that the nine PRGs were mainly involved in tumor immune mechanisms. In conclusion, we established a PRG signature based on scRNA-seq data from immune cells of patients with ICC. This PRG signature not only reflects the TME immune status but also provides new biomarkers for ICC prognosis.
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Affiliation(s)
- Miao Su
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Gastroenterology, Hengshui People's Hospital, Hengshui, China
| | - Kuang-Yuan Qiao
- Basic Medical College, Hebei Medical University, Shijiazhuang, China
| | - Xiao-Li Xie
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xin-Ying Zhu
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Department of Gastroenterology, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fu-Lai Gao
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chang-Juan Li
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Dong-Qiang Zhao
- Department of Gastroenterology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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McMillan RR, Saharia A, Abdelrahim M, Ghobrial RM. New Breakthroughs for Liver Transplantation of Cholangiocarcinoma. CURRENT TRANSPLANTATION REPORTS 2021. [DOI: 10.1007/s40472-021-00313-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Abstract
Purpose
Liver transplantation (LT) has gained ground as a treatment for cholangiocarcinoma. LT has achieved an established role as curative treatment for unresectable hilar cholangiocarcinoma (hCCA), and there are emerging data supporting its use in select patients with intrahepatic cholangiocarcinoma (iCCA). This review explores the current frontiers and future directions of LT for CCA.
Recent Findings
Results of retrospective studies support randomized trials of LT for resectable hCCA. Select patients with iCCA who have small tumors or favorable disease biology, as demonstrated by response to neoadjuvant therapy, have long-term survival after LT. Discoveries in the biology of iCCA show patients with FGFR and other genetic abnormalities have improved outcomes and may benefit from targeted therapies.
Summary
The outcomes of LT for CCA support its increased utilization. Policies should be considered to increase accessibility of donor organs for patients with iCCA.
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21
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Jin H, Zhang M, Huang L, Hao J, Zhou L. Diagnosis of intrahepatic cholangiocarcinoma by Raman spectroscopy provides high efficiency: A protocol for systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e23900. [PMID: 33429751 PMCID: PMC7793367 DOI: 10.1097/md.0000000000023900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 11/30/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND We aim to evaluate the efficiency of Raman spectroscopy (RS) in diagnosing suspected patients with intrahepatic cholangiocarcinoma (ICC), manifested by diagnostic sensitivity, specificity, and accuracy. METHODS We will research widely the articles concerning the use of RS in ICC through authenticated database including PubMed/Medline, EMBASE, Web of Science, Ovid, Web of Knowledge, Cochrane Library, and CNKI between January 2012 and November 2020, retrieving at least 1500 spectra with strict criteria. This study will be carried out in accordance to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We are going to summarize the test performance using random effects models. RESULTS Based on the pooled sensitivity, specificity, and diagnostic accuracy, we intend to provide the relative diagnostic efficiency in ICC through RS. CONCLUSION Through this systematic review and meta-analysis, we intend to provide the pooled sensitivity, specificity and diagnostic accuracy of RS in the diagnosis of suspected ICC. Other parameters like positive likelihood ratios (LR), negative LR, diagnostic odds ratio (DOR), and area under curve (AUC) of the summary receiver operating characteristics (SROC) curve will also be calculated and related figures will be drawn to help illustrate the efficacy of RS in the diagnosis of ICC.
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Affiliation(s)
- Hongyu Jin
- Department of Liver Surgery & Liver Transplantation Center
| | - Man Zhang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Key Laboratory of Obstetric & Gynecologic and Pediatric Disease and Birth Defects of Ministry of Education
| | | | | | - Lingyun Zhou
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
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22
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LHPP suppresses tumorigenesis of intrahepatic cholangiocarcinoma by inhibiting the TGFβ/smad signaling pathway. Int J Biochem Cell Biol 2021; 132:105845. [PMID: 33401010 DOI: 10.1016/j.biocel.2020.105845] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/17/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022]
Abstract
Phospholysine phosphohistidine inorganic pyrophosphate phosphatase (LHPP), a histidine phosphatase, plays an important role in tumor progression and metastasis as a tumor suppressor. Here, we investigate the effect of LHPP in intrahepatic cholangiocarcinoma (ICC). We discovered that LHPP was downregulated in tumor tissues and low levels of LHPP predicted poor survival. LHPP inhibited ICC cell growth, cell invasion and epithelial-mesenchymal transition (EMT) in vitro and in vivo. Mechanically, LHPP deactivated transforming growth factor‑beta (TGFβ) signaling pathway, and low level LHPP upregulated the expression of TGFβ and phosphorylation of smad2/3. Moreover, inhibition of this pathway reversed the biofunction of LHPP. In summary, these findings demonstrated that LHPP suppressed ICC through inhibiting the activation of TGFβ/smad signaling. Our results indicated that LHPP is a potential therapeutic target in ICC.
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23
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Machairas N, Kostakis ID, Schizas D, Kykalos S, Nikiteas N, Sotiropoulos GC. Meta-analysis of laparoscopic versus open liver resection for intrahepatic cholangiocarcinoma. Updates Surg 2020; 73:59-68. [PMID: 33219937 DOI: 10.1007/s13304-020-00930-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/11/2020] [Indexed: 02/06/2023]
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is a rare and aggressive hepatic malignancy. An up-to-date systematic review and meta-analysis was conducted aiming to compare outcomes between laparoscopic (LLR) and open liver resection (OLR) for patients with iCCA. A systematic literature search of Medline, Scopus, Google Scholar, and Cochrane databases was performed. A total of 8 studies comprising 2872 patients, who underwent LLR or OLR for iCCA, were included in our meta-analysis. LLR patients had smaller tumors [mean difference (MD): - 1.17 cm, 95% confidence intervals (CI) - 1.77 to - 0.57, p = 0.0001], underwent major resections less frequently [risk ratio (RR): 0.75, 95% CI 0.67-0.83, p < 0.00001] and R0 resections more frequently (RR: 1.05, 95% CI 1.01-1.09, p = 0.01), while lymphadenectomy was less common in the laparoscopic group (RR: 0.73, 95% CI 0.58-0.92, p = 0.007). The LLR group presented reduced blood loss (MD: - 270.16 ml, 95% CI - 381.53 to - 32.79, p = 0.002), need for transfusion (RR: 0.39, 95% CI 0.21-0.73, p = 0.003), overall morbidity (RR: 0.58, 95% CI 0.4-0.83, p = 0.003) and hospital stay (MD: - 3.48 days, 95% CI: - 6.94 to - 0.02, p = 0.05) compared to the OLR group. No differences were shown in operative time (MD: 1.6 min, 95% CI - 34.17-37.37, p = 0.93), major morbidity (RR: 0.65, 95% CI 0.38-1.11, p = 0.12), mortality (RR: 1.42, 95% CI 0.13-15.07, p = 0.77), overall (HR: 0.9, 95% CI 0.59-1.38, p = 0.63) and relapse-free survival (HR: 0.77, 95% CI 0.5-1.16, p = 0.21) between the two groups. LLR seems to benefit patients with iCCA in terms of short-term outcomes, whilst long-term outcomes are comparable among the two approaches.
