Glasgow预后评分对肝细胞癌肝切除术后远期预后的评估

Evaluation of Glasgow prognostic score for long-term prognosis after hepatectomy for hepatocellular carcinoma

目的探讨Glasgow预后评分(Glasgow prognostic score,GPS)在评估肝细胞癌(hepatocellular carcinoma,HCC)患者肝切除术后远期预后的临床价值。方法 2008年1月至2012年12月共317例HCC患者在延安市人民医院接受肝切除术,根据患者术前血GPS评分将患者分为GPS-0、GPS-1和GPS-2组,回顾性分析3组患者的临床特征,比较术后远期生存率和无进展生存期的差异,并分析GPS评分与HCC患者预后的相关性。结果 GPS-0组患者167例(52.7%),GPS-1组患者128例(40.4%),GPS-2组患者22例(6.9%),3组患者的AFP水平、肿瘤直径及手术切口感染的差异有统计学意义(t=29.308,P<0.001;t=11.092,P<0.001;χ2=28.659,P<0.001)。HCC患者的术后五年生存率和无进展生存期随GPS评分的增加而降低,门静脉浸润(HR=3.721,95%CI:3.232~4.411,P<0.001)和GPS评分(HR=6.433,95%CI:4.347~9.284,P<0.001)是影响HCC患者不良预后的独立危险因素。结论GPS是HCC患者肝切除术后远期预后评估的独立指标,基于GPS评分的分层评估体系在预测HCC患者的远期预后具有重要的临床价值。

Objective To investigate the clinical value of Glasgow prognostic score （GPS） in evaluating the longtermprognosis of hepatectomy for hepatocellular carcinoma （HCC）. Methods Total of 317 patients with HCCwho underwent hepatectomy in Yan’an People’s Hospital from January 2008 to December 2012 were selected.According to GPS score, all patients were divided into GPS-0, GPS-1 and GPS-2 group, and the differences ofthe clinical features, long-term survival rate and progression free survival time were retrospectively analyzed.The correlation between GPS grades and prognosis of patients with HCC was also analyzed. Results There were167 cases （52.7%） in GPS-0 group, 128 cases （40.4%） in GPS-1 group and 22 cases （6.9%） in GPS-2 group,respectively. The AFP levels, tumor diameter and incision infection rates were statistically significant among threegroups （t = 29.308, P 〈 0.001; t = 11.092, P 〈 0.001; χ2 = 28.659, P 〈 0.001）. The five-year survival rate andprogression-free survival of HCC patients decreased with the increase of GPS score. Portal vein invasion （HR =3.721, 95% CI： 3.232～4.411, P 〈 0.001） and GPS grades （HR = 6.433, 95% CI： 4.347～9.284, P 〈 0.001） wereindependent risk factors of poor prognosis in patients with HCC. Conclusions GPS is an independent predicatorfor long-term prognosis after hepatectomy of patients with HCC. Hierarchical evaluation system based on GPSgrade has important clinical value on predicting long-term prognosis of patients with HCC.