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PURPOSE Although CD4 + cytotoxic T cells (CTLs) have been reported by several investigators, their significance in antitumor immunity in human cancer is unclear.This study aims to further characterize CD4 + CTLs in hepatocellular carcinoma (HCC) patients, and to uncover the regulatory mechanisms by which they contribute to disease progression.Methods Five-hundred and forty-seven HCC patients, 46 liver cirrhosis (LC) patients, and 63 normal control individuals were enrolled.CD4 + CTLs were characterized by flow cytometry, immunohistochemistry and lyric granule exocytosis assays.Multivariate analysis of prognostic factors for overall survival was made using Coxs proportional hazards model.