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Affiliation(s)
- Nikolaos Machairas
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens Medical School, 17 Agiou Thoma Street, 11527, Athens, Greece. .,Department of HPB Surgery and Liver Transplant, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK.
| | - Ioannis D Kostakis
- Department of HPB Surgery and Liver Transplant, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, UK
| | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Kykalos
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens Medical School, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Nikolaos Nikiteas
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens Medical School, 17 Agiou Thoma Street, 11527, Athens, Greece
| | - Georgios C Sotiropoulos
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens Medical School, 17 Agiou Thoma Street, 11527, Athens, Greece
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24
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Distant Metastases in Patients with Intrahepatic Cholangiocarcinoma: Does Location Matter? A Retrospective Analysis of 370 Patients. JOURNAL OF ONCOLOGY 2020; 2020:7195373. [PMID: 33101412 PMCID: PMC7569461 DOI: 10.1155/2020/7195373] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/13/2020] [Accepted: 09/28/2020] [Indexed: 01/27/2023]
Abstract
Background Intrahepatic cholangiocarcinoma (ICC) is an aggressive tumor entity, and distant metastases are common. However, studies investigating patterns and clinical relevance of distant metastases are rare. Therefore, we aimed to analyze occurrence, location, and prognostic impact of distant metastases on overall survival (OS). Methods Between 1997 and 2018, 417 patients with ICC were treated at our tertiary care center. Distant metastases and intrahepatic tumor burden were retrospectively evaluated in a longitudinal approach using volumetric assessment of cross-sectional imaging studies and all available medical/histopathological reports. Results Finally, 370 patients with histopathologically confirmed ICC were included. Of these, 186 showed distant metastases, either initially (n = 59) or during follow-up (n = 127). The most common metastatic sites were the lung (n = 105), peritoneum (n = 81), and bone (n = 50). After detection of lung metastases, the residual median OS was 5.3 months; followed by peritoneal metastases, 4.5 months, and bone metastases, 4.4 months (P=0.17). At the time of first metastatic occurrence, residual OS according to intrahepatic tumor burden of <25%, 25–50%, and >50% was 6.5 months, 4.9 months, and 1.2 months, respectively (P < 0.001). In multivariate hazard regression, hepatic tumor burden, liver function, and subsequent treatment were significant predictors of survival. Conclusions During the disease course, every second patient developed extrahepatic metastases. While the presence of distant metastases was associated with poor patient outcomes, there was no significant difference between metastatic sites. However, hepatic tumor burden was the life-limiting risk factor in a majority of patients at the time of distant metastatic disease.
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25
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Bai M, Fu W, Su G, Cao J, Gao L, Huang C, Ma H, Zhang J, Yue P, Bai B, Lin Y, Meng W, Li X. The role of extracellular vesicles in cholangiocarcinoma. Cancer Cell Int 2020. [PMCID: PMC7709354 DOI: 10.1186/s12935-020-01526-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractCholangiocarcinoma (CCA) is a rare tumor that arises from cholangiocytes, the epithelial cells of the bile duct. The tumor is characterized by insidious onset, high degree of malignancy, poor prognosis and high recurrence rate. Due to the lack of specific biomarkers, it is difficult to diagnose CCA early and evaluate prognosis. Extracellular vesicles (EVs), which include apoptotic bodies, microvesicles and exosomes, have emerged as having important roles in cell-to-cell communication in both normal physiology and pathological conditions. Some research has found that EVs play a crucial role in the occurrence and development of CCA. EVs can carry specific molecular substances such as nucleic acids and proteins, which have potential for the diagnosis and therapy of CCA. This article reviews the current knowledge on the role of EVs in CCA. We highlight EVs and their functions in the physiology and pathophysiology of CCA, and discuss their therapeutic potential and their role as biomarkers.
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26
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Emerging pathways for precision medicine in management of cholangiocarcinoma. Surg Oncol 2020; 35:47-55. [PMID: 32827952 DOI: 10.1016/j.suronc.2020.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/06/2020] [Indexed: 12/27/2022]
Abstract
Cholangiocarcinoma (CCA) is the second most common biliary tract malignancy with a dismal prognosis. Surgical resection with a negative microscopic margin offers the only hope for long-term survival. However, the majority of patients present with advanced disease not amenable to curative resection, mainly due to late presentation and aggressive nature of the disease. Unfortunately, due to the heterogeneous nature of CCA as well as limitations of available chemotherapy medications, traditional chemotherapy regimens offer limited survival benefit. Recent advances in genomic studies and next-generation sequencing techniques have assisted in better understanding of cholangiocarcinogenesis and identification of potential aberrant signaling pathways. Targeting the specific genomic abnormalities via novel molecular therapies has opened a new avenue in management of CCA with encouraging results in preclinical studies and early clinical trials. In this review, we present emerging therapies for precision medicine in CCA.
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27
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Wu YN, He LH, Bai ZT, Li X. NRP1 is a Prognostic Factor and Promotes the Growth and Migration of Cells in Intrahepatic Cholangiocarcinoma. Cancer Manag Res 2020; 12:7021-7032. [PMID: 32848461 PMCID: PMC7426061 DOI: 10.2147/cmar.s260091] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/08/2020] [Indexed: 12/17/2022] Open
Abstract
Background Neuropilin-1 (NRP-1) participates in cancer cell proliferation and metastasis as a multifunctional co-receptor by interacting with multiple signaling pathways. However, few studies have addressed the precise function and prognosis analysis of NRP1 in intrahepatic cholangiocarcinoma (ICC). We aimed to study the correlations between NRP1 and clinicopathological characteristics and NRP1 effect on ICC cell line functions. Methods NRP1 mRNA and its protein levels in human ICC tissues and cell lines were detected by IHC, qRT-PCR, and WB method. Transwell, wound healing, and CCK-8 assays were performed to verify the effects of NRP1 knockdown and overexpression on cell migration and proliferation capability. Results NRP1 proteins and mRNA levels increased in ICC tissues compared to those in paired adjacent non-tumor tissues. High NRP1 expression of ICC tissues was related to poor prognosis. NRP1 expression level was expected to be an independent prognosticator for overall survival and cumulative tumor recurrence, and was closely related to tumor number (P=0.047). Knockdown of NRP1 inhibited cell proliferation and migration capability of RBE cells in vitro, and NRP1 overexpression in 9810 cells accelerated proliferation and migration. Additionally, NRP1 may promote cell proliferation and migration in ICC via the FAK/PI3-K/AKT pathway. Conclusion As an oncogene, NRP1 may function as a candidate target and prognostic biomarker of value for ICC therapy.
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Affiliation(s)
- Yong-Na Wu
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, People's Republic of China.,Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou 730000, Gansu Province, People's Republic of China.,Northwest Institute of Eco-Environment and Resources, Chinese Academy of Sciences, Lanzhou 730000, Gansu Province, People's Republic of China.,University of Chinese Academy of Sciences, Beijing 100049, People's Republic of China
| | - Li-Hong He
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, People's Republic of China.,Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou 730000, Gansu Province, People's Republic of China.,The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, People's Republic of China
| | - Zhong-Tian Bai
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, People's Republic of China.,Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou 730000, Gansu Province, People's Republic of China.,The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, People's Republic of China
| | - Xun Li
- Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, People's Republic of China.,Key Laboratory of Biological Therapy and Regenerative Medicine Transformation Gansu Province, Lanzhou 730000, Gansu Province, People's Republic of China.,The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, People's Republic of China
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28
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Kim JH, Yoon JH, Joo I, Lee JM. Evaluation of Primary Liver Cancers Using Hepatocyte-Specific Contrast-Enhanced MRI: Pitfalls and Potential Tips. J Magn Reson Imaging 2020; 53:655-675. [PMID: 32700807 DOI: 10.1002/jmri.27213] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022] Open
Abstract
When radiologists interpret hepatic focal lesions seen on dynamic magnetic resonance imaging (MRI) scans, it is important not only to distinguish malignant lesions from benign ones but also to distinguish nonhepatocellular carcinoma (HCC) malignancies from HCCs. In addition, most major guidelines, including those of the American Association for the Study of Liver Disease, European Association for the Study of the Liver, and Korean Liver Cancer Association and National Cancer Center, allow for the noninvasive imaging diagnosis of HCC in at-risk patients. However, ~40% of HCC cases show atypical imaging features mimicking non-HCC malignancies. Furthermore, several benign and malignant lesions, such as flash-filling hemangioma and intrahepatic mass-forming cholangiocarcinoma, frequently look like HCC. In contrast, although multiparametric MRI options, including hepatobiliary phase and diffusion-weighted imaging, provide useful information that could help address these challenges, there remain several unresolved issues with regard to the noninvasive diagnostic criteria characterizing HCC. In this article, we discuss the typical imaging features and challenging situations related to primary liver cancers in MRI, while considering how to make a correct diagnosis. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Jae Hyun Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ijin Joo
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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Xiong F, Gong J, Wang Q. Olaparib and Pembrolizumab Treatment for BRCA1-Mutated and PD-L1-Positive Intrahepatic Cholangiocarcinoma Recurrence and Metastasis: A Case Report. Onco Targets Ther 2020; 13:6385-6391. [PMID: 32753881 PMCID: PMC7342556 DOI: 10.2147/ott.s250454] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/07/2020] [Indexed: 01/05/2023] Open
Abstract
Olaparib has been applied as monotherapy to treat ovarian and breast cancer patients with malignant or suspected malignant BRCA1/2 mutations. Pembrolizumab has been approved to treat unresectable or metastatic tumors in patients who exhibited progression after previous treatment, regardless of histology. However, there are no reports on the use of olaparib and pembrolizumab for the treatment of BRCA1/2-mutated and PD-L1-positive intrahepatic cholangiocarcinoma (iCCA). This case report aimed to observe the safety and efficacy of olaparib and pembrolizumab in treating BRCA1-mutated and PD-L1-positive iCCA recurrence and metastasis. This case report describes a patient with BRCA1-mutated and PD-L1-positive iCCA recurrence and metastases who received olaparib and pembrolizumab. Olaparib (400 mg orally twice daily) and pembrolizumab (100 mg iv every 3 weeks) were administered to the patient for 9 months. The patient achieved complete response (CR) confirmed by liver magnetic resonance imaging (MRI)+ perfusion-weighted imaging (PWI)+ diffusion-weighted imaging (DWI), and the carcinoembryonic antigen (CEA), alpha fetoprotein (AFP), carbohydrate antigen 125 (CA-125), and carbohydrate antigen 199 (CA19-9) tumor marker levels were normal after treatment. There were no significant adverse events, and routine blood counts, coagulation function, and liver and kidney function were normal. The Eastern Cooperative Oncology Group (ECOG) performance status decreased from a score of 1 to a score of 0. Olaparib and pembrolizumab can effectively treat BRCA1-mutated and PD-L1-positive iCCA patients, and adverse effects were largely unobserved. More studies should be performed to promote the development of tumor genomics because the findings from these studies may help clinicians select suitable biomarkers to treat iCCA patients. As the use of immunotherapy alone to treat tumors may not achieve the expected effect, targeted therapy combined with immunotherapy has become a new approach in cancer treatment strategies.
