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©The Author(s) 2022.
World J Gastrointest Surg. Sep 27, 2022; 14(9): 1008-1025
Published online Sep 27, 2022. doi: 10.4240/wjgs.v14.i9.1008
Published online Sep 27, 2022. doi: 10.4240/wjgs.v14.i9.1008
Table 1 Propensity score matching results of associating liver partition and portal vein ligation for staged hepatectomy group and right hemi-hepatectomy group
| Variable | Before matching | After matching | ||||
| ALPPS (15 cases) | Hepatectomy (46 cases) | P valve | ALPPS (15 cases) | Hepatectomy (15 cases) | P valve | |
| Age (yr) | 45.1 ± 11.4 | 49.4 ± 9.6 | 0.157 | 45.1 ± 11.4 | 49.5 ± 9.9 | 0.276 |
| Sex (%) | 0.795 | 0.543 | ||||
| Female | 2 (13.3%) | 5 (10.9%) | 2 (13.3%) | 1 (6.7%) | ||
| Male | 13 (86.7%) | 41 (89.1%) | 13 (86.7%) | 14 (93.3%) | ||
| BMI | 22.4 ± 3.2 | 22.8 ± 3.1 | 0.644 | 22.4 ± 3.2 | 23.0 ± 3.4 | 0.608 |
| HCC end-stage score | 5.8 ± 2.3 | 5.4 ± 2.6 | 0.626 | 5.8 ± 2.3 | 6.1 ± 3.7 | 0.815 |
| BCLC stage | 0.775 | 0.915 | ||||
| A | 3 (20.0%) | 13 (28.3%) | 3 (20.0%) | 3 (20.0%) | ||
| B | 5 (33.3%) | 12 (26.0%) | 5 (33.3%) | 4 (26.7%) | ||
| C | 7 (46.7%) | 21 (45.7%) | 7 (46.7%) | 8 (53.3%) | ||
| AFP (%) | 0.031 | 1.000 | ||||
| ≥ 400 ng/mL | 11 (73.3%) | 19 (41.3%) | 11 (73.3%) | 11 (73.3%) | ||
| < 400ng/mL | 4 (26.7%) | 27 (58.7%) | 4 (26.7%) | 4 (26.7%) | ||
| Child-Pugh class (%) | 0.984 | 1.000 | ||||
| A | 14 (93.3%) | 43 (93.5%) | 14 (93.3%) | 14 (93.3%) | ||
| B | 1 (6.7%) | 3 (6.5%) | 1 (6.7%) | 1 (6.7%) | ||
| Tumor number (%) | 0.125 | 1.000 | ||||
| 1 | 10 (66.7%) | 39 (84.8%) | 10 (66.7%) | 10 (66.67%) | ||
| > 1 | 5 (33.3%) | 7 (15.2%) | 5 (33.3%) | 5 (33.33%) | ||
| Tumor size (cm) | 10.7 ± 4.5 | 7.7 ± 4.8 | 0.033 | 10.7 ± 4.5 | 9.0 ± 4.9 | 0.332 |
| Vascular invasion (%) | 0.952 | 0.705 | ||||
| Yes | 6 (40.0%) | 18 (39.1%) | 6 (40.0%) | 5 (33.3%) | ||
| No | 9 (60.0%) | 28 (60.9%) | 9 (60.0%) | 10 (66.6%) | ||
| Extrahepatic metastasis (%) | 1.000 | 1.000 | ||||
| Yes | 0 (0%) | 1 (2.2%) | 0 (0%) | 0 (0%) | ||
| No | 15 (100%) | 45 (97.8%) | 15 (100%) | 15 (100%) | ||
Table 2 Intraoperative and postoperative conditions of patients in associating liver partition and portal vein ligation for staged hepatectomy group and right hemi-hepatectomy group
