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INTRODUCTION: The prognostic role of the derived neutrophil-to-lymphocyte ratio (dNLR) in human patients with HER2+ breast cancer is not well understood. Here, we aimed to investigate the prognostic significance of dNLR in patients with HER2+ breast cancer undergoing neoadjuvant chemotherapy. METHODS: A total of 310 patients with non-distant metastatic HER2+ breast cancer who had received neoadjuvant chemotherapy in our hospital from May 2006 to November 2013 were retrospectively included in this study. Kaplan-Meier curves were used to assess overall survival (OS) and disease-free survival (DFS). The Cox regression model was used to evaluate the prognostic value of dNLR and Breast Imaging-Reporting and Data System (BI-RADS) classification, as well as other clinicopathological parameters in patients with HER2+ breast cancer treated with neoadjuvant chemotherapy. RESULTS: We found that dNLR prior to treatment was positively correlated with tumor size, tumor stage, lymphovascular invasion, and histological grade (P<0.05). The median OS of patients with high dNLR and low dNLR were 44.2 and 69.9, respectively (P<0.001), and the median DFS of patients with high dNLR and low dNLR were 15.3 and 22.1 months, respectively (P<0.001). Multivariate analysis showed that dNLR was an independent risk factor for OS (HR =1.726; 95% CI: 1.072-2.662; P=0.009) and DFS (HR =1.658; 95% CI: 1.125-2.426; P=0.026). Moreover, increased BI-RADS classification independently predicted short OS (HR =1.609; 95% CI: 1.216-2.351; P=0.015) and DFS (HR =1.925; 95% CI: 1.526-2.635; P=0.021). CONCLUSION: dNLR prior to treatment and BI-RADS classification are independent prognostic factors in patients with HER2+ breast cancer receiving neoadjuvant chemotherapy.

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AIM: To assess the application of the Kasai procedure in the surgical management of hilar bile duct strictures. METHODS: Ten consecutive patients between 2005 and 2011 with hilar bile duct strictures who underwent the Kasai procedure were retrospectively analyzed. Kasai portoenterostomy with the placement of biliary stents was performed in all patients. Clinical characteristics, postoperative complications, and long-term outcomes were analyzed. All patients were followed up for 2-60 mo postoperatively. RESULTS: Patients were classified according to the Bismuth classification of biliary strictures. There were two Bismuth III and eight Bismuth IV lesions. Six lesions were benign and four were malignant. Of the benign lesions, three were due to post-cholecystectomy injury, one to trauma, one to inflammation, and one to inflammatory pseudotumor. Of the malignant lesions, four were due to hilar cholangiocarcinoma. All patients underwent Kasai portoenterostomy with the placement of biliary stents. There were no perioperative deaths. One patient experienced anastomotic leak and was managed conservatively. No other complications occurred perioperatively. During the follow-up period, all patients reported a good quality of life. CONCLUSION: The Kasai procedure combined with biliary stents may be appropriate for patients with hilar biliary stricture that cannot be managed by standard surgical methods.

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Primary hepatic carcinoid tumor is rare and poses a challenge for diagnosis and management. We presented a case of primary hepatic carcinoid tumor in a 53-year-old female with a complaint of right upper abdominal pain. Computer tomography scans revealed a hypervascular mass in segment 4 of the liver. An ultrasonography-guided biopsy showed a carcinoid tumor. No other lesions were found by the radiological investigations. Surgery resection was performed and histopathological examination revealed a primary hepatic carcinoid tumor. Three years later, recurrence was found and transcatheter arterial chemoembolization was performed. After transcatheter arterial chemoembolization, the patient has been free of symptom and had no radiological disease progression for over 6 months. Surgical resection combination with transcatheter arterial chemoembolization is effective to offer excellent palliation.

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