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Affiliation(s)
- Fan Xiong
- Department of Integrative Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
| | - Jing Gong
- Department of Integrative Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
| | - Qi Wang
- Department of Integrative Traditional Chinese and Western Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China
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30
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Zhang JX, Li P, Chen Z, Lin H, Cai Z, Liao W, Pan Z. Impact of liver fibrosis score on prognosis after common therapies for intrahepatic cholangiocarcinoma: a propensity score matching analysis. BMC Cancer 2020; 20:556. [PMID: 32539768 PMCID: PMC7296657 DOI: 10.1186/s12885-020-07051-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/08/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Liver fibrosis or cirrhosis is associated with the dismal prognosis of hepatocellular carcinoma (HCC), and it might also be involved in intrahepatic cholangiocarcinoma (ICC). The effect of hepatic fibrosis on the survival of ICC patients is still unclear. This study aims to explore whether liver fibrosis impacts the overall survival (OS) and disease-specific survival (DSS) of ICC patients. METHODS Data of 729 eligible ICC patients receiving different therapies from the Surveillance, Epidemiology, and End Results database (2004-2015) were analyzed. Unmatched, propensity score-matched, and propensity score-weighted cohorts were used to investigate the relationships of different fibrosis scores (low fibrosis score vs. high fibrosis score) and survival. A Cox regression and Kaplan-Meier curves were used to explore the influence of fibrosis score on patients' survival. Stratified analyses based on treatment modality were conducted to compare the survival difference in ICC patients with different fibrosis scores. RESULTS Before matching, the one-, three-, and five-year OS were 50.9, 28.0, and 16.1% in the low fibrosis score group (n = 465) and 39.3, 20.1, and 8.0% in the high fibrosis score group (n = 264) (P < 0.001), respectively. After propensity score matching, the one-, three-, and five-year OS were 45.0, 26.0, and 10.2% in the low fibrosis score group and 36.0, 8.1, and 2.3% in the high fibrosis score group (P = 0.008), respectively. The multivariate Cox regression results showed that a high fibrosis score was an independent risk factor of OS. Additionally, patients with high fibrosis scores achieved low DSS after matching (P = 0.032). The survival benefits of the low fibrosis score group were consistent across treatment cohorts. CONCLUSIONS High fibrosis scores were associated with poor clinical outcomes of ICC patients receiving different common therapies.
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Affiliation(s)
- Jian Xi Zhang
- Department of hepatobiliary surgery, Xiamen Hospital, Beijing University of Chinese Medicine, Xiamen, Fujian, China
| | - Peipei Li
- Department of hepatobiliary surgery, Xiamen Hospital, Beijing University of Chinese Medicine, Xiamen, Fujian, China
| | - Zhibin Chen
- Department of hepatobiliary surgery, Xiamen Hospital, Beijing University of Chinese Medicine, Xiamen, Fujian, China
| | - Huogui Lin
- Department of General Surgery, Xiamen Haicang Hospital, 89 Haiyu Road, Haicang District, Xiamen, Fujian, China
| | - Zhezhen Cai
- Department of General Surgery, Xiamen Haicang Hospital, 89 Haiyu Road, Haicang District, Xiamen, Fujian, China
| | - Weijia Liao
- Department of General Surgery, Xiamen Haicang Hospital, 89 Haiyu Road, Haicang District, Xiamen, Fujian, China
| | - Zirong Pan
- Department of General Surgery, Xiamen Haicang Hospital, 89 Haiyu Road, Haicang District, Xiamen, Fujian, China.
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31
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Gurmikov BN, Vishnevsky VA, Kovalenko YA, Chzhao AV. [Long-term results of surgical treatment of intrahepatic cholangiocarcinoma]. Khirurgiia (Mosk) 2020:5-11. [PMID: 32500683 DOI: 10.17116/hirurgia20200515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the long-term outcomes of surgical treatment of intrahepatic cholangiocarcinoma depending tumor dimensions, vascular invasion, lymph node metastases, cellular differentiation and quality of resection. MATERIAL AND METHODS There were 46 patients with intrahepatic cholangiocellular cancer. Extended hemihepatectomy was made in 14 patients (30.4%), resection of two and three liver segments - in 17 cases (36.9%), standard hemihepatectomy - in 15 patients (32.6%). Liver resection was combined with extrahepatic bile duct resection in 5 (10.9%) patients. Liver resection was followed by biopsy of specimens. Dimension and number of tumors, differentiation grade, resection margin, liver capsule invasion, vascular invasion and regional lymph node metastases were analyzed. Forty-four (95.6%) patients were followed-up in long-term postoperative period. Statistical analysis was performed using Statistica 13.2 (Dell Inc., USA) and IBM SPSS Statistics v.25 (IBM Corp., USA) software package. Survival was analyzed using the Kaplan-Meier method. Overall 1-, 3- and 5-year survival rates with two-sided 95% confidence intervals (95% CI) were calculated using IBM SPSS Statistics v.25 software. RESULTS Median survival was 37 months, 1-year - 75.9% (60.9-90.9%), 3-year - 57.6% (35.5-79.6%), 5-year - 36% (8.2-63.7%). Median survival after R1 resection was 37 months, R2 resection - 12 months. Median survival was not achieved in R0 group. We found significant differences in overall survival depending on quality of resection. Tumor dimension over 5 cm, low-grade adenocarcinoma, microvascular invasion and lymph node metastases were associated with impaired postoperative survival. However, differences were not significant. CONCLUSION The main surgical strategy in patients with intrahepatic cholangiocarcinoma should be ensuring microscopically negative resection margin.
