中级评分系统对TACE与肝切除术治疗BCLC-B期中度肝细胞性肝癌的预后价值

The prognostic value of Intermediate Stage Score on patients with sub-classification of intermediate-stage hepatocellular carcinoma undergone liver resection and transarterial chemoembolization

目的探讨中级评分系统(intermediate stage score,ISS)在中度肝细胞性肝癌(intermediate-stage hepatocellular carcinoma,IHCC)患者接收受肝动脉化疗栓塞(transarterial chemoembolization,TACE)和肝切除(liver resection,LR)术后对预后评估的判断价值及指导意义。方法回顾性分析2009年4月至2011年10月温州医科大学附属第三医院行TACE或LR治疗的260例BCLC-B期IHCC患者的临床资料。其中,LR组139例,TACE组121例,共260例,所有病例均经住院或电话随访,根据患者临床及随访资料进行统计学分析。采用倾向性评分匹配(propensity scorematching,PSM)法去除混杂因素后,判断ISS在LR组和TACE组中的预后判断价值。结果 260例BCLC-B期患者中,男160例(61.5%),女100例(38.5%),平均年龄为(59.1±10.3)岁。不同ISS分级患者的中位生存时间存在差异,随ISS评级增高,中位生存时间降低,分别为:1级48个月,2级37.5个月,3级24个月,4级17.5个月,5级10个月,各组差异具有统计学意义(P<0.05)。LR组中ISS 4~5级患者预后差于ISS 1级患者(HR=2.542,95%CI=0.461~8.416);同样,在TACE组中ISS 4~5级患者预后也比ISS 1级患者更差(HR=2.542,95%CI=0.461~8.416);经似然比检验,ISS在LR及TACE组均是一个有效的预后预测因子(P=0.018和P=0.003)。进一步比较TACE和LR两治疗组间ISS的预后价值差异,结果显示,两组的相同ISS分级间预后并无差异(P=0.121)。结论 ISS可预测BCLC-B期IHCC患者的预后,减少异质性,是临床选择TACE和LR治疗方案的患者的有效预后判断工具。

objective To evaluate the prognostic value of the Intermediate Stage Score（ISS） on overall survival（OS） in interinediate-stage hepatocellular carcinoma（IHCC） patients treated with transarterial chemoembolization（TACE） or liver resection（LR）.Methods Two hundred and sixty BCLC-B IHCC patients undergone liver resection（n=139） or TACE（n=121） in the Third Affiliated Hospital of Wenzhou Medical University between Apr.2009 and Oct.2011 were retrospectively collected.All cases were followed-up through hospitalization or telephone,prognosis and survival analysis were carried out according to clinical data.Propensity Score Matching（PSM） was used to remove residual confounding factors and applied to LR and TACE group to determine the prognostic significance of ISS.Results Of all 260 patients with BCLC-B stage,there were 160 males（61.5%） and 100 females（38.5%）,with an average age of（59.1±10.3） years.The median overall survival of patients was altered with different ISS,and the median overall survival was decreased with the ISS increasing：48 months in ISS 1,37.5 months in ISS 2,24 months in ISS 3,17.5 months in ISS 4,and 10 months in ISS 5,with statistically significant among each group（P〈0.05）.The prognosis of patients with ISS 4~5 in the LR group was worse than that of the patients with ISS 1（HR=2.542,95%CI=0.461~8.416）,and the prognosis of patients with ISS 4~5 in the TACE group was also worse than that of the patients with ISS 1（HR= 2.542,95%CI=0.461~8.416）.The likelihood ratio test results showed that ISS was an effective prognostic factor of both the LR and TACE groups（P=0.018 and P=0.003）.However,there was no significant difference between the LR and TACE groups in the same ISS（P=0.121）.Conclusion ISS optimizes prognostic prediction in IHCC,reduce patient＇s heterogeneity,which is a useful prognostic tool for patients treated with TACE or LR.