CLIP评分系统对评价手术切除肝癌预后的意义

Prognostic value of CLIP score system for patients with resection of hepatocellular carcinoma

目的 探讨CLIP评分系统对判断手术切除肝癌预后的意义。 方法 回顾分析 1986年 1月～ 1998年 6月 174例肝细胞肝癌切除病例的临床资料 ,其中 15 3例获治愈性切除 ,并随访 3年以上。以影像学发现肿瘤复发及患者死亡或末次随访日期为截点确定无瘤生存时间。以术后 3年内是否复发分为早期复发 (≤ 3年复发 )、后期复发 (>3年 )及未复发 3组 ,确定复发危险因素。统计学处理采用SPSS 8 0forwindows软件包 ,复发危险因素采用卡方检验 (Pearson′s或确切概率法 ) ,生存期采用Kalain Meier法 ,Long rang比较生存曲线 ,多因素分析采用COX比例风险模型。以双侧α =0 0 5为统计学差异显著指标。 结果 本组术后 1、3、5、7、10年无瘤生存率分别为 5 7 2 %、2 8 3%、2 3 5 %、18 8%及 17 8%。与肿瘤早期复发相关因素为根治性切除、手术切缘、肿瘤大小、有否卫星结节、血管癌栓、肿瘤大体形态、肿瘤侵犯程度、TNM分期及CLIP评分 ;与后期复发相关因素为Child分级、CLIP评分。生存曲线比较单因素中 ,Child分级、根治性切除、手术切缘、肿瘤大小、有否卫星结节、血管癌栓、肿瘤大体形态、肿瘤侵犯程度、TNM分期及CLIP评分系统与预后有关 ;多因素COX比较仅根治性切除、手术切缘、TNM分期与预后有关。 结论 CLIP评?

Objective To evaluate the prognostic value of CLIP score system for patients with resection of HCC. Methods A retrospective survey was carried out in 174 patients undergoing resection of HCC from January 1986 to June 1998. 153 of 174 patients with curative resection were followed up for at least three years. Disease free survival rate was defined as the time relapsed from the date of image diagnosis and either the date of death or the date of the latest follow up visit, with final evaluation at June 30,2001. Recurrences were classified into early (≤3 year) and late (>3 year) recurrence. Risk factors for recurrences and prognostic factors for survival in each group were analyzed by the chi square test, the Kalain Meier estimation and the COX proportional hazards model respectively. Results The 1 ,3 ,5 ,7 ,and 10 year cumulative disease free survival rates were 57 2%,28 3%,23 5%,18 8% and 17 8%,respectively. The associated factors with early recurrence were as fellows: tumor size >5cm, microsatellite, venous invasion, tumor morphology, tumor extension, advanced TNM stages, CLIP scores, radical resection, and resection margin, respectively. But both CLIP scores and Child stage were associated with late recurrence. Univariate survival curves analysis expressed that Child grades, radical resection, resection margin, tumor size, microsatellite, venous invasion, tumor morphology, tumor extension, TNM stages, and CLIP scores were associated with prognosis. The multivariate analysis by COX proportional hazards model, the independent prognostic factors for survival were radical resection, resection margin, and TNM stages. Conclusions CLIP score, which takes into account both liver function and tumor extension, has displayed a unique superiority in predicting the tumor early and late recurrence and prognosis. It could be an useful tool in predicting the patient recurrence and prognosis with resection of HCC. Meanwhile, it may help physicians to decide the more appropriate management in advance for patients with HCC.