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Affiliation(s)
- B N Gurmikov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - V A Vishnevsky
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - Yu A Kovalenko
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A V Chzhao
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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32
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Peng YT, Zhou CY, Lin P, Wen DY, Wang XD, Zhong XZ, Pan DH, Que Q, Li X, Chen L, He Y, Yang H. Preoperative Ultrasound Radiomics Signatures for Noninvasive Evaluation of Biological Characteristics of Intrahepatic Cholangiocarcinoma. Acad Radiol 2020; 27:785-797. [PMID: 31494003 DOI: 10.1016/j.acra.2019.07.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 07/27/2019] [Accepted: 07/29/2019] [Indexed: 02/07/2023]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study was to establish and validate radiomics signatures based on ultrasound (US) medicine images to assess the biological behaviors of intrahepatic cholangiocarcinoma (ICC) in a noninvasive manner. MATERIALS AND METHODS This study consisted of 128 ICC patients. We focused on evaluating six pathological features: microvascular invasion, perineural invasion, differentiation, Ki-67, vascular endothelial growth factor, and cytokeratin 7. Region of interest (ROI) of ICC was identified by manually plotting the tumor contour on the grayscale US image. We extracted radiomics features from medical US imaging. Then, dimensionality reduction methods and classifiers were used to develop radiomic signatures for evaluating six pathological features in ICC. Finally, independent validation datasets were used to assess the radiomic signatures performance. RESULTS We extracted 1076 quantitative characteristic parameters on the US medicine images. Based on extracted radiomics features, the best performing radiomic signatures for evaluating microvascular invasion features were produced by hypothetical test + support vector machine (SVM), perineural invasion subgroup were least absolute shrinkage and selection operator + principal component analysis + support vector machine, differentiation subgroup were hypothetical test + decision tree, Ki-67 subgroup were hypothetical test + logistic regression, vascular endothelial growth factor subgroup were hypothetical test + Gradient Boosting Decision Tree (GBDT), and cytokeratin 7 subgroup were hypothetical test + bagging, respectively. CONCLUSION Through the high-throughput radiomics analysis based on US medicine images, we proposed radiomics signatures that have moderate efficiency in predicting the biological behaviors of ICC noninvasively.
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Affiliation(s)
- Yu-Ting Peng
- Department of Medical Ultrasonics, First Afliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang, China
| | - Chuan-Yang Zhou
- Department of Medical Ultrasonics, First Afliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang, China
| | - Peng Lin
- Department of Medical Ultrasonics, First Afliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang, China
| | - Dong-Yue Wen
- Department of Medical Ultrasonics, First Afliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang, China
| | - Xiao-Dong Wang
- Department of Medical Ultrasonics, First Afliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang, China
| | - Xiao-Zhu Zhong
- Department of Medical Ultrasonics, First Afliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang, China
| | - Deng-Hua Pan
- Department of Medical Ultrasonics, First Afliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang, China
| | - Qiao Que
- Department of Medical Ultrasonics, First Afliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang, China
| | - Xin Li
- GE Healthcare, Shanghai, China
| | | | - Yun He
- Department of Medical Ultrasonics, First Afliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang, China.
| | - Hong Yang
- Department of Medical Ultrasonics, First Afliated Hospital of Guangxi Medical University, No. 6 Shuangyong Road, Nanning 530021, Guangxi Zhuang, China.
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Qin X, Song Y. Bioinformatics Analysis Identifies the Estrogen Receptor 1 (ESR1) Gene and hsa-miR-26a-5p as Potential Prognostic Biomarkers in Patients with Intrahepatic Cholangiocarcinoma. Med Sci Monit 2020; 26:e921815. [PMID: 32435051 PMCID: PMC7257878 DOI: 10.12659/msm.921815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Intrahepatic cholangiocarcinoma arises from the epithelial cells of the bile ducts and is associated with poor prognosis. This study aimed to use bioinformatics analysis to identify molecular biomarkers of intrahepatic cholangiocarcinoma and their potential mechanisms. Material/Methods MicroRNA (miRNA) and mRNA microarrays from GSE53870 and GSE32879 were downloaded from the Gene Expression Omnibus (GEO) database. Differentially expressed miRNAs (DEMs) associated with prognosis were identified using limma software and Kaplan-Meier survival analysis. Predictive target genes of the DEMs were identified using miRWalk, miRTarBase, miRDB, and TargetScan databases of miRNA-binding sites and targets. Target genes underwent Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis. Hub genes were analyzed by constructing the protein-protein interaction (PPI) network using Cytoscape. DEMs validated the hub genes, followed by construction of the miRNA-gene regulatory network. Results Twenty-five DEMs were identified. Fifteen DEMs were upregulated, and ten were down-regulated. Kaplan-Meier survival analysis identified seven upregulated DEMs and nine down-regulated DEMs that were associated with the overall survival (OS), and 130 target genes were selected. GO analysis showed that target genes were mainly enriched for metabolism and development processes. KEGG analysis showed that target genes were mainly enriched for cancer processes and some signaling pathways. Fourteen hub genes identified from the PPI network were associated with the regulation of cell proliferation. The overlap between hub genes and DEMs identified the estrogen receptor 1 (ESR1) gene and hsa-miR-26a-5p. Conclusions Bioinformatics analysis identified ESR1 and hsa-miR-26a-5p as potential prognostic biomarkers for intrahepatic cholangiocarcinoma.
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Affiliation(s)
- Xianzheng Qin
- Queen Mary School of Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Yuning Song
- Queen Mary School of Nanchang University, Nanchang, Jiangxi, China (mainland)
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Krasnodębski M, Grąt M, Jastrzębski M, Szczęśniak M, Morawski M, Zając K, Patkowski W, Zieniewicz K. Unsatisfactory Long-term Results of Liver Transplant in Patients With Intrahepatic Cholangiocarcinoma. Transplant Proc 2020; 52:2463-2467. [PMID: 32327261 DOI: 10.1016/j.transproceed.2020.02.095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 02/05/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cholangiocarcinoma is the primary liver tumor forming from the biliary epithelium. Two major subtypes of this disease are distinguished because of the initial location: the extra- and intrahepatic form. The latter disease is currently a controversial indication for liver transplant (LT). The aim of this study was to evaluate the outcomes of LT of patients with intrahepatic cholangiocarcinoma. METHODS Based on postoperative histopathologic examination of the explanted liver, 8 patients with intrahepatic cholangiocarcinoma were identified from all LT recipients in the period between 1994 and 2019 and included in this retrospective cohort study. Four of the patients received transplants with a preoperative diagnosis of hepatocellular carcinoma; the remaining tumors were incidental findings. Patient survival was the primary outcome measure. RESULTS Six recipients had solitary lesion with a maximum tumor diameter of 6 cm. The median carbohydrate antigen 19-9 concentration prior to LT was 52.3 U/mL. The overall survival was 75.0%, 37.5%, and 25% after the first, third, and fifth year, respectively, with a median survival of 18 months. Age (P = .758), carbohydrate antigen 19-9 (P = .282), largest tumor size (P = .862), and the sum of the number of lesions and diameter of the largest tumor (P = .530) were not significantly associated with overall survival. Recurrence-free survival was 71.4% after 1 year and 28.6% after 3 and 5 years. Correspondingly, no significant predictors of worse recurrence-free survival were found. CONCLUSIONS Intrahepatic cholangiocarcinoma remains associated with a very high risk of recurrence and dismal survival after LT irrespective of macroscopic disease burden.
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Affiliation(s)
- Maciej Krasnodębski
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - Michał Grąt
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Jastrzębski
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Michalina Szczęśniak
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Morawski
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Zając
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Waldemar Patkowski
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Zieniewicz
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
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Hahn F, Müller L, Jungmann F, Mähringer-Kunz A, Tanyildizi Y, Düber C, Galle PR, Weinmann A, Kloeckner R. Survival prediction for patients with non-resectable intrahepatic cholangiocarcinoma undergoing chemotherapy: a retrospective analysis comparing the tumor marker CA 19-9 with cross-sectional imaging. J Cancer Res Clin Oncol 2020; 146:1883-1890. [PMID: 32232655 PMCID: PMC7256028 DOI: 10.1007/s00432-020-03200-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/24/2020] [Indexed: 12/13/2022]
Abstract
Purpose Carbohydrate antigen (CA) 19-9 has been established as the main serum marker for patients with intrahepatic cholangiocarcinoma (ICC). The aim of this study was to compare the prognostic value of CA 19-9 changes versus response determined by imaging in patients with ICC undergoing chemotherapy. Methods Between 2003 and 2018, 151 patients with histopathologically confirmed ICC underwent chemotherapy at our tertiary care center for non-resectable or recurrent ICC, of whom 121 were included in this study. Serum CA 19-9 levels and imaging were retrospectively evaluated during chemotherapy. Log-rank testing and optimal stratification were used to classify patients into risk groups. Results Prior to chemotherapy, baseline serum CA 19-9 levels above the previously published cut-off of 37 U/ml were associated with poor survival (median OS 8.7 vs. 12.4 months, p = 0.003). After the beginning of chemotherapy, an increase in CA 19-9 of more than 40 U/ml resulted in impaired residual survival (median OS 5.0 vs. 12.1 months, p < 0.001). However, progressive disease at the first follow-up imaging proved the strongest predictor for poor outcome (median OS 4.6 vs. 15.5 months, p < 0.001). In contrast to prior studies, our data did not show statistically relevant differences in survival time with respect to absolute or relative decreases in serum CA 19-9 levels. Conclusion In our study, the disease control rate—that is, the absence of progressive disease—was the strongest predictor of prolonged residual OS. To this end, both CA 19-9 changes and progressive disease on initial follow-up showed remarkable discriminatory power, with the latter slightly outperforming the former. Therefore, imaging should remain the mainstay of patient evaluation during follow-up. Electronic supplementary material The online version of this article (10.1007/s00432-020-03200-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Felix Hahn
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | - Florian Jungmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | - Aline Mähringer-Kunz
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | - Yasemin Tanyildizi
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Christoph Düber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131, Mainz, Germany
| | - Peter R Galle
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Arndt Weinmann
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Clinical Registry Unit (CRU), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckst. 1, 55131, Mainz, Germany.
