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Purpose@#To evaluate the safety and effectiveness of an enhanced recovery after surgery (ERAS) programme after curative liver resection in cirrhotic hepatocellular carcinoma (HCC) patients. @*Methods@#One hundred sixty-two patients were enrolled in the study; 80 patients whose data were collected prospectively were assigned to the ERAS group, and 82 patients whose data were collected retrospectively were assigned to the control group. Preoperative clinicopathologic factors, surgical factors, and postoperative outcomes of the 2 groups were compared. Logistic regression was applied to explore potential predictors of hospital stay and morbidity. @*Results@#The postoperative hospital stay, postoperative complication rate, and recovery of liver function on postoperative day 5 seemed to be better in the ERAS group. The composition of complications was different in the 2 groups; pleural effusion and postoperative ascites were more common in the control group, and indocyanine green retention at 15 minutes, operation time, preoperative alanine aminotransferase, and number of liver segmentectomies were associated with postoperative complications rather than ERAS intervention. @*Conclusion@#The ERAS programme is safe and effective for HCC patients with chronic liver disease undergoing hepatectomy, but it seems that surgical factors, such as operation type, have a greater impact on morbidity than other factors. Operative characteristics such as the method of blood loss control and the volume of liver resection should be augmented into ERAS protocol of hepatectomy.
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Objective:To investigate the distribution of na?ve T cell and memory T cell subsets in the peripheral blood of non-small cell lung cancer (NSCLC) patients.Methods:A total of 25 NSCLC patients from the Oncology Department of the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from June to December 2018 were included in the study, and 20 healthy volunteers in the same period were used as controls. Flow cytometry was used to analyze the na?ve T cell and memory T cell subsets in peripheral blood. The results were analyzed by SPSS 16.0.Results:The percentage and absolute number of na?ve T cell/stem-like central memory T cells (T N/SCM) in NSCLC patients declined compared to the control group [(7.71±1.11)% vs. (15.84±2.00)%, t=3.685, P=0.001; (8.38±1.23)×10 7/L vs. (3.40±0.43)×10 8/L, t=6.130, P<0.001]. The percentage and absolute number of central memory T cells (T CM) in NSCLC patients declined compared to the control group [(6.62±1.16)% vs. (17.88±0.83)%, t=7.641, P<0.001; (7.98±1.78)×10 7/L vs. (3.40±0.31)×10 8/L, t=9.028, P<0.001]. The absolute number of CD8 + T CM in NSCLC patients declined compared to the control group [(5.19±1.04)×10 6/L vs. (1.49±0.15)×10 7/L, t=5.561, P<0.001]. The percentage of effector memory T cells (T EM) in NSCLC patients increased compared to the control group [(38.27±2.01)% vs. (17.37±1.06)%, t=8.776, P<0.001]. The percentage and absolute number of CD8 + T EM in NSCLC patients increased compared to the control group [(13.93±1.55)% vs. (4.65±0.52)%, t=5.310, P<0.001; (1.48±0.14)×10 8/L vs. (9.97±1.14)×10 7/L, t=2.584, P=0.014]. The percentage of effector memory T cells re-expressing CD45RA (T EMRA) in NSCLC patients increased compared to the control group [(17.33±1.86)% vs. (8.48±1.01)%, t=3.989, P<0.001]. The percentage and absolute number of CD8 + T CM in stage Ⅰ-Ⅱ patients declined compared to stage Ⅲ-Ⅳ patients [(0.33±0.06)% vs. (0.89±0.34)%, t=2.600, P=0.020; (3.99±0.84)×10 6/L vs. (9.03±3.07)×10 6/L, t=2.270, P=0.040]. There were no statistically significant differences in the na?ve T cells and memory T cell subsets of NSCLC patients with different pathological types. Conclusion:In NSCLC patients, the na?ve/memory T cell subsets are changed compared with the healthy volunteers. The T N/SCM and T CM those with the characteristics of differentiation ability and long-term survival are reduced, and those of the stage Ⅰ-Ⅱ patients are reduced significantly. T EM and T EMRA with immunological effect are increased significantly.
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Purpose@#To evaluate the safety and effectiveness of an enhanced recovery after surgery (ERAS) programme after curative liver resection in cirrhotic hepatocellular carcinoma (HCC) patients. @*Methods@#One hundred sixty-two patients were enrolled in the study; 80 patients whose data were collected prospectively were assigned to the ERAS group, and 82 patients whose data were collected retrospectively were assigned to the control group. Preoperative clinicopathologic factors, surgical factors, and postoperative outcomes of the 2 groups were compared. Logistic regression was applied to explore potential predictors of hospital stay and morbidity. @*Results@#The postoperative hospital stay, postoperative complication rate, and recovery of liver function on postoperative day 5 seemed to be better in the ERAS group. The composition of complications was different in the 2 groups; pleural effusion and postoperative ascites were more common in the control group, and indocyanine green retention at 15 minutes, operation time, preoperative alanine aminotransferase, and number of liver segmentectomies were associated with postoperative complications rather than ERAS intervention. @*Conclusion@#The ERAS programme is safe and effective for HCC patients with chronic liver disease undergoing hepatectomy, but it seems that surgical factors, such as operation type, have a greater impact on morbidity than other factors. Operative characteristics such as the method of blood loss control and the volume of liver resection should be augmented into ERAS protocol of hepatectomy.
