Colorectal cancer is the most prevalent malignant tumor in Japan, with an increasing prevalence worldwide. 1,2 Overall, 20%-25% of these patients show liver metastases at the time of discovery, and 40%-50% develop colorectal liver metastases (CRLM) after primary lesion resection. 3 Hepatic resection is the only treatment that offers the possibility of prolonging life, with a 5-y survival rate of 33%-50%. 4,5 For improving prognosis, prognostic factors after hepatectomy for CRLM are important. Beppu et al reported prognostic prediction using six preoperative factors: synchronous metastases, primary lymph node positive, tumor number, tumor size, extrahepatic metastatic disease at hepatectomy, and preoperative carbohydrate antigen 19-9 level. 6 Recent reports suggest that nutritional factors, independent of tumor staging, such as the neutrophillymphocyte ratio (NLR), Glasgow Prognostic Score (GPS), prognostic nutrient index (PNI), and platelet-lymphocyte ratio (PLR) predict cancer-specific survival in various cancers, including CRLM.

A 56-year-old Japanese female simultaneously developed thrombocytopenia, sicca symptoms, and an elevation of transaminase. Antiphospholipid antibodies were detected in her serum. The presence of anti-SS-A antibodies in the serum and sialectasis, disclosed by sialography, suggested the presence of primary Sjogren's syndrome (SjS). The laboratory data and the biopsy of the liver showed compatible findings with autoimmune hepatitis (AIH). Thrombocytopenia and liver dysfunction satisfactorily responded to corticosteroid. To our knowledge, this is the first reported case of SjS with AIH and antiphospholipid antibody syndrome (APAS). Analysis of serum cytokine levels showed a predominance of ThO-Thl response, which is not compatible with AIH, in this complicated autoimmune state. (Internal Medicine 39: 73-76, 2000)

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Aim The C‐reactive protein (CRP)‐albumin‐lymphocyte (CALLY) index is a novel inflammation‐based biomarker, which has been associated with long‐term outcomes in patients with hepatocellular carcinoma. We aimed to investigate whether the CALLY index can predict the prognosis for distal cholangiocarcinoma after pancreaticoduodenectomy. Methods The study comprised 143 patients who had undergone primary pancreaticoduodenectomy for distal cholangiocarcinoma between 2002 to 2019. The CALLY index was defined as (albumin × lymphocyte)/ (CRP × 10 4 ). We investigated the association of CALLY index with disease‐free survival and overall survival by univariate and multivariate analyses. Results Eighty‐seven (61%) patients had a preoperative CALLY index <3.5. In multivariate analysis, obstructive jaundice drainage ( P < .01), poorly differentiated tumor ( P < .01), and CALLY index<3.5 ( P = .02) were independent predictors of disease‐free survival, while obstructive jaundice drainage ( P < .01), poorly differentiated tumor ( P < .01), and CALLY index <3.5 ( P = .02) were independent predictors of overall survival. Conclusion The CALLY index may be an independent and significant indicator of poor long‐term outcomes in patients with distal cholangiocarcinoma after pancreaticoduodenectomy, suggesting the importance of comprehensive assessment for inflammatory status.