| ALPPS | Hepatectomy | ||
| Stage-I ALPPS | Stage-II ALPPS | ||
| Surgery time (min) | 342 (229-459) | 293 (167-400) | 338 (140-515) |
| Intraoperative blood loss (mL) | 230 (100-500) | 619 (200-1800) | 344 (190-638) |
| Postoperative bile leakage (yes/no) | 0/15 | 0/15 | 2/13 |
| Postoperative complications, Clavien-Dino (I/II/III/IV) | 13/1/1/0 | 8/4/2/1 | 9/4/1/1 |
| Classification of postoperative liver failure, ISGLS (A/B/C) | 4/10/1 | 4/9/2 | 6/8/1 |
| 90 d survival after operation (death/alive) | 0/15 | 1/14 | 1/14 |
Table 3 Comparison of positive expression rates of tumor-infiltrating lymphocyte subpopulations in tumor tissues in stage-I associating liver partition and portal vein ligation for staged hepatectomy, stage-II associating liver partition and portal vein ligation for staged hepatectomy, and right hemi-hepatectomy groups
| ALPPS | Hepatectomy | Variance analysis | |||
| Stage-I ALPPS | Stage-II ALPPS | F valve | P valve | ||
| Total T cells (%) | 3.3 ± 2.9 | 3.1 ± 2.0 | 2.8 ± 1.8 | 0.188 | 0.829 |
| CD4+ T cells (%) | 1.0 ± 0.9 | 1.2 ± 1.1 | 0.9 ± 0.5 | 0.458 | 0.635 |
| CD8+ T cells (%) | 0.8 ± 0.7 | 1.0 ± 0.9 | 0.6 ± 0.4 | 0.546 | 0.583 |
| Treg cells (‰) | 0.2 ± 0.1 | 0.2 ± 0.2 | 0.3 ± 0.1 | 0.166 | 0.848 |
| B cells (%) | 1.7 ± 1.3 | 1.3 ± 0.7 | 2.1 ± 0.8 | 0.726 | 0.490 |
| NK cells (%) | 0.7 ± 0.2 | 0.4 ± 0.2 | 0.7 ± 0.2 | 0.664 | 0.520 |
Table 4 Comparison of positive expression rates of tumor-infiltrating lymphocyte subpopulations in adjacent tissues in stage-I associating liver partition and portal vein ligation for staged hepatectomy, stage-II associating liver partition and portal vein ligation for staged hepatectomy, and right hemi-hepatectomy groups
| ALPPS | Variance analysis | ||||
| Stage-I ALPPS | Stage-II ALPPS | Hepatectomy | F valve | P valve | |
| Total T cells (%) | 2.0 ± 0.6 | 1.9 ± 0.9 | 1.8 ± 1.3 | 0.129 | 0.879 |
| CD4+ T cells (%) | 0.8 ± 0.3 | 0.9 ± 0.3 | 0.9 ± 0.7 | 0.258 | 0.774 |
| CD8+ T cells (%) | 0.8 ± 0.3 | 1.0 ± 0.5 | 1.0 ± 0.7 | 0.510 | 0.604 |
| Treg cells (‰) | 0.0 ± 0.1 | 0.0 ± 0.0 | 0.0 ± 0.0 | 0.292 | 0.748 |
| B cells (%) | 2.0 ± 1.2 | 1.8 ± 0.8 | 1.7 ± 0.5 | 0.269 | 0.765 |
| NK cells (%) | 0.7 ± 0.7 | 0.6 ± 0.5 | 0.8 ± 0.7 | 0.550 | 0.581 |
