, Taek Chung, Dong Kyu Kim, Hyungjin Rhee Intrahepatic cholangiocarcinoma (iCCA) is a heterogeneous bile duct adenocarcinoma with a rising global incidence and a poor prognosis. This review aims to present a comprehensive overview of the most recent radiological research on iCCA, focusing on its histopathologic subclassification and the use of imaging findings to predict prognosis and inform treatment decisions. Histologically, iCCA is subclassified into small duct (SD-iCCA) and large duct (LD-iCCA) types. SD-iCCA typically arises in the peripheral small bile ducts and is often associated with chronic hepatitis or cirrhosis. It presents as a mass-forming lesion with a relatively favorable prognosis. LD-iCCA originates near the hepatic hilum, is linked to chronic bile duct diseases, and exhibits more aggressive behavior and poorer outcomes. Imaging is essential for differentiating these subtypes and assessing prognostic factors like tumor size, multiplicity, vascular invasion, lymph node metastasis, enhancement patterns, and intratumoral fibrosis. Imaging-based prognostic models have demonstrated predictive accuracy comparable to traditional pathological staging systems. Furthermore, imaging findings are instrumental in guiding treatment decisions, including those regarding surgical planning, lymphadenectomy, neoadjuvant therapy, and the selection of targeted therapies based on molecular profiling. Advancements in radiological research have improved our understanding of iCCA heterogeneity, facilitating prognosis prediction and treatment personalization. Imaging findings assist in subclassifying iCCA, predicting outcomes, and informing treatment decisions, thus optimizing patient management. Incorporating imaging-based approaches into clinical practice is crucial for advancing personalized medicine in the treatment of iCCA. However, further high-level evidence from international multicenter prospective studies is required to validate these findings and increase their clinical applicability.
, Il Tae Son, Bo Young Oh Colorectal cancer (CRC) is a globally prevalent and challenging malignancy. Accurate prognosis prediction is essential for optimizing patient care. This comprehensive review discusses the intricate relationships between inflammatory response markers and CRC prognosis. Inflammatory response markers have gained prominence as a prognostic tool. Elevations in the preoperative neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and C-reactive protein-albumin ratio predict a poor prognosis for patients with CRC. A decreased lymphocyte-monocyte ratio is also a poor prognostic factor. A high Glasgow prognostic score and a high modified Glasgow prognostic score are associated with adverse outcomes, including reduced survival. While significant progress has been made, challenges remain in standardizing the clinical application of these inflammatory response markers. Prospective research and further investigations are warranted to refine the prognostic models. Enhanced understanding and utilization of these inflammatory response markers will help advance personalized treatment strategies, refine surveillance protocols, and improve the management of CRC.
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, Hee Jung Park, Chang Mo Moon, Seong-Eun Kim, Hye-Kyung Jung, Ki-Nam Shim, Sung-Ae Jung, Min Sun Cho Cancer stem cells are defined as focal cluster of cells within a tumor that possess the capacity for self-renewal and differentiation into phenotypically heterogeneous cells. Cluster of differentiation 44 (CD44) is considered one of the gastric cancer stem cell markers. We aimed to investigate how the expression of CD44 varies according to the clinicopathologic characteristics in gastric cancer.
For this study, 157 patients who received an operation due to gastric cancer between May 1998 and December 2009 were selected. CD44 immunohistochemistry was reviewed using the semi-quantitative scoring of intensity and proportion. The sum of the intensity and proportion scores was calculated, and a score of 2 or less was deemed ‘CD44-negative’ and 3 or more as ‘CD44-positive.’
Among the final 143 subjects, 69 (48.3%) were CD44 positive. Older age, intestinal type gastric cancer, lymphatic invasion, and lymph node metastasis were significantly correlated with expression of CD44. In the multivariate analysis, older age was the only independent factor associated with CD44 expression (P=0.028). CD44 expression was correlated with overall survival, 5-year survival, and disease-free survival. In the multivariate analysis, older age, male gender, and lymphatic invasion were independent predictors of poor overall survival. Also, older age and lymphatic invasion were significant factors in 5-year survival, and lymphatic invasion was an independent factor of poor disease-free survival.
Older age (≥60 years) was independently associated with CD44 expression in gastric cancer patients. Also, CD44 expression was correlated with poor prognosis in gastric cancer patients.
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, Tae-Jin Song, Young-Jae Kim, Ji Hoe Heo, Kyung-Yul Lee, Young Eun Kim, Min Uk Jang, Soo-Jin Cho, Suk Yun Kang Although there have been several reports that described characteristics for young age stroke, information regarding very young age (18–30 years old) has been limited. We aimed to analyze demographic factors, stroke subtype, and 3-month outcome in acute ischemic stroke patient who have relatively very young age in multicenter stroke registry.
We evaluated all 122 (7.1%) consecutive acute ischemic stroke (within 7 days after symptom onset) patients aged 18 to 30 from 17,144 patients who registered in multicenter prospective stroke registry, 1997 to 2012. Etiology was classified by Trial of Org 10172 in Acute Stroke Treatment criteria. Stroke severity was defined as National Institutes of Health Stroke Scale (NIHSS) and stroke outcome was defined by modified Rankin scale (mRS) at 3 months after index stroke.
The mean age of all included patients was 25.1±3.7 years and 76 patients (62.2%) were male. The median NIHSS at admission was 4. Considering stroke subtype, 37 patients (30.3%) had stroke of other determined etiology (SOD), 37 (30.3%) had undetermined negative evaluation (UN) and 31 (25.4%) had cardioembolism (CE) were frequently noted. After adjusting age, sex and variables which had P<0.1 in univariable analysis (NIHSS and stroke subtype), CE stroke subtype (odds ratio, 4.68; 95% confidence interval, 1.42–15.48; P=0.011) were significantly associated with poor functional outcome (mRS≥3).
In very young age ischemic stroke patients, SOD and UN stroke subtype were most common and CE stroke subtype was independently associated with poor discharge outcome.
, Sun Young Yi Endoscopic Retrograde Cholangiopancreatogrphy (ERCP) and endoscopic sphincterotomy are useful for both diagnosis and treatment of patients with acute gallstone pancreatitis. In this study, we assessed the feasibility of emergency ERCP in patients with all gallstone pancreatitis.
We retrospectively reviewed the medical records of 66 patients, who underwent ERCP with a diagnosis of acute gallstone pancreatitis between July 1994 and December 2002. Obstructive jaundice from gallstones is excluded, because it is a distinct indication of emergency ERCP. Patients were divided into the group A (emergency ERCP group : ERCP was performed within 72 hours after hospitalization, mean 37.0±16.4 hours, range 6-70 hours) and group B (elective ERCP group ; ERCP, over 72 hours after hospitalization, mean 124.0±49.3 hours, range 76-288 hours). Comparisons of the clinical characteristics and incidence of complications were made between these two groups.
There was no significant difference for biochemical measurements, severity of pancreatitis, complications of pancreatitis, characteristics of ampulla, and length of hospital stay between the two groups, Group A had more cases (40.9%) with macroscopic stones on ERCP than group B (24.2%).
Although ERCP was a very useful modality for the diagnosis and treatment of patients having acute gallstone pancreatitis, an emergency ERCP would not be necessary unless there is definite obstructive jaundice.
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