肝细胞肝癌临床分期系统的比较

Comparison of different clinical staging systems for hepatocellular carcinoma

目的比较中国分期(CS)、CLIP评分系统和TNM分期对肝细胞肝癌临床疗效的评价和对预后的判断。方法回顾性分析2000年1月至2003年10月我院收治的107例肝细胞肝癌患者的临床资料,根据患者确诊时的情况,按CS分期和CLIP评分系统分别作出分期。对其中53例行外科手术切除的患者,再根据组织学作出TNM分期。按CS分期、CLIP评分系统和TNM分期,分别计算患者的累积生存率,以Kaplan-Meier曲线表示,并以Log rank方法进行比较。结果全部病例均获随访。CS分期的Ⅰa、Ⅰb期和CLIP评分为0的患者,3年生存率均为100%。CS分期的Ⅲa期,1、2年生存率分别为68.0%和51.0%;Ⅲb期1年生存率为20.9%。按CLIP评分系统,评分>4的患者,1、2、3年生存率分别为57.1%、49.9%和33.5%。行外科切除的患者中,CS分期的Ⅰa期和TNM的Ⅰ期,3年生存率均为100%;CS分期的Ⅱb期,1、3年生存率分别为83.3%和75.0%;TNM的Ⅲ期,1、3年生存率分别为93.7%和77.5%。结论CLIP分期易于根据早期临床特征准确反映预后。CS分期在判断患者预后方面同样有效,尤其适用于合并严重肝硬化的患者。

Objective To compare the prognostic efficacy of three clinical staging systems： the Chinese system （CS）, CLIP scores, and TNM for hepatocellular carcinoma （HCC）. Methods 107 cases diagnosed as HCC between January 2000 and October 2003 were retrospectively analyzed. Their clinical stages were decieded on the basis of data in CLIP or Chinese staging system when the HCC diagnosis had been confirmed. Fifty-three of the 107 patients underwent surgical resection. The TNM stage was therefore determined according to surgico-pathological results. The survival of those patients with respective to different stages were analyzed and compared using Kaplan-Meier curves and Log rank method. Results All the patients were followed up after treatment. The 3-year survival rate in the CS Ⅰa, Ib and CLIP 0 group were 100%. The 1- and 2-year survival rates of CS Ⅲa group was 68% and 51%, respectively. The 1-year survival in CS Ⅲb group was only 20.9%. The 1-, 2-, and 3-year survival rate in patients with a CLIP score beyond 4 was 57.1%, 49.9%, and 33.5%, respectively. In patients treated with surgical resection, the CS Ⅰa group and TNM Ⅰ group had a 3-year survival rate of 100%. The 1- and 3-year survival rate in CS Ⅱb were 83.3% and 75.0%, in TNM Ⅲgroup 93.7% and 77.5%. Conclusion The CLIP system may provide accurate prediction of prognosis based on early clinical features. The CS system is comparably efficient in predicting the prognosis of HCC patients, particularly in patients with severe cirrhosis.