Table 5 Comparison of tumor-infiltrating lymphocyte subpopulations between tumor and adjacent tissues in associating liver partition and portal vein ligation for staged hepatectomy group
| Stage-I ALPPS | Stage-II ALPPS | |||||
| Tumor | Adjacent | P valve | Tumor | Adjacent | P valve | |
| Total T cells (%) | 3.3 ± 2.9 | 2.0 ± 0.6 | 0.116 | 3.1 ± 2.0 | 1.9 ± 0.9 | 0.056 |
| CD4+ T cells (%) | 1.0 ± 0.9 | 0.8 ± 0.3 | 0.403 | 1.2 ± 1.1 | 0.9 ± 0.3 | 0.278 |
| CD8+ T cells (%) | 0.8 ± 0.7 | 0.8 ± 0.3 | 0.902 | 1.0 ± 0.9 | 1.0 ± 0.5 | 0.792 |
| Treg cells (‰) | 0.2 ± 0.1 | 0.0 ± 0.1 | 0.056 | 0.2 ± 0.2 | 0.0 ± 0.0 | 0.156 |
| B cells (%) | 1.7 ± 1.3 | 2.0 ± 1.2 | 0.515 | 1.3 ± 0.7 | 1.8 ± 0.8 | 0.085 |
| NK cells (%) | 0.7 ± 0.2 | 0.7 ± 0.7 | 0.985 | 0.4 ± 0.2 | 0.6 ± 0.5 | 0.403 |
Table 6 Comparison of tumor-infiltrating lymphocyte subpopulations between tumor and adjacent tissues in right hemi-hepatectomy group
| Right hemi-hepatectomy | |||
| Tumor tissues | Adjacent tissues | P valve | |
| Total T cells (%) | 2.8 ± 1.8 | 1.8 ± 1.3 | 0.105 |
| CD4+ T cells (%) | 0.9 ± 0.5 | 0.9 ± 0.7 | 0.840 |
| CD8+ T cells (%) | 0.6 ± 0.4 | 1.0 ± 0.7 | 0.101 |
| Treg cells (‰) | 0.3 ± 0.1 | 0.0 ± 0.0 | 0.043 |
| B cells (%) | 2.1 ± 0.8 | 1.7 ± 0.5 | 0.645 |
| NK cells (%) | 0.7 ± 0.2 | 0.8 ± 0.7 | 0.678 |
Table 7 Comparison of immunological data during stage-I associating liver partition and portal vein ligation for staged hepatectomy
| Item | Preoperative | Stage-I ALPPS | F value | P value | |||
| POD1 | POD3 | POD5 | POD7 | ||||
| T lymphocyte count (cells/μL) | 1331.5 ± 600.0 | 472.8 ± 289.9 | 682.0 ± 346.9 | 837.9 ± 383.6 | 1012.5 ± 444.2 | 10.095 | 0.001 |
| Total T lymphocyte percentage (%) | 67.8 ± 8.7 | 59.6 ± 8.5 | 68.4 ± 12.3 | 70.5 ± 11.7 | 68.9 ± 10.3 | 6.717 | 0.000 |
| CD4+ T lymphocytes (cells/μL) | 806.3 ± 428.2 | 241.1 ± 202.2 | 412.3 ± 224.7 | 520.1 ± 255.1 | 608.0 ± 266.1 | 9.049 | 0.002 |
| CD8+ T lymphocyte (cells/μL) | 438.2 ± 194.2 | 187.6 ± 96.6 | 238.9 ± 141.0 | 277.4 ± 143.5 | 361.2 ± 201.6 | 11.294 | 0.001 |
| Natural killer cells (%) | 16.5 ± 7.8 | 27.2 ± 8.6 | 10.8 ± 6.9 | 11.0 ± 3.7 | 11.2 ± 3.7 | 17.341 | 0.000 |
| IgA (g/L) | 3.11 ± 1.28 | 2.63 ± 1.64 | 1.87 ± 0.77 | 2.08 ± 0.79 | 2.69 ± 1.24 | 10.025 | 0.001 |
