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Background Hepatocellular carcinoma has a high recurrence rate even after curative surgery, and hepatocellular carcinoma risk–predictive biomarkers will enable identification of patients who most need close monitoring and cancer-preventive intervention. Hepatocellular carcinoma has 2 different recurrence patterns—a multicentric recurrence and an intrahepatic metastasis. We have reported that the molecular gene signature from the gene expression of adjacent liver can be used to predict multicentric recurrence of hepatocellular carcinoma, but the signature to predict recurrence from intrahepatic metastasis has not been established. We aimed to identify the recurrence from intrahepatic metastasis gene signature from the gene expression of tumor to predict recurrence from intrahepatic metastasis. Methods The intrahepatic metastasis-risk signature was created based on the exhaustive analysis using a microarray transcriptome database of hepatocellular carcinoma. The intrahepatic metastasis-risk signature was measured in a cohort of 80 hepatocellular carcinoma patients, and the correlation with hepatocellular carcinoma recurrence and overall survival and each gene signature were analyzed and validated. Results The gene signature assay classified the patients into high- (n = 20), intermediate- (n = 40), and low-risk (n = 20) groups. The high-risk prediction was independently associated with higher early hepatocellular carcinoma recurrence (hazard ratio = 3.7, P = .03) in multivariable modeling adjusted by tumor size, tumor number, and microvascular invasion. Gene set enrichment analysis demonstrates that the gene sets associated with “cell cycle” or “histone modulation” are highly enriched in the high intrahepatic metastasis gene signature group Conclusion The intrahepatic metastasis gene signature predicts early recurrence and is associated with malignant potential related to the promoted cell cycle.

Background Patients' prognoses have been predicted by the preoperative inflammation-based score, but predicting a patient's risk for operative load remains challenging. This study investigates the usefulness of the postoperative C-reactive protein/albumin (CRP/Alb) ratio in patients with pancreatic ductal adenocarcinoma (PDAC). Methods This study retrospectively assessed 142 patients who underwent pancreatic resection for PDAC between 2004 and 2014. The time at which perioperative CRP/Alb ratio most influences the prognosis was identified, and the correlations among the perioperative CRP/Alb ratio, clinicopathological factors, and patient outcomes were investigated. Results Among the perioperative CRP/Alb ratios, only a high CRP/Alb ratio at postoperative day 14 (POD14) was significantly associated with shorter overall survival (OS) and relapse-free survival (RFS). High CRP/Alb ratio at POD 14 was related to high BMI, large amount of intraoperative bleeding, and the presence of complications. Finally, high CRP/Alb at POD14 was an independent prognostic factor of poor OS and RFS. Conclusions The CRP/Alb ratio at POD14 is a useful predictive marker of surgical invasion, biological reaction, and prognosis in PDAC patients.

Graphical abstract, Highlights • A rare case of colon cancer metastasis mimicking IPNB at the extra-hepatic bile duct. • Immunohistochemical staining of cytokeratin was useful to identify the primary site. • There may be an incidental metastatic route via the bile stream from liver metastases., Introduction An accurate diagnosis of the primary cancer in cases with metastatic lesions is quite important because misdiagnosis may lead to the selection of incorrect adjuvant therapy and worse long-term outcomes after surgery. The metastatic sites associated with the dissemination of colon cancer are well known and normally predictable, which includes the lymphatic, haematogenous, or peritoneal regions, while other locations are quite rare. Presentation of case In this report, we present a case of colon cancer with an unusual metastatic pattern mimicking an intraductal papillary neoplasm of the bile duct (IPNB) present in the extra-hepatic bile duct with a cytokeratin (CK)-7–negative and CK-20–positive profile (intestinal type). Discussion In the case of this patient who had a history of colon cancer, immunohistochemical staining for the CKs was useful for distinguishing between primary IPNB and colon cancer metastases. We suspect that the metastatic pattern of this case of colon cancer that mimicked IPNB at the extra-hepatic bile duct developed incidentally via the bile stream. Conclusion This is a rare case of colon cancer metastasis mimicking IPNB at the extra-hepatic bile duct. Our findings also suggest that there may be an incidental 4th metastatic route via the bile stream.