title: Circulating CD14+HLA-DR-/lowmyeloid-derived suppressor cells predicted early recurrence of hepatocellular carcinoma after surgery.
abstract: OBJECTIVE
  Myeloid-derived suppressor cells (MDSCs) play an important role in tumor progression. The aim of the present study was to investigate the prognostic value of MDSCs for early recurrence of hepatocellular carcinoma (HCC) in patients undergoing curative resection.
  
  
  METHODS
  Myeloid-derived suppressor cells were measured by flow cytometry. The correlation between MDSCs and tumor recurrence was analyzed using a cohort of 183 patients who underwent curative resection between February 2014 and July 2015. Prognostic significance was further assessed using Kaplan-Meier survival estimates and log-rank tests.
  
  
  RESULTS
  In vivo, CD14+HLA-DR-/lowMDSCs inhibit T cell proliferation and secretion. The frequency of CD14+HLA-DR-/lowMDSCs was significantly higher in HCC patients (3.7 ± 5.3%, n = 183) than in chronic hepatitis patients (1.4 ± 0.6%, n = 25) and healthy controls (1.1 ± 0.5%, n = 50). High frequency of MDSCs was significantly correlated with recurrence (time to recurrence) (P < 0.001) and overall survival (P = 0.034). Patients with HCC in the high MDSC group were prone to more vascular invasion (P = 0.018) and high systemic immune-inflammation index (SII) (P = 0.009) than those in the low MDSC group. Scatter-plot analyses revealed a significant positive correlation between the SII level and the frequency of MDSCs (r = 0.188, P = 0.011). Patients with HCC with a high MDSC frequency and high SII level had significantly shorter time to recurrence (P < 0.001) and overall survival (P = 0.028) than those with a low MDSC frequency and low SII.
  
  
  CONCLUSIONS
  An increased frequency of MDSCs was correlated with early recurrence and predicted the prognosis of patients with HCC undergoing curative resection. The HCC patients with high frequency of MDSCs should be provided more advanced management and frequent monitoring.
authors.affiliation: Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Xing-Hui
authors.initials: XH
authors.lastname: Gao
authors.affiliation: Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Lu
authors.initials: L
authors.lastname: Tian
authors.affiliation: Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Jiong
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Xiao-Lu
authors.initials: XL
authors.lastname: Ma
authors.affiliation: Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Chun-Yan
authors.initials: CY
authors.lastname: Zhang
authors.affiliation: Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Liver Surgery, Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Yun-Fan
authors.initials: YF
authors.lastname: Sun
authors.affiliation: Department of Liver Surgery, Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Hu
authors.affiliation: Department of Liver Surgery, Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Shuang-Jian
authors.initials: SJ
authors.lastname: Qiu
authors.affiliation: Department of Liver Surgery, Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Department of Liver Surgery, Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Fan
authors.affiliation: Department of Laboratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
authors.affiliation: Department of Liver Surgery, Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Xin-Rong
authors.initials: XR
authors.lastname: Yang
keywords: hepatocellular carcinoma; myeloid-derived suppressor cells; recurrence; systemic immune-inflammation index