ABSTRACT
BACKGROUND: Surgical treatment remains the best option for patients with hepatocellular carcinoma (HCC) caused by chronic hepatitis B virus (HBV) infection. However, there is no optimal tool based on readily accessible clinical parameters to predict postoperative complications. Herein, our study aimed to develop models that permitted risk of severe complications to be assessed before and after liver resection based on conventional variables. METHODS: A total of 1,047 patients treated by hepatectomy for HCC with HBV infection at three different centers were recruited retrospectively between July 1, 2014, and July 1, 2018. All surgical complications were recorded and scored by the Comprehensive Complication Index (CCI). A CCI ≥26.2 was used as a threshold to define patients with severe complications. We built two models for the CCI, one using preoperative and one using preoperative and postoperative data. Besides, CCI and other potentially relevant factors were evaluated for their ability to predict early recurrence and metastasis. All the findings were internally validated in the Hangzhou cohort and then externally validated in the Lanzhou and Urumqi cohorts. RESULTS: Multivariable analysis identified National Nosocomial Infections Surveillance (NNIS) index, tumor number, gamma-glutamyltransferase (GGT), total cholesterol (TC), potassium, and thrombin time as the key preoperative parameters related to perioperative complications. The nomogram based on the preoperative model [preoperative CCI After Surgery for Liver tumor (CCIASL-pre)] showed good discriminatory performance internally and externally. A more accurate model [postoperative CCI After Surgery for Liver tumor (CCIASL-post)] was established, combined with the other four postoperative predictors including leukocyte count, basophil count, erythrocyte count, and total bilirubin level. No significant association was observed between CCI and long-term complications. CONCLUSION: Based on the widely available clinical data, statistical models were established to predict the complications after hepatectomy in patients with HBV infection. All the findings were extensively validated and shown to be applicable nationwide. Such models could be used as guidelines for surveillance follow-up and the design of post-resection adjuvant therapy.
ABSTRACT
Objective:To investigate the changes of natural killer (NK) cells, natural killer T (NKT) cells and T lymphocytes in the peripheral blood after nanosecond pulse ablation of hepatic vesicular hydatid in rats with different energy levels.Methods:A total of 32 SD rats were randomly divided into hepatic vesicular hydatid model group, low voltage group (1 000 V), medium voltage group (1 500 V) and high voltage group (2 000 V). The hydatid model of rats was established by selective injection of 100 μl of echinococcosis head suspension with concentration of 500/100 μl into the left hepatic portal vein in all the 4 groups. After 3 months, nanosecond pulse therapy was applied to the left lobe vesicular hydatid lesions in the low voltage group, medium voltage group and high voltage group. On the third day after treatment, flow detector was used to calculate the ratio of CD 4+ T to CD 8+ T in peripheral blood of four groups by CD 3+ T, CD 4+ T, CD 8+ T, NK cells and NKT cells. Results:CD 3+ T was expressed in the high voltage group with (62.08±2.75)%, the medium voltage group with (63.84±7.73)%, the low voltage group with (55.19±8.55)% and the control group with (54.76±8.28)% ( P<0.05). CD 4+ T number was larger in high voltage group (43.7±6.51)% than medium voltage group (38.82±5.47)%, low voltage group (37.31±6.96)% and model group (38.12±3.04)% ( P<0.05). CD 8+ T ratio in the high voltage group was (20.03±2.40)%, the medium voltage group was (21.22±1.74)%, the low voltage group was (19.00±3.06)%, and the model group (20.56±3.98)%, with no statistically significant difference ( P>0.05). NK cells ratio in high voltage group was (6.49±1.60)%, medium voltage group was (3.02±0.32)%, low voltage group was (3.42±0.91)% and model group was (3.44±0.55)% ( P<0.05). NKT cells ratio in high voltage group was (1.53±0.16)%, medium voltage group was (0.82±0.09)%, in low voltage group was (0.70±0.17)% and model group (0.78±0.10)% ( P<0.05). CD 4+ T/CD 8+ T high voltage group was (2.26±0.65), medium voltage group was (1.90±0.40), low voltage group was (1.98±0.37) and model group was (2.06±0.35) ( P<0.05). Conclusion:High voltage (2 000 V) increased number of T, NK and NKT cells in peripheral blood compared with medium voltage (1 500 V) and low voltage (1 000 V), which may be the immune response of the body caused by nanosecond pulse ablation of hepatic vesicular hydatid in rats.
