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// Yan-Fang Xing 1, 2, 3, * , Jin-Xiang Lin 4, * , Xing Li 4, * , Qu Lin 4, * , Xiao-Kun Ma 4, * , Jie Chen 4 , Dong-Hao Wu 4 , Li Wei 4 , Liang-Hong Yin 1, 2 , Xiang-Yuan Wu 4 1 Department of Nephrology, First Affiliated Hospital of Jinan University, Guangzhou 510630, People’s Republic of China 2 School of Medicine, Jinan University, Guangzhou 510632, People’s Republic of China 3 Department of Nephrology, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, People’s Republic of China 4 Department of Medical Oncology, Guangdong Key Laboratory of Liver Disease Research, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, People’s Republic of China * These authors contributed equally to this work Correspondence to: Liang-Hong Yin, email: 13725251458@126.com Xiang-Yuan Wu, email: wuxiangy@mail.sysu.edu.cn Keywords: advance directive, medical decision making, cancer, patients’ preference Received: February 08, 2017 Accepted: March 21, 2017 Published: April 28, 2017 ABSTRACT Background: Advance directives are a sensitive issue among traditional Chinese people, who usually refrain from mentioning this topic until it is imperative. Medical decisions for cancer patients are made by their families, and these decisions might violate patients’ personal will. Objectives: This study aimed to examine the acceptance of advance directives among Chinese cancer patients and their families and patient participation in this procedure and, finally, to analyze the moral risk involved. Results: While 246 patients and their family members refused official discussion of an advance directive, the remaining 166 patients and their families accepted the concept of an advance directive and signed a document agreeing to give up invasive treatment when the anti-cancer treatment was terminated. Of these, only 24 patients participated in the decision making. For 101 patients, anti-cancer therapy was ended prematurely with as many as 37 patients not told about their potential loss of health interests. Materials and Methods: Participants were 412 adult cancer patients from 9 leading hospitals across China. An advance directive was introduced to the main decision makers for each patient; if they wished to sign it, the advance directive would be systematically discussed. A questionnaire was given to the oncologists in charge of each patient to evaluate the interaction between families and patients, patients’ awareness of their disease, and participation in an advance directive. Conclusions: Advance directives were not widely accepted among Chinese cancer patients unless anti-cancer therapy was terminated. Most cancer patients were excluded from the discussion of an advance directive.

// Xing Li 1, 2, 3 , Yan-Fang Xing 4 , Ai-Hua Lei 1, 2 , Qiang Xiao 1, 2 , Zhi-Huan Lin 3 , Ying-Fen Hong 3 , Xiang-Yuan Wu 3 , Jie Zhou 1, 2 1 Program in Immunology, Affiliated Guangzhou Women and Children’s Medical Center, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China 2 Institute of Human Virology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China 3 Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China 4 Department of Nephrology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China Correspondence to: Xiang-Yuan Wu, email: wuxiangy@mail.sysu.edu.cn Jie Zhou, email: zhouj72@mail.sysu.edu.cn Keywords: neutrophil counts, hepatocellular carcinoma, patient selection, prognosis, myeloid derived suppressor cell Received: October 07, 2016 Accepted: February 06, 2017 Published: February 17, 2017 ABSTRACT Myeloid Derived Suppressor Cell (MDSC) has been raised to be a novel target for multiple cancers. However, target agents on MDSC have not display promising efficacy. One of the critical reasons shall be less optimal patient selection. In the present study, we aimed to identify clinical parameters relevant to MDSC level in hepatocellular carcinoma (HCC) patients for future MDSC targeted therapy. In the present study, a series of 55 HCC patients (testing group) and 20 healthy donors were analyzed investigating frequencies of MDSC in peripheral blood mononuclear cells (PBMC). As a result, we found that MDSC level was increased in HCC patients compared to healthy donors (10.33% vs 1.54%, p < 0.0001). The monocytes (r 2 = 0.2875, p < 0.0001), neutrophils (r 2 = 0.3630, p < 0.0001) and platelet counts (r 2 = 0.0828, p = 0.0331) in circulation was positively associated with MDSC level. Then, the prognostic value of the above predictors was determined in a retrospective database of 255 HCC patients (validation group). The baseline characteristics of testing and validation group were similar. Multivariate analysis by Cox regression revealed that neutrophil count was an independent predictor for overall survival (OS) ( p = 0.000, HR 1.065, 95% CI 1.028–1.103), with the rest parameters failed to reach a significant result. In summary, the present study firstly identified blood neutrophil counts was a predictor of MDSC level in PBMC for HCC patients. And, patients with higher neutrophil count level might be the optimal patient subgroup for MDSC targeted therapy.

