In recent years, accumulated evidence suggest that the systemic inflammatory response plays a significant role in various malignancies including HCC. NLR is one of the systemic inflammation markers, high postoperative NLR has been shown to be related to poor prognosis of HCC, and reduction of postoperative NLR is associated better prognosis. Our research first reports that Tα1 can reduce postoperative NLR. The decline of NLR was associated with reduction of neutrophils and increment of lymphocytes. As lymphocytes have pivotal roles in inhibiting proliferation and metastatic activity of tumor cells. A relative lymphopenia may reflect deficient immune response to malignances. On the other hand, increased neutrophils can increase the level of circulating vascular endothelial growth factor, angiopoietin-1, and matrix metalloproteinase-9 which are major contributors to tumor-related angiogenesis.[21,22] Second, the immune response against tumor is weakened in HCC patients.[23,24] Tα1 can stimulate both adaptive and innate immune system against tumor by various paths. For instance, augmenting T-cell function, modulating cytokine and chemokine production, and augmenting the function of macrophages and other immune cells involving innate immune system.[6,25] Furthermore, Tα1 even suppress proliferation and induce apoptosis of tumor cells. Third, postoperative active HBV replication has been proved to be associated with early HCC recurrence and shortened OS. Several studies have proved that combination of antivirus therapy and Tα1 postoperatively may be more effective in control HBV infection, and thus improve the prognosis of HCC. Therefore, Tα1 may improve the prognosis of HBV-related HCC by inhibiting HBV active replication.[20,27]
There are several limitations in our study. First, this is a retrospective analysis from our single institution, and the sample size is relatively small. Second, the analysis of the dynamic change of NLR did not incorporate all the recruited patients, because of lacking the integrity of the follow-up blood cell data and patients had clinical symptoms or signs of sepsis at the time of blood sampling for NLR. Therefore, the result of dynamic NLR change must be tested in prospective research. Third, the present study only investigates the effect of Tα1 in small HCC patients who underwent liver resection, it is uncertain its effect in other stages of HCC, or other modalities of treatment.
In conclusion, our study demonstrated that Tα1 as adjuvant therapy in small HCC after liver resection may delay recurrence and prolong OS. It is rational for small HCC patients who have high risk for recurrence after resection to receive Tα1 adjuvant therapy.
The authors thank Scientific and Technological Support Project of Sichuan Province (2015SZ0049) for the support.
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