临床常用分期标准对原发性肝癌术后三年生存率的预测价值比较

Comparative study of the prognostic value of different staging systems in patients with resectable hepatocellular carcinoma

目的评价目前主要的4种肝癌分期标准CLIP评分,TNM、BCLC、Okuda分期对手术治疗后肝癌患者短期疗效的预测价值,选出不同临床阶段中的最优分期标准。方法研究对象随机选自2003年3月到2008年7月在我院肝胆外科手术治疗的原发性肝癌患者,使用线性趋势卡方检验和似然比卡方检验评估各分期标准的同质性,使用COX比例风险模型计算了不同分期分别从模型中剔除时其相应对数似然估计值(-2 Loglikelihood)的升高大小。结果患者1、2、3年总体生存率分别为84.7%、64.1%、42.9%,中位生存时间31个月,在4种评分标准中,CLIP评分和BCLC分期在同质性、判别力、梯度单一性和对模型预后预测价值的独立因素大小比较中要高于TNM和Okuda分期。结论 CLIP评分、BCLC分期对肝癌切除术后的预测价值优于TNM、Okuda分期。

Objective To investigate established staging systems of hepatocellular carcinoma（HCC） in routine clinical use to determine their potential for predicting survival of Chinese patients with resectable HCC.Methods The follow - up data of 165 patients who underwent hepatic resection for HCC from March 2003 to July 2008 at our hospital were retrospectively analyzed.The tumors of all patients were staged using the Cancer of the Liver Italian Program（CLIP） system,the Barcelona Clinic Liver Cancer（BCLC） system,the Okuda system,and the tumor - nodes - metastasis（TNM） system.The overall survival rates associated with each staging system were calculated using the life table method. The likelihood ratio and linear trend Chi - squared tests were used to compare the homogeneity and monotonicity of the relationship between stage and mortality rate of each staging system.Regression modeling was used to rank the independent contribution of each staging system. Results Survival rates for 1,2 and 3 years were 84.7%,64.1% and 42.9%,respectively.The median survival time was 31 months.Among the four clinical staging systems evaluated,CLTP/BCLC showed the best homogeneity,discriminatory capacity,and monotonicity of gradients. The independent contribution of each staging system was determined to be CLIP/BCLC TNM/Okuda.Conclusion The CLIP and BCLC systems have higher prognostic value,with better stratification and higher discriminatory capacity,than the TNM and Okuda systems.