// Dan-Yun Ruan 1, * , Ze-Xiao Lin 1, * , Tian-Tian Wang 1, * , Hui Zhao 2 , Dong-Hao Wu 1 , Jie Chen 1 , Min Dong 1 , Qu Lin 1 , Xiang-Yuan Wu 1 , Yang Li 2 1 Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangdong, China 2 Department of Liver Surgery, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China * These authors contributed equally to this work Correspondence to: Yang Li, email: Liyang840920@hotmail.com Xiang-Yuan Wu, email: Wuxiangy@mail.sysu.edu.cn Keywords: hepatocellular carcinoma, Barcelona clinic liver cancer stage, resection, nomogram, survival Received: April 10, 2016 Accepted: August 10, 2016 Published: August 17, 2016 ABSTRACT Background and Aims: This retrospective cohort study developed a prognostic nomogram to predict the survival of hepatocellular carcinoma (HCC) patients diagnosed as beyond Barcelona clinic liver cancer stage A1 after resection and evaluated the possibility of using the nomogram as a treatment algorithm reference. Results: The predictors included in the nomogram were total tumour volume, Child-Turcotte-Pugh class, plasma fibrinogen and portal vein tumour thrombus. Patients diagnosed as beyond A1 were stratified into low-, medium- and high-risk groups using nomogram scores of 0 and 51 with the total points of 225. Patients within A1 exhibited similar recurrence-free survival (RFS) and overall survival (OS) rates compared with the low-risk group. Patients in the medium-risk group exhibited a similar OS but a worse RFS rates compared with patients within A1. The high-risk group was associated with worse RFS and OS rates compared with the patients within A1 (3-year RFS rates, 27.0% vs. 60.3%, P < 0.001; 3-year OS rates, 49.2% vs. 83.1%, P < 0.001). Methods: A total of 352 HCC patients undergoing curative resection from September 2003 to December 2012 were included to develop a nomogram to predict overall survival after resection. Univariate and multivariate survival analysis were used to identify prognostic factors. A visually orientated nomogram was constructed using a Cox proportional hazards model. Conclusions: This user-friendly nomogram offers an individualized preoperative recurrence risk estimation and stratification for HCC patients beyond A1 undergoing resection. Resection should be considered the first-line treatment for low-risk patients.

// Xiu-Rong Cai 1, 2, * , Xing Li 1, 2, * , Jin-Xiang Lin 1 , Tian-Tian Wang 1, 2 , Min Dong 1, 2 , Zhan-Hong Chen 1, 2 , Chang-Chang Jia 2, 3 , Ying-Fen Hong 1, 2 , Qu Lin 1, 2 and Xiang-Yuan Wu 1, 2 1 Department of Medical Oncology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, People’s Republic of China 2 Guangdong provincial Key Laboratory of Liver Disease Research, Guangzhou 510630, People’s Republic of China 3 Cell-gene Therapy Translational Medicine Research Center, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, People’s Republic of China * These authors have contributed equally to this work Correspondence to: Xiang-Yuan Wu, email: wuxiangy@mail.sysu.edu.cn Qu Lin, email: linqu@mail.sysu.edu.cn Keywords: cytokine induced killer cell, liver cancer, adoptive cells therapy, immunotherapy, meta-analysis Received: June 13, 2016 Accepted: November 12, 2016 Published: February 17, 2017 ABSTRACT Background: High recurrence rate after curative treatment is the major problem for hepatocellular carcinoma (HCC). Cytokine-induced killer cells (CIKs) therapy was extensively studied among HCC patients. However, the value of CIKs therapy was controversial. A meta-analysis was performed to investigate the efficacy of adjuvant CIKs after invasive treatments among HCC patients. Methods: We searched online for literatures studying sequential CIKs therapy for HCC patients. Recurrence-free survival (RFS), progress-free survival (PFS) and overall survival (OS) were set as the main endpoints. Both overall and subgroup analysis were accomplished. Results: A total of 12 clinical trials with 1,387 patients were included. The pooled analysis showed a significant improvement of RFS, PFS and OS in CIK group (HR 0.56, 95% CI 0.47-0.67, p