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Pu XH, Yue S, Wu HY, Yang J, Fan XS, Fu Y, Ye Q, Chen J. C-MET in intrahepatic cholangiocarcinoma: High-Frequency amplification predicts protein expression and a unique molecular subtype. Pathol Res Pract 2020; 216:152857. [PMID: 32089411 DOI: 10.1016/j.prp.2020.152857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/10/2020] [Accepted: 02/10/2020] [Indexed: 12/16/2022]
Abstract
As an increasing number of gene alterations have been discovered in intrahepatic cholangiocarcinoma (ICC), molecular targets are promising for the diagnosis and treatment of distinct subpopulations carrying unique molecular signatures. C-MET amplification is associated with a variety of tumors, including ICC; however, the characteristics of this alteration have not been assessed in ICC. By determining the ratios of C-MET/chromosome enumeration probe (CEP) 7 double-colour probes, we evaluated the presence of C-MET amplification in a cohort of 133 ICC tumors by fluorescence in situ hybridization (FISH). We further determined the levels of MET protein expression by immunohistochemistry (IHC) and analyzed clinicopathologic records. Of the samples, 21 (15.8 %) had high-frequency and 41 (30.8 %) had low-frequency C-MET genetic amplification, and 71 (53.4 %) had a normal C-MET gene. There were significant differences in gross classification (p = 0.045), microscopic cholangitis (p = 0.030), mucus level in tumors (p = 0.012) and T stage (p = 0.007) between the three groups. When we combined high-frequency and low-frequency amplifications of C-MET into one group, only microscopic cholangitis (p = 0.010) and stage (p = 0.016) showed significant differences compared to normal C-MET gene expression. However, when we combined the low-frequency C-MET amplification group with the normal C-MET group and compared this combined group with the high-frequency C-MET amplification group, the high-frequency group had more younger patients (p = 0.047), had more non-mass-forming (MF)-type cases according to gross classification (p = 0.015), secreted more mucus (p = 0.002) and appeared to have a higher T stage (p = 0.031) than the combined group. For IHC results, although only cluster C-MET amplification predicted protein overexpression, high-frequency amplification was associated with more protein expression than the other genetic statuses (p = 0.000). As low-frequency C-MET amplification exhibited similar biology to that of the normal gene, we regarded high-frequency amplification of C-MET as a unique molecular subtype. It may play important roles in tumor progression and may be used as a prognostic marker for targeted therapy.
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Affiliation(s)
- Xiao-Hong Pu
- Departments of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Shen Yue
- Department of Medical Genetics, Nanjing Medical University, Nanjing 211166, Jiangsu Province, China
| | - Hong-Yan Wu
- Departments of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Jun Yang
- Departments of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Xiang-Shan Fan
- Departments of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Yao Fu
- Departments of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China
| | - Qing Ye
- Departments of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China.
| | - Jun Chen
- Departments of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, Jiangsu Province, China.
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Machairas N, Lang H, Jayant K, Raptis DA, Sotiropoulos GC. Intrahepatic cholangiocarcinoma: Limitations for resectability, current surgical concepts and future perspectives. Eur J Surg Oncol 2020; 46:740-746. [PMID: 32007379 DOI: 10.1016/j.ejso.2020.01.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 11/14/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022] Open
Abstract
Intrahepatic cholangiocarcinoma (iCCA) is the second most common hepatic malignancy and its incidence has been shown to increase significantly during the past decades. Complete surgical resection is currently acknowledged as the only curative treatment option able to provide adequate long-term outcomes. We herein review technical, functional and oncologic limitations for resectability, discuss current surgical aspects as well as highlight the fields in which future research and practice should focus on in order to ameliorate long-term outcomes in patients with iCCA.
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Affiliation(s)
- Nikolaos Machairas
- Department of HPB Surgery and Liver Transplant, Royal Free London, London, United Kingdom.
| | - Hauke Lang
- Department of General, Visceral and Transplant Surgery, University Medical Center of the Johannes Gutenberg, University Mainz, Mainz, Germany
| | - Kumar Jayant
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Dimitri A Raptis
- Department of HPB Surgery and Liver Transplant, Royal Free London, London, United Kingdom
| | - Georgios C Sotiropoulos
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Functions of FGFR2 corrupted by translocations in intrahepatic cholangiocarcinoma. Cytokine Growth Factor Rev 2019; 52:56-67. [PMID: 31899106 DOI: 10.1016/j.cytogfr.2019.12.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/18/2019] [Indexed: 12/23/2022]
Abstract
Cholangiocarcinoma, originating from the biliary duct, represents a subset of liver cancer. With about 8000 new cases of cholangiocarcinoma diagnosed annually in the U.S., these fall into three categories: intrahepatic, peri-hilar, and extrahepatic cholangiocarcinoma. Arising from the epithelium of the bile duct, intrahepatic cholangiocarcinoma (ICC) is a universally fatal malignancy with very few treatment options. The poor prognosis and lack of molecular targeted therapies highlights ICC as a critical unmet medical need. With advances in sequencing technology, numerous chromosomal translocations have been discovered as drivers in cancer initiation and progression. Particularly in ICC, chromosomal translocations involving Fibroblast Growth Factor Receptor 2 (FGFR2) have been frequently identified, resulting in the creation of oncogenic fusion proteins. At the N-terminus, these fusion proteins share a nearly-identical FGFR2 moiety retaining an intact kinase domain and, at the C-terminus, a dimerization/oligomerization domain provided by different partner genes, including: Periphilin 1 (PPHLN1), Bicaudal family RNA binding protein 1 (BICC1), Adenosylhomocysteinase Like 1 (AHCYL1), and Transforming Acidic Coiled-Coil Containing Protein 3 (TACC3). A number of pre-clinical and clinical trials have shown the effectiveness of FGFR inhibitors in treating FGFR2 fusion-positive ICC patients. However, the efficacy of these inhibitors may be short-lived due to acquired resistance. In this review, we provide an overview of FGFR2 fusions, comparing their structures and mechanism of dimerization, examining the importance of FGFR2 as a partner gene, as well as highlighting the significance of alternative splicing of FGFR2 in these fusion proteins. In addition, we discuss various therapeutic options and their associated potencies in targeting these translocation-induced ICCs.