| IgG (g/L) | 15.11 ± 3.70 | 10.52 ± 2.89 | 8.70 ± 2.72 | 8.89 ± 2.69 | 9.82 ± 2.70 | 62.360 | 0.000 |
| IgM (g/L) | 1.27 ± 0.68 | 0.89 ± 0.40 | 0.71 ± 0.39 | 0.82 ± 0.38 | 1.08 ± 0.53 | 6.114 | 0.008 |
| Complement C1q (mg/L) | 194.5 ± 28.7 | 168.9 ± 44.2 | 140.4 ± 39.6 | 157.7 ± 45.9 | 159.17 ± 55.3 | 6.726 | 0.000 |
| Complement C3 (g/L) | 1.18 ± 0.19 | 0.87 ± 0.15 | 0.79 ± 0.19 | 0.87 ± 0.21 | 0.91 ± 0.26 | 44.808 | 0.000 |
| Complement C4 (g/L) | 0.40 ± 0.18 | 0.26 ± 0.12 | 0.23 ± 0.11 | 0.25 ± 0.12 | 0.28 ± 0.15 | 8.731 | 0.002 |
| Interleukin-6 (g/L) | 10.7 ± 17.0 | 177.4 ± 121.6 | 84.0 ± 62.3 | 52.6 ± 40.9 | 41.2 ± 35.1 | 7.877 | 0.003 |
| CD19 expression rate (%) | 10.5 ± 4.0 | 9.6 ± 5.62 | 12.1 ± 5.6 | 12.7 ± 5.2 | 13.3 ± 6.1 | 1.866 | 0.129 |
Table 8 Comparison of immunological data during stage-II associating liver partition and portal vein ligation for staged hepatectomy
| Item | Preoperative | Stage-II ALPPS | F value | P value | |||
| POD1 | POD3 | POD5 | POD7 | ||||
| T lymphocyte count (cells/μL) | 1414.4 ± 634.0 | 455.9 ± 255.4 | 716.3 ± 311.3 | 796.3 ± 282.8 | 913.4 ± 387.1 | 17.626 | 0.000 |
| Total T lymphocyte percentage (%) | 67.8 ± 8.7 | 63.7 ± 9.2 | 72.3 ± 7.5 | 74.8 ± 6.4 | 73.6 ± 7.2 | 8.288 | 0.000 |
| CD4+ T lymphocytes (cells/μL) | 806.3 ± 428.2 | 246.4 ± 168.2 | 375.9 ± 170.1 | 493.9 ± 196.7 | 537.9 ± 231.3 | 7.925 | 0.003 |
| CD8+ T lymphocytes (cells/μL) | 438.2 ± 194.2 | 168.5 ± 89.4 | 290.3 ± 184.7 | 291.9 ± 159.0 | 356.1 ± 210.8 | 8.775 | 0.000 |
| Natural killer cells (%) | 16.5 ± 7.8 | 23.0 ± 7.1 | 12.7 ± 4.6 | 8.7 ± 4.8 | 10.2 ± 3.2 | 15.615 | 0.000 |
| IgA (g/L) | 3.11 ± 1.28 | 2.37 ± 1.88 | 2.31 ± 1.41 | 2.59 ± 1.30 | 3.40 ± 1.66 | 8.900 | 0.002 |
| IgG (g/L) | 15.11 ± 3.70 | 8.71 ± 2.10 | 8.11 ± 1.90 | 8.53 ± 1.66 | 9.68 ± 2.26 | 12.604 | 0.000 |
| IgM (g/L) | 1.27 ± 0.68 | 0.70 ± 0.37 | 0.67 ± 0.28 | 0.70 ± 0.36 | 0.83 ± 0.37 | 1.277 | 0.001 |
| Complement C1q (mg/L) | 194.5 ± 28.7 | 140.8 ± 33.8 | 111.1 ± 39.1 | 118.5 ± 41.3 | 124.2 ± 42.1 | 14.422 | 0.000 |
| Complement C3 (g/L) | 1.18 ± 0.19 | 0.72 ± 0.27 | 0.54 ± 0.20 | 0.58 ± 0.20 | 0.62 ± 0.18 | 24.345 | 0.000 |
| Complement C4 (g/L) | 0.40 ± 0.18 | 0.22 ± 0.16 | 0.15 ± 0.12 | 0.15 ± 0.14 | 0.17 ± 0.16 | 15.305 | 0.000 |
