4B). Fourth, the production of GzmA, GzmB, and perforin by new CD4+ T cells from HCC patients was also enhanced following anti-CD3/CD28 stimulation for 4 days when Treg cells were depleted from PBMCs (Fig. 4C). These data strongly suggest that the cytolytic capability of CD4+ CTLs can be markedly suppressed by Treg cells by way of the inhibition of the release and self-renewal of cytolytic molecules, as well as by the prevention of a new generation of CD4+ CTLs. To investigate the association between CD4+ CTLs and HCC progression, 83 HCC patients with stage III disease were divided into

two groups (the high CD4+ CTLs and low CD4+ CTLs groups), according to the median percentage of circulating CD4+ CTLs. The analysis showed Selleck CDK inhibitor that the low CD4+ CTL group patients had significantly poorer survival rates compared with the high CD4+ CTL group patients (P < 0.001) (Fig. 5A). In addition,

we analyzed the association between peripheral CD4+ CTL percentages and HCC recurrence after resection in 100 HCC patients with stage I and II who underwent tumor resection and were followed until tumor recurrence. The data showed that the DFS rate in the high CD4+ CTL group patients was significantly higher than in the low CD4+ CTL group patients (P < 0.01, Fig. 5B). Cox's proportional hazards model analysis revealed that the GzmB+ and perforin+ CD4+ CTLs were independent prognostic factors for survival of HCC patients with stage III, and the hazard ratio (HR) was 0.391 (95% confidence interval [CI], 0.202-0.757; P = 0.005) and 0.373 (95% CI, 0.198-0.702; P Pifithrin �� = 0.002) for GzmB+ and perforin+ CD4+ CTLs, respectively (Table 2). Circulating GzmB+CD4+ CTLs were also independent prognostic factors for DFS in HCC patients with stage I and II (HR, 0.097; 95% CI, 0.021-0.438; P = 0.002), as well

as disease stage (HR, 1.756; 95% CI, 1.032-2.772; P = 0.023) (Table 2). However, circulating GzmA+ and perforin+CD4+ T cells were not found to be independent prognostic factors for DFS in these HCC patients. The association between intratumoral CD4+ CTLs and DFS or OS was further investigated by immunohistochemical double-staining in 315 HCC patients. The results showed that the low MCE公司 GzmB+CD4+ T cells group patients had significantly poorer DFS and OS in comparison to the high group of patients (P < 0.001) (Fig. 5C,D). Cox’s proportional hazards model showed that GzmB+CD4+ T cells were independent prognostic factors for both DFS and OS (HR, 0.697; 95% CI, 0.524-0.926; P = 0.013 for DFS; HR, 0.597; 95% CI, 0.443-0.804; P = 0.001 for OS) (Table 2). It was also found that the disease stage was an independent prognostic factor for DFS and OS, whereas the Child-Pugh score was an independent prognostic factor for DFS in these HCC patients (Table 2).