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Gurmikov BN, Kovalenko YA, Vishnevsky VA, Chzhao AV. Molecular genetic aspects of intrahepatic cholangiocarcinoma: literature review. ADVANCES IN MOLECULAR ONCOLOGY 2019. [DOI: 10.17650/2313-805x-2019-6-1-37-43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- B. N. Gurmikov
- A.V. Vishnevsky National Medical Research Center of Surgery, Ministry of Health of Russia
| | - Yu. A. Kovalenko
- A.V. Vishnevsky National Medical Research Center of Surgery, Ministry of Health of Russia
| | - V. A. Vishnevsky
- A.V. Vishnevsky National Medical Research Center of Surgery, Ministry of Health of Russia
| | - A. V. Chzhao
- A.V. Vishnevsky National Medical Research Center of Surgery, Ministry of Health of Russia
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Targeting c-MET by Tivantinib through synergistic activation of JNK/c-jun pathway in cholangiocarcinoma. Cell Death Dis 2019; 10:231. [PMID: 30850583 PMCID: PMC6408560 DOI: 10.1038/s41419-019-1460-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/17/2019] [Accepted: 02/05/2019] [Indexed: 12/14/2022]
Abstract
Clinical treatment options for human cholangiocarcinoma (CC) are limited. c-MET, a high-affinity receptor for hepatocyte growth factor (HGF), is deregulated in many cancers. Its role in cholangiocarcinogenesis remains unclear. In current study, 23 corresponding tumor- and non-tumor tissues, taken from patients with intrahepatic (iCC) and perihilar cholangiocarcinoma (pCC), who underwent liver resection, were analyzed. The relationship of clinicopathological features and c-MET, as well as c-jun N-terminal kinase (JNK) was evaluated. The anti-tumor effects of Tivantinib, a small-molecule inhibitor with potent activity against the c-MET kinase, was investigated in three human CC cell lines, namely HUCC-T1, TFK-1, and EGI-1. In comparison with the results obtained in non-tumor tissue samples, c-MET was overexpressed in 91.3 % of tumor tissues (p < 0.01). The JNK expression was higher in tumor tissue compared with the corresponding non-tumor tissue sample in 17.4% patients (p < 0.01). The inhibition of aberrant c-MET expression in human CC cell lines was achieved by blocking the phosphorylation of c-MET with Tivantinib. Notable losses in cell viability and colony-forming capability were detected (p < 0.01). Synergistic activation of the JNK/c-jun pathway was demonstrated after Tivantinib treatment. Knockdown of the JNK by siRNA or competitive binding of c-MET receptor by stimulation with HGF-antagonized anti-tumor effects of Tivantinib was observed. Our data suggest that inhibition of c-MET could be a possible alternative approach for the treatment of human CC, for which Tivantinib may an effective inhibitor. The synergistic activation of the JNK/c-jun pathway contributed to the elevated apoptosis in CC cells via treatment with Tivantinib.
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Jang HH, Park SB, Hong JS, Lee HL, Song YH, Kim J, Jung YH, Kim C, Kim DM, Lee SE, Jeong YI, Kang DH. Piperlongumine-Eluting Gastrointestinal Stent Using Reactive Oxygen Species-Sensitive Nanofiber Mats for Inhibition of Cholangiocarcinoma Cells. NANOSCALE RESEARCH LETTERS 2019; 14:58. [PMID: 30778693 PMCID: PMC6379506 DOI: 10.1186/s11671-019-2887-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 01/31/2019] [Indexed: 05/03/2023]
Abstract
BACKGROUND The aim of this study is to fabricate drug-eluting gastrointestinal (GI) stent using reactive oxygen species (ROS)-sensitive nanofiber mats for treatment of cholangiocarcinoma (CCA) cell. A ROS-producing agent, piperlongumine (PL)-incorporated nanofiber mats were investigated for drug-eluting stent (DES) application. METHODS Selenocystamine-conjugated methoxy poly(ethylene glycol) (MePEG) was conjugated with poly(L-lactide) (PLA) to produce block copolymer (LEse block copolymer). Various ratios of poly(ε-caprolactone) (PCL) and LEse block copolymer were dissolved in organic solvent with PL, and then nanofiber mats were fabricated by electro-spinning techniques. RESULTS The higher amount of LEse in the blend of PCL/LEse resulted in the formation of granules while PCL alone showed fine nanofiber structure. Nanofiber mats composed of PCL/LEse polymer blend showed ROS-sensitive drug release, i.e., PL release rate from nanofiber mats was accelerated in the presence of hydrogen peroxide (H2O2) while nanofiber mats of PCL alone have small changes in drug release rate, indicating that PL-incorporated nanofiber membranes have ROS responsiveness. PL itself and PL released from nanofiber mats showed almost similar anticancer activity against various CCA cells. Furthermore, PL released from nanofiber mats properly produced ROS generation and induced apoptosis of CCA cells as well as PL itself. In HuCC-T1 cell-bearing mice, PL-incorporated nanofiber mats showed improvement in anticancer activity. CONCLUSION PL-incorporated ROS-sensitive nanofiber mats were coated onto GI stent and showed improved anticancer activity with ROS responsiveness. We suggested PL-incorporated ROS-sensitive nanofiber mats as a promising candidate for local treatment of CCA cells.
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Affiliation(s)
- Hyung Ha Jang
- School of Medicine, Pusan National University, Yangsan, Gyeongnam 50612 South Korea
| | - Su Bum Park
- Research Institute of Convergence of Biomedical Sciences, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam 50612 South Korea
| | - Jeong Sup Hong
- Division of Animal Care, Yonam College, Cheonan, Chungnam 31005 South Korea
| | - Hye Lim Lee
- Research Institute of Convergence of Biomedical Sciences, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam 50612 South Korea
| | - Yeon Hui Song
- Research Institute of Convergence of Biomedical Sciences, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam 50612 South Korea
| | - Jungsoo Kim
- Research Institute of Convergence of Biomedical Sciences, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam 50612 South Korea
| | - Yun Hye Jung
- Research Institute of Convergence of Biomedical Sciences, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam 50612 South Korea
| | - Chan Kim
- Amotech Co. Ltd, Incheon, Gyeonggi-do South Korea
| | - Doo-Man Kim
- Department of Photonics Engineering, Chonnam National University, Gwangju, 61186 South Korea
| | - Sang Eun Lee
- Research Institute of Convergence of Biomedical Sciences, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam 50612 South Korea
| | - Young-Il Jeong
- Research Institute of Convergence of Biomedical Sciences, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam 50612 South Korea
| | - Dae Hwan Kang
- School of Medicine, Pusan National University, Yangsan, Gyeongnam 50612 South Korea
- Research Institute of Convergence of Biomedical Sciences, Pusan National University Yangsan Hospital, Yangsan, Gyeongnam 50612 South Korea
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Simile MM, Bagella P, Vidili G, Spanu A, Manetti R, Seddaiu MA, Babudieri S, Madeddu G, Serra PA, Altana M, Paliogiannis P. Targeted Therapies in Cholangiocarcinoma: Emerging Evidence from Clinical Trials. ACTA ACUST UNITED AC 2019; 55:medicina55020042. [PMID: 30743998 PMCID: PMC6409688 DOI: 10.3390/medicina55020042] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 12/13/2022]
Abstract
Cholangiocarcinoma (CCA) is a highly-aggressive malignancy arising from the biliary tree, characterized by a steady increase in incidence globally and a high mortality rate. Most CCAs are diagnosed in the advanced and metastatic phases of the disease, due to the paucity of signs and symptoms in the early stages. This fact, along with the poor results of the local and systemic therapies currently employed, is responsible for the poor outcome of CCA patients and strongly supports the need for novel therapeutic agents and strategies. In recent years, the introduction of next-generation sequencing technologies has opened new horizons for a better understanding of the genetic pathophysiology of CCA and, consequently, for the identification and evaluation of new treatments tailored to the molecular features or alterations progressively elucidated. In this review article, we describe the potential targets under investigation and the current molecular therapies employed in biliary tract cancers. In addition, we summarize the main drugs against CCA under evaluation in ongoing trials and describe the preliminary data coming from these pioneering studies.
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Affiliation(s)
- Maria Maddalena Simile
- Department of Medical, Surgical, and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy.
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Zhang Z, Zang M, Wang S, Wang C. Effects of propofol on human cholangiocarcinoma and the associated mechanisms. Exp Ther Med 2018; 17:472-478. [PMID: 30651824 DOI: 10.3892/etm.2018.6908] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/26/2018] [Indexed: 12/17/2022] Open
Abstract
Cholangiocarcinoma (CCA) is the most common type of biliary duct malignancy. Propofol is a fast-acting intravenous anesthetic, which also exerts an anti-cancer effect. The aim of the current study was to explore the effects of propofol on human CCA and the associated mechanisms in vitro. The results indicated that as concentration (0, 1, 5 and 10 µg/ml) of propofol and treatment time (24, 48 and 72 h) increased, the cell inhibition rate of human CCA QBC939 cells increased. Furthermore, treatment with various concentrations of propofol for 48 h resulted in a decrease in migration and invasion capacity in QBC939 cells. Propofol also induced the apoptosis of QBC939 cells and cell cycle arrest in G1 phase. Propofol treatment increased the expression level of Bax and decreased that of Bcl-2. In addition, the effects of propofol on gene expression were evaluated, including Wnt3α, β-catenin, Snail1 and c-myc in the Wnt/β-catenin signaling pathway. It was identified that as the concentration of propofol increased, the expression of these genes decreased. In conclusion, the current results indicate that propofol is a promising therapeutic agent for the treatment of CCA.
