CIS分期系统对预测肝癌预后的价值研究

Prospective validation of the CIS staging system of Chinese hepatocellular carcinoma

目的:比较联合记分(CIS)系统与Okuda、TNM和CLIP分期对国人原发性肝癌患者的预后分层能力,探讨CIS分期系统对预测肝癌预后的价值。方法:2003～2004年54例肝癌前瞻性纳入研究,记录诊断时CIS、Okuda、TNM和CLIP分期。采用Kaplan-Meier法绘制生存曲线,单因素分析行Log-rank检验,多因素分析采用Cox风险比例模型分析。结果:至2005年1月,全组54例患者死亡24例,失访3例,总的中位生存期为9.0个月。CIS2、3、4和5的中位生存期分别为9.0、2.3、2.1和0.6个月。Kaplan-Meier生存曲线和Cox风险比例模型分析显示,CIS系统较Okuda和TNM分期系统可以更好地预测生存期,与CLIP记分有相似的分层能力。结论:CIS分期可能较Okuda和TNM分期系统提供了更准确的预后信息,特别是对国人晚期肝癌,可用以指导临床治疗。

Objective：To compare the discriminatory ability of the China integrated score（CIS） system with the Okuda and CLIP score and TNM staging system in a group of patients with hepatocellular carcinoma （HCC）. Methods： Fifty-four patients with HCC were recruited and prospectively followed up. Staging was performed at the baseline using the CIS, Okuda, TNM and CLIP systems. Survival curves were plotted with the kaplan-meier method and were compared by using a log-rank test. A multivariate analysis on 4 staging systems was performed using a Cox＇s regression model to identify independent prognostic factor. Results：The CIS score was able to predict survival better than the Okuda or TNM staging system, as confirmed by the kaplan-meier comparison of survival curves and by the Cox＇s regression analysis, with a median survival rate of 9.0, 2. 3,2. 1 and 0. 6 months in patients with CIS 2, 3,4 and 5, respectively. The CIS system performed as well as the CLIP score. Conclusion：The CIS system compared with Okuda or TNM staging system, which gives more accurate prognostic information, particularly in the advanced phase of HCC. It could be useful in treatment planning by improving baseline prognostic evaluation of patients with HCC.