| Interleukin-6 (pg/mL) | 10.7 ± 17.0 | 210.3 ± 160.9 | 62.6 ± 27.6 | 37.1 ± 19.7 | 41.6 ± 61.3 | 12.206 | 0.000 |
| CD19 expression rate (%) | 10.5 ± 4.0 | 9.4 ± 5.1 | 10.2 ± 4.1 | 11.2 ± 5.8 | 11.0 ± 5.6 | 0.522 | 0.720 |
Table 9 Comparison of immunological data during conventional hepatectomy
| Item | Preoperative | Conventional hepatectomy | F value | P value | |||
| POD1 | POD3 | POD5 | POD7 | ||||
| T lymphocyte count (cells/μL) | 1194.7 ± 305.4 | 447.1 ± 240.9 | 808.8 ± 313.7 | 835.7 ± 323.7 | 1032.7 ± 323.6 | 123.342 | 0.000 |
| Total T lymphocyte percentage (%) | 71.2 ± 5.2 | 58.9 ± 14.5 | 65.9 ± 11.7 | 72.3 ± 9.1 | 72.8 ± 7.7 | 17.676 | 0.000 |
| CD4+ T lymphocytes (cells/μL) | 761.1 ± 146.6 | 244.1 ± 113.9 | 515.9 ± 155.1 | 520.7 ± 168.7 | 644.8 ± 149.1 | 198.675 | 0.000 |
| CD8+T lymphocytes (cells/μL) | 379.9 ± 119.0 | 147.9 ± 98.5 | 226.8 ± 104.5 | 253.0 ± 110.4 | 331.8 ± 120.9 | 106.219 | 0.000 |
| Natural killer cells (%) | 17.9 ± 4.7 | 25.8 ± 8.4 | 14.1 ± 3.0 | 12.9 ± 4.6 | 13.8 ± 3.8 | 12.893 | 0.000 |
| IgA (g/L) | 2.67 ± 1.49 | 2.23 ± 1.34 | 2.11 ± 1.32 | 2.44 ± 1.50 | 2.82 ± 1.60 | 19.117 | 0.000 |
| IgG (g/L) | 11.78 ± 5.58 | 8.14 ± 3.97 | 7.89 ± 3.98 | 8.09 ± 4.05 | 8.55 ± 3.95 | 35.249 | 0.000 |
| IgM (g/L) | 0.91 ± 0.39 | 0.54 ± 0.31 | 0.63 ± 0.26 | 0.66 ± 0.27 | 0.82 ± 0.30 | 24.051 | 0.000 |
| Complement C1q (mg/L) | 174.6 ± 51.3 | 142.8 ± 49.9 | 121.9 ± 46.9 | 125.1 ± 52.1 | 132.2 ± 47.0 | 39.750 | 0.000 |
| Complement C3 (g/L) | 1.11 ± 0.45 | 0.84 ± 0.41 | 0.74 ± 0.37 | 0.70 ± 0.36 | 0.73 ± 0.37 | 31.517 | 0.000 |
| Complement C4 (g/L) | 0.32 ± 0.13 | 0.24 ± 0.11 | 0.21 ± 0.11 | 0.22 ± 0.11 | 0.24 ± 0.12 | 37.071 | 0.000 |
| Interleukin-6 (pg/mL) | 16.3 ± 17.7 | 171.6 ± 119.2 | 73.3 ± 46.3 | 43.5 ± 28.8 | 44.1 ± 31.1 | 8.981 | 0.002 |
| CD19 expression rate (%) | 13.04 ± 2.21 | 9.93 ± 3.05 | 10.68 ± 3.40 | 12.81 ± 4.37 | 14.03 ± 3.62 | 11.115 | 0.000 |
- Citation: Wang W, Deng ZF, Wang JL, Zhang L, Bao L, Xu BH, Zhu H, Guo Y, Wen Z. Change of tumor-infiltrating lymphocyte of associating liver partition and portal vein ligation for staged hepatectomy for hepatocellular carcinoma. World J Gastrointest Surg 2022; 14(9): 1008-1025
- URL: https://www.wjgnet.com/1948-9366/full/v14/i9/1008.htm
- DOI: https://dx.doi.org/10.4240/wjgs.v14.i9.1008