Aims:  Combined hepatocellular cholangiocarcinoma (CHC) is a rare form of primary liver cancer, showing a mixture of hepatocellular and biliary features. Data suggest that most CHC arise from hepatic progenitor cells (HPCs). The aim was to investigate the origin of CHC.Methods and results:  Twelve cases of CHC were studied by immunohistochemistry for hepatocytic (hepPar1, α‐fetoprotein), cholangiocytic cytokeratin [(CK) 7, CK19], hepatic progenitor cell (OV‐6), haematopoietic stem cell (c‐kit, CD34), as well as CD45 and chromogranin‐A markers. The combination of double‐fluorescence immunostaining consisted of HepPar1 with CK19, and c‐kit with OV‐6. All 12 cases demonstrated more or less transitional areas, with strands/trabeculae of small, uniform, oval‐shaped cells including scant cytoplasm and hyperchromatic nuclei embedded within a thick, desmoplastic stroma; however, two cases were found to consist entirely of such transitional areas. Simultaneous co‐expression of hepPar1 and CK7, or CK19, was demonstrated in 10/12 (83.3%) cases of CHC. c‐kit expression was noted in 10/12 (83.3%) cases, of which 7/10 (70%) showed co‐expression of OV‐6.Conclusions:  The results suggest that CHC are of HPC origin, supporting the concept that human hepatocarcinogenesis may originate from the transformation of HPCs.

Anthropometric measures could predict the new onset of diabetes mellitus (DM). Recently, a new anthropometric measure (a body shape index, ABSI) was developed, and ABSI could predict premature mortality, even better than WC and BMI. The main aims of the study were to assess the DM predictive power of ABSI based on the follow-up data over 15 years collected from a general Chinese population. The data were collected in 1992 and then again in 2007 from the same group of 711 individuals. Because 24 of them were diagnosed with DM in 1992, our analysis was eventually based on the usable data collected from the remaining 687 individuals (male: 58.1%). ABSI was defined as WC/(BMI^2/3height^1/2), expressing WC and height in m. After adjusting for confounders, increasing the population ABSI by one standard deviation would result in an increased HR of 41% (95%CI: 12%–77%), compared to 73% (95%CI: 37%–118%) for BMI and 96% (95%CI: 53%–150%) for WC. WC had the best discriminatory power for DM (AROC: 0.701, 95%CI: 0.641–0.760), followed by BMI (AROC: 0.668, 95%CI: 0.601–0.734) and ABSI (AROC: 0.647, 95%CI: 0.581–0.713). ABSI could predict the new onset of DM in the Chinese population independently. Since the confidence intervals for the HR coefficients and AROCs overlapped, the predictive ability of ABSI for DM was not better than WC and BMI. The three measures had similar predictive abilities for DM. Further studies about ethnic specificities of ABSI are needed and warranted.

Background: The aim of this study was to compare the outcome after simultaneous hepatectomy and splenectomy with that after hepatectomy alone for hepatocellular carcinoma with associated hypersplenism. Methods: Two hundred and four patients with hepatocellular carcinoma and cirrhotic hypersplenism were divided non-randomly into two groups. Ninety-four underwent simultaneous hepatectomy and splenectomy and 110 underwent hepatectomy alone. White blood cell (WBC) and platelet counts, total serum bilirubin levels, immune function, incidence of complications and 5-year survival rates in the two groups were compared. Results: WBC and platelet counts, distribution of T cell subsets, and levels of bilirubin, interferon γ and interleukin 2 were different between the two groups after operation. All patients who underwent hepatectomy and splenectomy but only 15·5 per cent of those who had hepatectomy alone completed adjuvant chemotherapy. The 5-year tumour-free survival rate was significantly higher after hepatectomy and splenectomy than after hepatectomy alone (37 versus 27·3 per cent; P = 0·003), although overall survival rates were similar. Conclusion: Simultaneous hepatectomy and splenectomy was associated with improved 5-year tumour-free survival in patients with hepatocellular carcinoma and hypersplenism.