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Affiliation(s)
- Zhuo Zhang
- Department of Hepatobiliary and Pancreas Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Mingcui Zang
- Department of Hepatobiliary and Pancreas Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Shuang Wang
- Department of Hepatobiliary and Pancreas Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Chunli Wang
- Department of Hepatobiliary and Pancreas Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Kang Q, Zou H, Zhou L, Liu LX, Cai JB, Xie N, Li WH, Zhang C, Shi WH, Wang LM, Zhang WH, Zhu H, Wang SF, Zhang XW. Role of the overexpression of TRAF4 in predicting the prognosis of intrahepatic cholangiocarcinoma. Int J Oncol 2018; 53:286-296. [PMID: 29749456 DOI: 10.3892/ijo.2018.4383] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/24/2018] [Indexed: 11/05/2022] Open
Abstract
The incidence of intrahepatic cholangiocarcinoma (ICC) is progressively increasing worldwide, and its prognosis remains poor. Accumulating evidence has demonstrated that tumor necrosis factor receptor-associated factor 4 (TRAF4), an adaptor protein, is involved in the carcinogenesis and progression of several tumor types. However, the function of TRAF4 in predicting prognosis, and mediating migration and invasion of ICC remains to be elucidated. In the present study, immunohistochemistry, western blotting and reverse transcription-quantitative polymerase chain reaction assays were used to determine that the expression of TRAF4 at the mRNA and protein levels in ICC tissues was significantly higher compared with that in non‑tumor tissues. The overexpression of TRAF4 was positively correlated with poor differentiation, regional lymphatic metastasis, and high tumor‑node-metastasis staging. Inhibiting the expression of TRAF4 using small interfering RNA decreased the migration and invasion of ICC cells in vitro. In addition, the AKT inhibitor perifosine eliminated the effect of TRAF4 on the invasion and migration of ICC cells in vitro. Clinically, the overexpression of TRAF4 was correlated with shorter overall survival rate and elevated recurrence rate in patients with ICC. Furthermore, patients with ICC with a high expression of TRAF4 and lymphatic metastasis were closely associated with a poorer prognosis compared with the other groups. Multivariate analysis indicated that the overexpression of TRAF4 was an independent prognostic indicator for patients with ICC. It was identified that a high level of TRAF4 facilitated the invasiveness of ICC cells via the activation of AKT signaling. The overexpression of TRAF4 may be a prognostic biomarker and candidate therapeutic target for patients with ICC.
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Affiliation(s)
- Qiang Kang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650106, P.R. China
| | - Hao Zou
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650106, P.R. China
| | - Lei Zhou
- Yunnan Key Laboratory of Stem Cells and Regenerative Medicine, Institute of Molecular and Clinical Medicine, Kunming Medical University, Kunming, Yunnan 650031, P.R. China
| | - Li-Xin Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650106, P.R. China
| | - Jia-Bin Cai
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Nan Xie
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650106, P.R. China
| | - Wei-Hao Li
- Department of Orthodontics, School and Hospital of Stomatology, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Chao Zhang
- School of Public Health, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Wan-Hong Shi
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650106, P.R. China
| | - Lian-Min Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650106, P.R. China
| | - Wei-Han Zhang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650106, P.R. China
| | - Hong Zhu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650106, P.R. China
| | - Shu-Fen Wang
- Yunnan Key Laboratory of Stem Cells and Regenerative Medicine, Institute of Molecular and Clinical Medicine, Kunming Medical University, Kunming, Yunnan 650031, P.R. China
| | - Xiao-Wen Zhang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650106, P.R. China
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Zhang J, Su G, Tang Z, Wang L, Fu W, Zhao S, Ba Y, Bai B, Yue P, Lin Y, Bai Z, Hu J, Meng W, Qiao L, Li X, Xie X. Curcumol Exerts Anticancer Effect in Cholangiocarcinoma Cells via Down-Regulating CDKL3. Front Physiol 2018; 9:234. [PMID: 29615928 PMCID: PMC5870041 DOI: 10.3389/fphys.2018.00234] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/02/2018] [Indexed: 01/03/2023] Open
Abstract
Curcumol is the major component extracted from root of Rhizoma Curcumae. Recent studies have shown that curcumol exerts therapeutic effects against multiple conditions, particularly cancers. However, the therapeutic role and mechanism of curcumol against cholangiocarcinoma cells are still unclear. In our current research, we tested the effect of curcumol in cholangiocarcinoma cells, and using two-dimensional electrophoresis, proteomics and bioinformatics, we identified cyclin-dependent kinase like 3 (CDKL3) as a potential target for curcumol. We have demonstrated that curcumol can evidently suppress growth and migration of cholangiocarcinoma cells. Furthermore, curcumol could significantly block the cell cycle progression of the cholangiocarcinoma cells. These effects could be largely attributed to the inhibition of CDKL3 by curcumol. Further studies have recapitulated the oncogenic role of CDKL3 in that knockdown of CDKL3 by lentiviral mediated transfection of shRNA against CDKL3 also led to a significant inhibition on cell proliferation, migration, invasion, and cell cycle progression. Given the high level of CDKL3 expression in human cholangiocarcinoma tissues and cell lines, we speculated that CDKL3 may constitute a potential biological target for curcumol in cholangiocarcinoma.
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Affiliation(s)
- Jinduo Zhang
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China.,School of Basic Medical Sciences, Institute of Genetics, Lanzhou University, Lanzhou, China.,Gansu Province Institute of Hepatopancreatobiliary, Lanzhou, China.,Gansu Province Key Laboratory Biotherapy and Regenerative Medicine, Lanzhou, China
| | - Gang Su
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,School of Basic Medical Sciences, Institute of Genetics, Lanzhou University, Lanzhou, China
| | - Zengwei Tang
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China.,Gansu Province Institute of Hepatopancreatobiliary, Lanzhou, China.,Gansu Province Key Laboratory Biotherapy and Regenerative Medicine, Lanzhou, China
| | - Li Wang
- School of Basic Medical Sciences, Institute of Genetics, Lanzhou University, Lanzhou, China.,School of Stomatology, Lanzhou University, Lanzhou, China
| | - Wenkang Fu
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China.,Gansu Province Institute of Hepatopancreatobiliary, Lanzhou, China.,Gansu Province Key Laboratory Biotherapy and Regenerative Medicine, Lanzhou, China
| | - Sheng Zhao
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,School of Basic Medical Sciences, Institute of Genetics, Lanzhou University, Lanzhou, China
| | - Yongjiang Ba
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China.,Gansu Province Institute of Hepatopancreatobiliary, Lanzhou, China.,Gansu Province Key Laboratory Biotherapy and Regenerative Medicine, Lanzhou, China
| | - Bing Bai
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China.,Gansu Province Institute of Hepatopancreatobiliary, Lanzhou, China.,Gansu Province Key Laboratory Biotherapy and Regenerative Medicine, Lanzhou, China
| | - Ping Yue
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China.,Gansu Province Institute of Hepatopancreatobiliary, Lanzhou, China.,Gansu Province Key Laboratory Biotherapy and Regenerative Medicine, Lanzhou, China
| | - Yanyan Lin
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China.,Gansu Province Institute of Hepatopancreatobiliary, Lanzhou, China.,Gansu Province Key Laboratory Biotherapy and Regenerative Medicine, Lanzhou, China
| | - Zhongtian Bai
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Gansu Province Institute of Hepatopancreatobiliary, Lanzhou, China.,Gansu Province Key Laboratory Biotherapy and Regenerative Medicine, Lanzhou, China.,The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Jinjing Hu
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Gansu Province Institute of Hepatopancreatobiliary, Lanzhou, China.,Gansu Province Key Laboratory Biotherapy and Regenerative Medicine, Lanzhou, China
| | - Wenbo Meng
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou, China.,School of Basic Medical Sciences, Institute of Genetics, Lanzhou University, Lanzhou, China.,Gansu Province Institute of Hepatopancreatobiliary, Lanzhou, China.,Gansu Province Key Laboratory Biotherapy and Regenerative Medicine, Lanzhou, China
