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Tian-Ming Gao,1,&ast; Sheng-Jie Jin,1,&ast; Fang Fang,2,&ast; Jian-Jun Qian,1 Chi Zhang,1 Bao-Huan Zhou,1 Dou-Sheng Bai,1 Guo-Qing Jiang1 1Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, 225001, People’s Republic of China; 2Department of Gastrointestinal Surgery, Clinical Medical College, Yangzhou University, Yangzhou, 225001, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guo-Qing Jiang; Dou-Sheng Bai, Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, 98 West Nantong Road, Yangzhou, 225000, People’s Republic of China, Email jgqing2003@hotmail.com; bdsno1@hotmail.comPurpose: Although laparoscopic splenectomy and azygoportal disconnection (LSD) can significantly decrease portal vein pressure and even the incidence of hepatocellular carcinoma (HCC) in patients with cirrhotic portal hypertension (CPH), postoperative HCC inevitably occurs in certain patients. The purpose of this study was to seek a novel preoperative non-invasive predictive indicator to predict the occurrence of postoperative HCC.Patients and Methods: From April 2012 to April 2022, we collected clinical data of 178 hepatitis B virus (HBV)-related CPH patients. Based on inverse treatment probability weighting, candidate variables for predicting postoperative HCC were determined by means analysis. Then, a novel preoperative non-invasive prediction indicator (ie, type IV collagen-alpha fetoprotein-fibrosis-4 score [IVAF-FIB-4]) was established based on candidate variables, and its predictive ability was explored.Results: Postoperative HCC occurred in 9 (5.1%) patients. Correlation analyses showed that the IVAF-FIB-4 had a significant positive correlation with HCC (r = 0.835, P < 0.001). IVAF-FIB-4 showed a high accuracy (the area under the receiver operating characteristic curve: 0.939, 95% confidence interval [CI]: 0.818– 1.000; sensitivity: 88.9%; specificity: 93.5%). At the end of follow-up, the incidence density of HCC in patients with IVAF-FIB-4 (1) was significant higher than that in patients with IVAF-FIB-4 (0) (138.1/1000 vs 1.1/1000 person-years; rate ratio: 130.475, 95% CI: 16.318– 1043.227). In logistic regression, IVAF-FIB-4 was an independent risk factor for HCC (odds ratio: 668.000, 95% CI: 53.895– 8279.541; P < 0.001).Conclusion: IVAF-FIB-4 is a novel preoperative noninvasive predictive indicator for predicting postoperative HCC in HBV-related CPH patients after LSD, with satisfactory predictive ability.Keywords: liver fibrotic markers, splenectomy, azygoportal disconnection, hepatocellular carcinoma, risk

Jin-Yong Lin,1,2,* Dou-Sheng Bai,1,* Bao-Huan Zhou,1,2,* Ping Chen,1 Jian-Jun Qian,1 Sheng-Jie Jin,1 Guo-Qing Jiang1 1Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China; 2Department of Hepatobiliary Surgery, The Second Clinical College, Dalian Medical University, Dalian, China *These authors contributed equally to this work Background: Although the prognostic implications of negative lymph nodes (NLNs) has been reported for a variety of tumors, little information has been published about the NLNs in gallbladder cancer (GBC).Patients and methods: In this study, clinicopathological characteristics and survival times of patients who had undergone surgery for GBC were collected from the Surveillance, Epidemiology, and End Results Program-registered TNM stage database and analyzed. Univariate and multivariate Cox proportional hazards models were used to identify the predictors of survival.Results: It was found that a cutoff of one to two NLNs is optimal when assessing the association with survival, survival rates being consistently better with two or more NLNs than with fewer than two. This optimal cutoff value of 2 was identified as an independent prognostic factor by univariate and multivariate analyses (all P