肝癌不同分期标准对肝癌切除治疗患者生存预测价值对比

Survival prediction comparison of liver cancer different staging criteria on liver cancer ;resection

目的：探讨不同肝癌分期标准对肝癌术后患者的生存预测价值。方法回顾性分析2008年3月至2012年3月4家医院（长治医学院附属和济医院、山西省肿瘤医院、山西医科大学附属第二医院、山西省中医院）收治的218例肝癌术后患者的临床资料并进行随访，所有患者在初次诊断时均按照中国肝癌协会分期（CS）、意大利肝癌研究组（CLIP）、TNM分期、奥田邦雄分期系统（OKUDA）进行评分，评价4个分期系统对肝癌术后患者6个月的生存预测价值，并采用COX比例风险模型计算从模型中分别剔除不同分期时其对应的对数似然估计值，从而评判哪种分期标准对预后预测的价值更高。结果218例肝癌术后患者的随访时间为2～36个月，平均随访时间为（22.34±5.89）个月，3年生存率为33.94%，中位生存时间为25.38个月。4种分期方法中，各分期间区分度最好的是TNM分期、OKUDA分期标准。同时TNM分期、OKUDA分期标准的同质性、判别力及梯度单一性、对COX模型独立贡献价值均较高。结论肝癌患者肝切除后采用TNM分期、OKUDA分期标准,对患者的预后预测具有较高的价值。

Objective To investigate the prediction value of liver cancer different staging criteria on liver cancer resection. Methods Clinical data of 218 cases with advanced liver cancer in four hospitals were selected. All patients were scored by CS、CLIP、TNM staging and OKUDA. Evaluated this four staging systems on survival prediction value of 6 month advanced liver cancer. COX proportional hazard model was used to eliminate likelihood estimator in order to judge which staging criteria had better prognosis prediction. Results Follow-up period of 218 cases was 2-36 month, average follow-up time was （22.34±5.89）month, three-year survival rate was 33.94%, median survival time was 25.38 month. Of the four staging methods, degree of distinction was better TNM staging、OKUDA staging criteria. At the mean time,homogeneity,discrimination power,gradient singularity of TNM staging and OKUDA staging criteria all had higher contributed value. Conclusions Application of TNM staging, OKUDA on liver cancer resection have better survival prediction value.