不同肝癌分期系统预测混合型肝细胞-胆管细胞癌患者手术预后的比较

Comparison of the Predictive Values of Eight Staging Systems for Primary Liver Cancer in Prognosis of Combined Hepatocellular-cholangiocellular Carcinoma Patients after Surgery

目的比较不同原发性肝癌分期系统对混合型肝细胞-胆管细胞癌(c HCC-CC)手术治疗患者的预后预测能力。方法将2005年5月至2013年8月在中国人民解放军总医院行手术治疗、有术后病理确诊结果、临床资料和随访资料完备的54例c HCC-CC纳入研究。利用8种肝癌分期系统对该组病例分期,采用病例构成比、生存曲线、受试者工作特征曲线分别比较各分期系统的病例分层能力、预后区分能力及预后结果预测能力。结果肝内胆管癌肿瘤-淋巴结-转移[TNM(ICC)]分期及日本集成分期评分病例构成相对均衡。本组病例术后12和24个月累计生存率分别为65.5%、56.3%。各期生存曲线差异有统计学意义(P<0.05)的分期有TNM(ICC)分期(Ⅰ期比Ⅱ期,P=0.012;Ⅱ期比Ⅲ&Ⅳ期,P=0.002)、奥田邦雄分期(Ⅰ期比Ⅱ期,P=0.025)、法国分期(A期比B期,P=0.045)。术后12和24个月各分期系统受试者工作特征曲线下面积由大到小分别为TNM(ICC)分期(0.836、0.847)、巴塞罗那临床肝癌分期(0.744、0.780)、日本集成分期评分(0.723、0.764)、意大利肝癌评分(0.710、0.786),其余分期系统的受试者工作特征曲线下面积差异无统计学意义。结论 TNM(ICC)分期对c HCC-CC病例分层能力、预后区分能力及预后结果预测能力均优于其他7种分期系统。

Objective To compare the predictive values of eight staging systems for primary liver cancer in the prognosis of combined hepatocellular-cholangiocellular carcinoma（ c HCC-CC） patients after surgery.Methods The clinical data of 54 c HCC-CC patients who underwent hepatectomy or liver transplantation fromMay 2005 to Augest 2013 in Chinese PLA General Hospital were collected. We evaluated the prognostic value of the Okuda staging system,Cancer of the Liver Italian Program（ CLIP） score,French staging system,Barcelona Clinic Liver Cancer（ BCLC） staging system,7th edition of tumour-node-metastasis（ TNM） staging system for hepatocellular carcinoma and intrahepatic cholangiocarcinoma（ ICC）, Japan Integrated Staging（ JIS） score,and Chinese University Prognostic Index. The distribution,Kaplan-Meier method,Log-rank test,and area under a receiver operating characteristic curve were used to compare the prognosis-predicting ability of these different staging systems in 54 c HCC-CC patients after surgery. Results The TNM staging system for ICC and JIS score had a better distribution of cases. The 12-and 24-month survivals of the entire cohort were 65. 5% and 56. 3%,respectively. A Log-rank test showed that there was a significant difference existing in the cumulative survival rates of different stage patients when using TNM staging system for ICC（ stage Ⅰ vs. stage Ⅱ,P = 0. 012; stage Ⅱ vs.stage Ⅲ-Ⅳ,P = 0. 002）,Okuda staging system（ stage Ⅰ vs. stage Ⅱ,P = 0. 025）,and French staging system（ stage A and stage B,P = 0. 045）. The 12-and 24-month area under curve of TNM staging system for ICC,BCLC staging system,JIS score,and CLIP score were 0. 836 and 0. 847,0. 744 and 0. 780,0. 723 and0. 764,and 0. 710 and 0. 786,respectively. Conclusion The 7th edition of TNM staging system for ICC has superior prognostic value to other seven staging systems in c HCC-CC patients undergoing surgical treatment.