The Study On The Correlation Between Preablation Lymphocyte Subset Level In Hepatocellular Carcinoma Patients And The Tumor Progress And Tumor Size After Microwave Ablation

Background:Hepatocellular carcinoma is the sixth most common cancer in the world.Common methods of treatment for HCC include transplantation,ablation,TACE,resection and target drug treatment.Ultrasound-guided percutaneous microwave ablation(MWA)is one of the treatment methods for small HCC,its safety and effectiveness have been widely recognized.However,tumor progression after ablation remains a difficult and urgent problem to be solved after HCC treatment.A large number of literatures have supported that the tumor progression of liver cancer is related to the body's own immune status.The internationally accepted method of immune evaluation now evaluates the patient's own immune status through the detection of lymphocyte subsets.Purpose:1)Analyze the correlation factors of tumor progression in HCC patients by analyzing of preablation lymphocyte subsets detection results in HCC patients who have been treated with MWA.2)Analyze the preablation lymphocyte subsets difference between patients with different sized tumor by classification of HCC patients who have been treated with MWA.Method:Inclusion conditions:maximum diameter of single lesion? 8cm,total number of intrahepatic lesions?3 and maximum lesion diameter?3 cm,Child-pugh grade A or B,pathologically confirmed for HCC and lymphocyte subsets detection.1)523 cases of HCC patients who met the conditions of participation and have received microwave ablation from Feb.2005 to Jun.2017 were chosen for this study.According to the six-month follow-up,the patients are divided into:Group with tumor progression,group without tumor progression,group with local recurrence,group with intrahepatic metastasis and group with distant metastasis.Analyze the relationship between preoperative lymphocyte subsets and tumor progression in patients.2)According to their tumor size,the patients are divided into:The maximum diameter of tumor shall be less than 3 cm;the maximum diameter of tumor shall be in the range of 3cm-5cm;the maximum diameter of tumor shall be larger than 5cm;analyze the difference between preablation lymphocyte subsets in the patients with different grades.Result:1)All patients met follow-up time>6 months,there were 374 cases without tumor progression and 149 cases had tumor progression after microwave ablation.among which 11 patients have local recurrence,121 cases with intrahepatic metastasis,2 cases appear distant metastases,7 cases with intrahepatic metastasis and local recurrence,0 case with local recurrence and extrahepatic metastasis,6 cases with intrahepatic metastasis and extrahepatic metastasis,and 2 cases with local recurrence and intrahepatic and metastasis.Through univariate and multivariate analysis,it is found that the proportion of CD 19+significantly correlates with the tumor progression after treatment(P=0.02).The analysis of single factor analysis shows that the proportion of preoperative NKT and CD4-CD25-CD29-correlate with local recurrence(P=0.034,P=0.012).The analysis of multivariate shows that CD3+CD4-CD8+ ratio is correlated with intrahepatic metastasis within half a year after treatment(P<0.021).2)Group by tumor size,there were 384 cases with the maximum diameter of tumor less than 3cm;114 cases with the maximum diameter of tumor from 3cm to 5cm;And 25 cases with the maximum size of the tumor more than 5cm.It is found that the ratio of T-reg,CD4+CD25+CD29+ is different when the tumor maximal diameter is less than 3cm and more than 5cm(P=0.025,P=0.027).Conclusions:1)CD19+?CD4-CD25-CD29-,and NTK were protective factors for tumor progression after MWA of HCC.CD3+CD4-CD8+ is a risk factor for tumor progression after MWA of HCC.2)The proportion of T-reg and CD4+CD25+CD29+in patients with large HCC is significantly higher than that of patients with small HCC,indicating that immunosuppression is more pronounced in large tumors than in small tumors.