ObjectiveTo summarize the diagnosis and treatment progress of combined hepatocellular-cholangiocarcinoma (cHCC-CCA) in recent years, in order to provide a reference for clinical diagnosis and treatment decision-making. MethodThe recent literature related to the diagnosis and treatment of cHCC-CCA was reviewed. ResultsThere was no specific guideline or consensus on the diagnosis and management of cHCC-CCA. The diagnosis of the cHCC-CCA was challenging by imaging alone, and the tumor markers such as alpha fetoprotein and carbohydrate antigen 19-9 were of particular value in clinical diagnosis, but it was ultimately relied on the pathological examination results. For the patients with early cHCC-CCA, the radical surgery was recommended to undergo if possible, but there was some controversy regarding the efficacy of liver transplantation and the mode of recurrence and metastasis. For the patients with advanced cHCC-CCA, the systemic therapy was being explored further, and some retrospective analyses of small samples suggested that the gemcitabine and platinum-containing chemotherapy regimens might be beneficial. With the better success of immunotherapy and targeted therapies in hepatocellular carcinoma and cholangiocarcinoma, it might provide some experiences for treatment selection of cHCC-CCA. ConclusionscHCC-CCA has a lower incidence rate and stronger heterogeneity. Its diagnosis mainly relies on surgical pathology, and treatment strategy is lack of high-level evidence-based medical evidence and rigorously designed clinical studies are still needed to explore its efficacy and safety in the future.
ObjectiveTo provide a scoping review of the healthcare provider patient-sharing network. MethodsPubMed, EMbase, Scopus, ProQuest, Web of Science Core Collection, ScienceDirect, SAGE, Wiley Online Library, Google Scholar, CNKI and WanFang Data databases were electronically searched to collect studies on patient-sharing network of healthcare providers from inception to July 31, 2021. Two reviewers independently screened literature, extracted data and then Arksey and O 'Malley's scoping review method was used to analyze the study. ResultsA total of 110 studies were included. In which, 70.0% were published in 2016 and later, 78.2% were carried out in the United States, 96.4% used secondary data, and 45.5% adopted social network analysis methods such as exponential random graph model. In terms of network characteristics, 43.6% of the studies adopted the theoretical framework of social network theory, and the network node type was mainly 1-mode, accounting for 87.3%. When constructing the physician patient-sharing networks, 64.5% of the studies had a threshold of 1 patient. We also synthesized existing studies on patient-sharing networks of healthcare providers in the light of factors of networks and related outcomes. ConclusionThe studies of healthcare provider patient-sharing network have potentials to improve clinical practice and health policies. Further studies should consider adopting longitudinal design to validate evidence of study, expanding the scope of study subjects except physicians and enriching the evidence of the relationship between network and health-related outcomes.
ObjectiveTo summarize the experience of the whole process management of hepatocellular carcinoma (HCC) patients with high-risk of recurrence and metastasis based on the multidisciplinary team (MDT) mode, and to improve the clinicians’ understanding of the concept of whole process management, so as to improve the survival rate of patients with HCC. MethodThe clinicopathologic data of a HCC patient with high-risk of recurrence and metastasis admitted to the Division of Liver Surgery, Department of General Surgery, West China Hospital of Sichuan University were retrospectively analyzed. ResultsA 52-year-old male patient was diagnosed with HCC with intrahepatic metastasis (China liver cancer staging Ⅱ b, Barcelona Clinic Liver Cancer stage B) after admission due to “epigastric discomfort for 1+-month and liver occupying for 1+-week”. Through discussion by the MDT mode, the allogeneic liver transplantation was performed after successful downstaging following two conversion therapies. No serious complications occurred after operation, and the patient was discharged on the 23rd day after operation. Up to now, pulmonary bacterial and fungal infections and pulmonary metastases had been found during the postoperative follow-up. After anti-infective therapy and targeted therapy combined with radiotherapy, the patient was significantly relieved, had survived for 34 months after operation, and was still under regular follow-up. ConclusionsFor HCC patients with high-risk of recurrence and metastasis, MDT mode has a good clinical benefit for the whole process management of patient. Through the MDT model, the diagnosis, treatment, and follow-up of HCC are organically integrated, and the patient’ s diagnosis and treatment plans are dynamically adjusted to realize the whole process management of HCC patient, and to raise the survival rate and improve quality of life of HCC patient.