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Jin-Kai Feng,1,* Ju-Xian Sun,1,* Zong-Han Liu,1,* Jing-Wen Gu,2,* Zhen-Hua Chen,3 Chang Liu,1 Wei-Xing Guo,1 Jie Shi,1 Shu-Qun Cheng1 1Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, People’s Republic of China; 2College of Basic Medical Sciences, Second Military Medical University, Shanghai, People’s Republic of China; 3Department of General Surgery, Zhejiang Provincial Armed Police Corps Hospital, Hangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shu-Qun ChengDepartment of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, People’s Republic of ChinaTel +86 21- 81875251Fax +86 21- 65562400Email chengshuqun@aliyun.comBackground: The occurrence of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT) is rare. The aim of the study was to evaluate the effectiveness and safety of transarterial chemoembolization (TACE) for patients with unresectable HCC with BDTT.Methods: This retrospective study was conducted on newly diagnosed HCC and BDTT patients who were initially treated with TACE or conservative management (CM) from 2009 to 2018. Survival outcomes of patients treated with TACE were compared with those of patients given CM. Multivariate analyses were performed to identify independent prognostic factors related to survival.Results: Out of 100 patients included in this study, 40 patients underwent TACE, while the remaining 60 received CM. The median survival time of the TACE group was 8.0 months longer than that of the CM group (13.0 versus 5.0 months, P < 0.001). The 6-, 12-, 18-, 24-month overall survival (OS) rates were 90.0%, 52.5%, 22.5%, and 12.5%, respectively, for the TACE group compared with 26.7%, 8.3%, 5.0%, and 3.3%, respectively, for the CM group. Multivariate analyses showed that treatment allocation (hazard ratio [HR], 0.421; 95% confidence interval [CI], 0.243– 0.730; P = 0.002), Child–Pugh status (HR, 2.529; 95% CI, 1.300– 4.920; P = 0.006) and total bilirubin level (HR, 1.007; 95% CI, 1.004– 1.009; P < 0.001) on first admission were independent predictors of OS. There was no procedure-related mortality within one month after TACE treatment.Conclusion: TACE is a safe and effective treatment method that may improve the OS of patients with unresectable HCC with BDTT.Keywords: hepatocellular carcinoma, bile duct tumor thrombus, transarterial chemoembolization, conservative management, overall survival

Jin-Kai Feng, Ju-Xian Sun, Zong-Han Liu, Shu-Qun Cheng Department of Hepatic Surgery VI, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 200433, People’s Republic of ChinaCorrespondence: Shu-Qun ChengEastern Hepatobiliary Surgery Hospital, Second Military Medical University, 225 Changhai Road, Shanghai, 200433, People’s Republic of ChinaTel +86 21-81875251Fax +86 21-65562400Email chengshuqun@aliyun.com Dear editorWe read with great interest the recently published article in Cancer Management and Research by Yang et al, 1 in which they conducted a retrospective study to compare the long-term prognosis between hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) and those with bile duct tumor thrombus (BDTT). The authors reported that HCC patients with BDTT had worse overall survival (OS) and a higher tumor recurrence rate compared to patients with PVTT. This article, with its novelty and clinical implication, adds to the current knowledge and provides the rationale for further study to assess the prognostic differences among HCC patients with distinct types of tumor thrombus. However, we would like to raise the following concerns.First, the number of patients in this study is too small to draw a conclusive result regarding whether the prognosis of BDTT patients is inferior or superior to that of PVTT patients. Sufficient sample size is a critical factor to guarantee the validity and credibility of scientific reports. Therefore, we suggest the authors enlarge the sample size. View the original paper by Yang and colleaguesA Response to Letter has been published for this article.

Xiaowan Chen,1,* Junhua Zhao,1,* Ailin Li,1,2 Peng Gao,1 Jingxu Sun,1 Yongxi Song,1 Jingjing Liu,1 Ping Chen,1 Zhenning Wang11Department of Surgical Oncology and General Surgery, 2Department of Radiation Oncology, First Hospital of China Medical University, Shenyang, People’s Republic of China*These authors contributed equally to this workBackground: The prognostic significance of claudin 4 (CLDN4) in patients with gastric cancer (GC) is controversial. This meta-analysis aims to assess the correlation between CLDN4 expression and clinicopathological characteristics and assess the prognostic significance of CLDN4 in GC.Methods: We searched the PubMed and Embase databases. We performed the meta-analysis with odds ratio (OR), hazard ratio (HR), and 95% confidence interval (CI) as effect values.Results: Fourteen studies containing 2,106 patients with GC were analyzed. The overall analysis showed that CLDN4 expression was associated with increasing pT category, tumor size, and lymph node metastasis in patients with GC (pT3–T4 vs pT1–T2: OR =1.56, 95% CI =1.13–2.16; P

Jingxu Sun,1,* Yongxi Song,1,* Zhenning Wang,1 Guoli Wang,2 Peng Gao,1 Xiaowan Chen,1 Zhaohua Gao,1 Huimian Xu1 1Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang, People’s Republic of China; 2Department of Biochemistry and Molecular Biology, China Medical University, Shenyang, People’s Republic of China *These authors contributed equally to this work Background: MicroRNAs are associated with tumor genesis and progression in various carcinomas. MicroRNA-148a (miR-148a) was reported to have low expression in gastrointestinal cancers, and might be regulated by promoter region DNA methylation. Methods: Bisulfite-modified sequencing was used to determine the promoter region DNA methylation status of human gastrointestinal cancer cell lines. Expression levels of miR-148a in cell lines treated with 5-aza-2′-deoxycytidine were determined by quantitative real-time polymerase chain reaction. Total DNA was extracted from the tissues of 64 patients with gastric cancer and 51 patients with colorectal cancer. Methylation status was determined by methylation-specific polymerase chain reaction. All statistical analyses were performed with SPSS 17.0 software. Results: The promoter regions of genes in human gastrointestinal cancer cell lines were all hypermethylated, except for HT-29, and the expression of miR-148a tended to be higher than in controls after treatment with 5-aza-2′-deoxycytidine. The methylation-specific polymerase chain reaction results showed that 56.25% of gastric cancer tissues and 19.61% of colorectal cancer tissues were hypermethylated. A strong correlation was found between the expression of miR-148a and the methylation status of promoter regions (P