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Objective@#To carry out a prospective cohort study of combined intra-operative radiotherapy for centrally located hepatocellular carcinomas (HCC) and to observe the safety and postoperative complications.@*Methods@#A total of 79 patients with centrally located HCC who underwent hepatectomy were divided into two groups: experimental group (combined with targeted intra-operative radiotherapy, 32 cases) and control group (single surgical operation, 47 cases). Patients in the experimental group received intra-operative electron radiotherapy after tumor resection, while patients in the control group received to intra-operative electron radiotherapy.The haemorrhagia amount and operation time during the operation, intra-operative liver function and the recovery of liver and gastrointestinal tract of patients in these two groups were compared.@*Results@#No postoperative 30-day mortality was observed in all of the patients. The average total operation time of patients in the experimental group was (319±76) min, significantly longer than (233±76) min of the control group (P<0.001). The average aspartate transaminase (AST) level of patients in the experimental group at postoperative day 1 was 562.5 U/L, significantly higher than 347.0 U/L of control group (P=0.031). However, the average prothrombin activity levels of patients in the experimental group at postoperative day 3 and day 7 were (68.3±17.9)% and (73.4±10.2)%, respectively, significantly lower than (78.9±15.9)% and (80.0±10.6)% of control group (both P<0.05). There were no significant differences of tumor volume, differentiation degree, satellite lesion, dorsal membrane invasion, microvascular invasion between these two groups (all P>0.05). There were no significant differences of hospital stay, ventilation time, the incidence of hepatic insufficiency, ascites, pleural effusion, infection, biliary fistula between these two groups (all P>0.05). There were no significant differences of alanine aminotransferase (ALT), albumin, total bilirubin between these two groups at postoperative day 1, 3, 5 and 7 (all of P>0.05).@*Conclusion@#The resection of centrally located HCC combined with intra-operative radiotherapy may increase the total operation time, delay the early postoperative recovery of liver function, but it is still safe and feasible.@*Trial registration@#National Cancer Centre /Cancer Hospital, Chinese Academy of Medical Sciences, ChiCTR-TRC-12002802.
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Objective@#To analyze the clinicopathological features and prognosis of patients with small hepatocellular carcinoma.@*Methods@#The clinicopathological and follow-up data of 98 patients with small hepatocellular carcinoma who underwent R0 resection from January 2009 to December 2013 were analyzed retrospectively.@*Results@#All of the patients were followed up. Their postoperative 1-year, 3-year and 5-year overall survival rates were 99.0%, 91.7%, and 76.3%, respectively. Their postoperative median overall survival (OS) period was 52 months. The postoperative progression-free survival rates were 86.7%, 66.2% and 55.0%, respectively, and the median progression-free survival (PFS) period was 43.5 months. The univariate analysis showed that satellite nodules, liver capsule invasion and postoperative recurrence time were associated with OS (P<0.05), and long-term heavy drinking, satellite nodules and liver capsule invasion with PFS (P<0.05). The multivariate analysis indicated that long-term heavy drinking was an independent factor influencing the progression-free survival period of patients with small hepatocellular carcinoma (P=0.003) and postoperative recurrence time and liver capsule invasion were independent factors affecting their overall survival period (P<0.05).@*Conclusions@#The treatment of small hepatocellular carcinoma still concentrates on the active treatment of surgery. It is beneficial to patients to minimize the resection scope of normal liver under the premise of R0 removal of tumor. Postoperative recurrence time of ≤2 years suggests poor prognosis of small hepatocellular carcinoma. Long-term heavy drinking can accelerate the recurrence of small hepatocellular carcinoma.
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Objective To study the characteristics of peripheral blood lymphocyte subsets in patients with lung cancer,gastric cancer and breast cancer.Methods Five hundred and eight patients with cancer from the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine (256 cases with lung cancer,152 cases with gastric cancer,100 cases with breast cancer),and 50 healthy volunteers were collected.Two ml peripheral blood were obtained from these cases.The distribution of lymphocyte subsets in peripheral blood was measured by flow cytometry in these cases.The data were analyzed using SPSS 16.0 software.Results The number of lymphocytes of cancer patients was decreased,the healthy volunteers was 5125,breast cancer patient was 3642,gastric cancer patient was 3178,lung cancer patient was 2895.The case of outliers of lymphocyte subsets classified based on the three kinds of cancer was 218 (85.2％,lung cancer),133 (87.5％,gastric cancer),88 (88.0％,breast cancer).The case of outliers of T-lymphocyte subsets classified based on the three kinds of cancer was 83 (32.4％,lung cancer),32 (32.0％,breast cancer),44 (28.9％,gastric cancer).The case of outliers of CD4 +/CD8 + classified based on the three kinds of cancer was 185 (72.3％,lung cancer),108 (71.1％,gastric cancer),84 (84.0％,breast cancer).The case of outliers of natural killer-lymphocyte subsets classified based on the three kinds of cancer was 32 (12.5％,lung cancer),22 (14.5％,gastric cancer),16 (16.0％,breast cancer).The case of outliers of B-lymphocyte subsets classified based on the three kinds of cancer was 38 (14.8％,lung cancer),52 (34.2％,gastric cancer),12 (12.0％,breast cancer).Compared to healthy subjects,the CD19+％ of patients with lung cancer was decreased (12.8 ± 5.0 vs.11.5 ± 5.7,t =3.006,P =0.003);the CD4 + ％ of patients with gastric cancer was decreased (39.2 ±7.7 vs.35.3 ± 7.6,t =2.315,P =0.023);the CD19 + ％ of patients with gastric cancer was decreased (12.8 ± 5.0 vs.8.9 ± 4.2,t =3.302,P =0.010);the CD8 + ％ of patients with breast cancer was increased (24.0 ± 8.1 vs.29.1 ± 13.0,t =2.019,P =0.047).Conclusion The number of lymphocytes in cancer patients is decreased,the abnormal rates of lymphocyte subsets in the three kinds of cancer patients are higher than those in healthy volunteers,the lymphocyte subsets of different kinds of cancers perform different characteristics.