| | - Liang Qiao
- Storr Liver Centre, Westmead Institute for Medical Research, University of Sydney, Westmead, NSW, Australia
| | - Xun Li
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,Gansu Province Institute of Hepatopancreatobiliary, Lanzhou, China.,Gansu Province Key Laboratory Biotherapy and Regenerative Medicine, Lanzhou, China.,The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xiaodong Xie
- The First Clinical Medical College, Lanzhou University, Lanzhou, China.,School of Basic Medical Sciences, Institute of Genetics, Lanzhou University, Lanzhou, China
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Kang Q, Zou H, Yang X, Cai JB, Liu LX, Xie N, Wang LM, Li YH, Zhang XW. Characterization and prognostic significance of mortalin, Bcl-2 and Bax in intrahepatic cholangiocarcinoma. Oncol Lett 2017; 15:2161-2168. [PMID: 29434920 PMCID: PMC5777101 DOI: 10.3892/ol.2017.7570] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/10/2017] [Indexed: 12/28/2022] Open
Abstract
Intrahepatic cholangiocarcinoma (ICC) is an aggressive type of cancer, and its incidence and mortality rates are increasing worldwide. Mortalin is a highly conserved chaperone protein involved in multiple pathological and physiological processes, including anti-apoptosis, carcinogenesis and metastasis. The Bcl-2 family of proteins can be divided into pro-survival and pro-apoptotic members, including B-cell lymphoma 2 (Bcl-2) and Bcl-2-like protein 4 (Bax). The aim of the present study was to investigate the association between mortalin, Bcl-2 and Bax, as well as the prognostic significance of the combined expression of mortalin, Bcl-2 and Bax in ICC. Immunohistochemistry was used to determine the expression of mortalin, Bcl-2 and Bax in 116 ICC samples and to assess the association between expression of 3 markers and clinicopathological features of ICC patients. This revealed that ICC tumor tissues overexpressed mortalin and Bcl-2 and exhibited low expression of Bax in ICC tumor tissues compared with that in corresponding peritumoral samples. According to Pearson's correlation coefficient analysis, high expression of mortalin in ICC was positively correlated with Bcl-2 expression and negatively correlated with Bax expression. Furthermore, multiple linear regression analysis demonstrated that mortalin was positively associated with Bcl-2, but not with Bax, in patients with ICC. Patients with ICC exhibiting high expression of mortalin/Bcl-2 or low expression of Bax were closely associated with a malignant ICC phenotype, a relatively low overall survival rate and a high recurrence rate. Multivariate analysis indicated that mortalin and Bcl-2 were independent prognostic indicators for ICC patients. Meanwhile, the concomitant overexpression of mortalin and Bcl-2 and the low expression of Bax were independent markers for predicting a relatively poor prognosis of ICC. The overexpression of mortalin and Bcl-2 and/or the low expression of Bax are implicated in the anti-apoptotic effect and tumor progression of ICC. Mortalin or Bcl-2, or a combination of mortalin, Bcl-2 and Bax may be used to predict the prognosis of ICC, as well as potential therapeutic targets.
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Affiliation(s)
- Qiang Kang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650105, P.R. China
| | - Hao Zou
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650105, P.R. China
| | - Xuan Yang
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Jia-Bin Cai
- Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Li-Xin Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650105, P.R. China
| | - Nan Xie
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650105, P.R. China.,Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, P.R. China
| | - Lian-Min Wang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650105, P.R. China
| | - Yue-Hua Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650105, P.R. China
| | - Xiao-Wen Zhang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, Kunming Medical University, Kunming, Yunnan 650105, P.R. China
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Kwak TW, Lee HL, Song YH, Kim C, Kim J, Seo SJ, Jeong YI, Kang DH. Vorinostat-eluting poly(DL-lactide-co-glycolide) nanofiber-coated stent for inhibition of cholangiocarcinoma cells. Int J Nanomedicine 2017; 12:7669-7680. [PMID: 29089762 PMCID: PMC5655133 DOI: 10.2147/ijn.s141920] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose The aim of this study was to fabricate a vorinostat (Zolinza™)-eluting nanofiber membrane-coated gastrointestinal (GI) stent and to study its antitumor activity against cholangiocarcinoma (CCA) cells in vitro and in vivo. Methods Vorinostat and poly(DL-lactide-co-glycolide) dissolved in an organic solvent was sprayed onto a GI stent to make a nanofiber-coated stent using an electro-spinning machine. Intact vorinostat and vorinostat released from nanofibers was used to assess anticancer activity in vitro against various CCA cells. The antitumor activity of the vorinostat-eluting nanofiber membrane-coated stent was evaluated using HuCC-T1 bearing mice. Results A vorinostat-incorporated polymer nanofiber membrane was formed on the surface of the GI stent. Vorinostat was continuously released from the nanofiber membrane over 10 days, and its release rate was higher in cell culture media than in phosphate-buffered saline. Released vorinostat showed similar anticancer activity against various CCA cells in vitro compared to that of vorinostat. Like vorinostat, vorinostat released from nanofibers induced acetylation of histone H4 and inhibited histone deacetylases 1⋅3⋅4/5/7 expression in vitro and in vivo. Furthermore, vorinostat nanofibers showed a higher tumor growth inhibition rate in HuCC-T1 bearing mice than vorinostat injections. Conclusion Vorinostat-eluting nanofiber membranes showed significant antitumor activity against CCA cells in vitro and in vivo. We suggest the vorinostat nanofiber-coated stent may be a promising candidate for CCA treatment.
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Affiliation(s)
- Tae Won Kwak
- Medical Convergence Textile Center, Gyeongbuk, Republic of Korea
| | - Hye Lim Lee
- Biomedical Research Institute, Pusan National University Hospital, Pusan, Republic of Korea
| | - Yeon Hui Song
- Biomedical Research Institute, Pusan National University Hospital, Pusan, Republic of Korea
| | - Chan Kim
- Amogreentech Co. Ltd. Gyeonggi-do, Republic of Korea
| | - Jungsoo Kim
- Biomedical Research Institute, Pusan National University Hospital, Pusan, Republic of Korea
| | - Sol-Ji Seo
- Biomedical Research Institute, Pusan National University Hospital, Pusan, Republic of Korea
| | - Young-Il Jeong
- Biomedical Research Institute, Pusan National University Hospital, Pusan, Republic of Korea
| | - Dae Hwan Kang
- Biomedical Research Institute, Pusan National University Hospital, Pusan, Republic of Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Gyeongnam, Republic of Korea
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Impact of adjuvant chemotherapy on survival in patients with intrahepatic cholangiocarcinoma: a multi-institutional analysis. HPB (Oxford) 2017; 19:901-909. [PMID: 28728891 DOI: 10.1016/j.hpb.2017.06.008] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/10/2017] [Accepted: 06/14/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND The benefit of adjuvant chemotherapy for resected intrahepatic cholangiocarcinoma (ICC) is unclear. The aim of the current study was to investigate the impact of adjuvant chemotherapy on survival among patients undergoing resection of ICC using a multi-institutional database. METHODS 1154 ICC patients undergoing curative-intent hepatectomy between 1990 and 2015 were identified from 14 institutions. Cox proportional hazard modeling was used to determine the impact of adjuvant chemotherapy on overall survival (OS). RESULTS Following resection, 347 (30%) patients received adjuvant chemotherapy, most commonly a gemcitabine-based regimen (n = 184, 52%). Patients with T2/T3/T4 disease were more likely to receive adjuvant therapy compared with patients with T1a/T1b disease (OR 2.5, 95%CI 1.89-3.23; P < 0.001). Among patients who did and did not receive adjuvant therapy, patients with T2/T3/T4 tumors had a 5-year OS of 37% (95%CI 28.9-44.4) versus 30% (95%CI 23.8-35.6), respectively (p = 0.006). Similarly patients with N1 disease who received adjuvant chemotherapy tended to have improved 5-year OS (18.3%, 95%CI 9.0-30.1 vs. no adjuvant therapy 12%, 95%CI 3.9-24.4; P = 0.050). CONCLUSIONS While adjuvant chemotherapy did not influence the prognosis of all ICC patients following surgical resection, it was associated with a potential survival benefit in subgroups of patients at increased risk for recurrence, such as those with advanced tumors.
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