ABSTRACT
Objective:To identify the risk factors for survival prognosis of patients with early-stage hepatocellular carcinoma (HCC) after ultrasound-guided percutaneous microwave ablation (US-PMMA), and to compare the overall survival (OS), cancer specific survival (CSS) and disease-free survival (DFS) between different early-stage HCC patients.Methods:A total of 1 563 patients with early-stage hepatocellular carcinoma (HCC) who underwent MWA in the interventional ultrasound department of the Chiese PLA General Hospital from January 2002 to December 2017 were retrospectively analyzed. Propensity score matching (PSM) balanced the baseline parameters between the elderly group (≥60 years) and the young group (<60 years). Multivariate Cox regression analysis was used to identify the risk factors of OS, CSS and DFS. OS, CSS and DFS probabilities for different patients stratified by respective predictors were calculated with Kaplan-Meier method and compared using the Log-Rank test.Results:All parameters were balanced except for age after PSM.Tumor diameter(95% CI=1.1-1.4, P<0.001), number of tumors(95% CI=1.2-1.9, P<0.001), γ-GT (95% CI=1.0-1.0, P<0.001) and AFP (HR=1.5, 95% CI=1.2-1.8, P<0.001) were shared predictors for OS, CSS and DFS. Age (95% CI=1.2-1.8, P<0.001) and neutrophile to lymphocyte ratio (NLR) (95% CI=1.0-1.0, P=0.043) were another two predictors for both OS and CSS. Albumin predicted OS only, and sex and cirrhosis just predicted DFS. Over the follow-up period (12-156 months), log-rank tests showed that all predictors significantly affected the corresponding OS, CSS or DFS(all P<0.01). Among them, multiple tumors had the greatest impact on OS, CSS and DFS. Compared with patients with single lesion, OS, CSS and DFS in patients with multiple lesions decreased by 9.2%, 2.5% and 4.1% respectively at the 12 years of follow-up, and the median survival time was shortened by 12.3 months, 25.0 months and 11.3 months, respectively (log-rank P=0.049 for OS; P=0.007 for CSS; P<0.001 for DFS). Conclusions:The prognostic benefits from MWA treating early-stage HCC in patients with different survival risk factors are different. Clinically feasible correction of hypoproteinemia and liver disfunction are of great significance to improve the prognosis of early-stage HCC patients after US-PMMA.
ABSTRACT
Objective To examine the expression of IgA1 and B1a positive cells in palatine tonsils of IgA nephropathy (IgAN) patients, and to analyze the association between B1a cells and clinicopathological changes. Methods Eight patients diagnosed as IgAN by renal biopsy and 8 chronic tonsillitis patients without nephritis as control were enrolled in the study.Immunofluorescence and laser scanning confocal microscope (LSCM) were applied to observe the localization and quantitative calculation of Bla and IgA1 positive cells. Statistic analysis of the association of B1a cells with proteinuria and pathological Lee's grading was performed. Results Bla cells were mainly localized in germinal center of tonsil, and IgA1 positive cells were mainly localized in subepithelium of tonsil. Compared to control group, the percent of B1a cells and IgA1 positive cells was significantly higher in IgAN (P＜0.01). There was a positive correlation between Bla cells and IgA1 cells (P＜0.05). In IgAN, the percent of B1a cells in patients with hematuria and proteinuria was obviously higher than that of patients with hematuria only (P＜0.05). The number of Bla cells in IgAN patients with≥Lee's grade Ⅲ was significantly higher than that of those ＜ grade Ⅲ (P＜0.05). Conclusions IgA1 may be secreted by Bla cells in the tonsil of IgAN patients. The number of B1a cells is correlated with exacerbation of proteinuria and pathological severity, which may play an important role in pathogenesis of IgAN.