巴塞罗那临床肝癌分期与香港肝癌分期对肝细胞癌患者预后预测价值的比较

Value of Barcelona Clinic Liver Cancer staging system versus Hong Kong Liver Cancer staging system in predicting the prognosis of patients with hepatocellular carcinoma

目的比较临床实践中巴塞罗那临床肝癌(BCLC)分期与香港肝癌(HKLC)分期对肝细胞癌(HCC)患者预后的预测价值。方法回顾性分析2008年7月-2013年7月广西医科大学附属肿瘤医院收治的436例HCC初治病例的临床资料,根据HKLC和BCLC分期系统完成分期评分,采用Kaplan-Meier法绘制生存曲线,并使用log-rank法比较两个分期系统不同分期累积生存率,同时采用Cox模型分别计算两个分期系统的似然比χ2值(LRχ2),采用受试者工作特征曲线下面积(AUC)和C-index指数分析BCLC分期与HKLC分期系统的辨别力和单一趋势性。结果 HKLC分期中相邻两分期间生存率差异均有统计学意义(P值均<0. 05)。在BCLC分期中除0期与A期外,其余各期中相邻分期间生存率差异亦均有统计学意义(P值均<0. 001)。采用Cox模型分析,HKLC (LRχ2=131. 14)比BCLC分期(LRχ2=100. 69)显示出更好的同质性。BCLC分期与HKLC分期的C-index值分别为0. 703[95%可信区间(95%CI):0. 675～0. 731]、0. 720(95%CI:0. 692～0. 748),二者差异有统计学意义(P <0. 001)。BCLC分期与HKLC分期的1年累积生存率AUC分别为0. 783(95%CI:0. 745～0. 821)、0. 811(95%CI:0. 774～0. 849),二者差异有统计学意义(P=0. 026)。结论 BCLC分期与HKLC分期对HCC患者均有良好的预后预测价值,但HKLC分期表现更佳。

ObjectiveTo investigate the value of Barcelona Clinic Liver Cancer (BCLC) staging system versus Hong Kong Liver Cancer (HKLC) staging system in predicting the prognosis of patients with hepatocellular carcinoma (HCC). MethodsA retrospective analysis was performed for the clinical data of 436 previously untreated patients with HCC who were admitted to The Affiliated Tumor Hospital of Guangxi Medical University from July 2008 to July 2013, and the staging score was determined according to the HKLC and BCLC staging systems. The Kaplan-Meier method was used to plot survival curves, and the log-rank test was used to compare the cumulative survival rate between the patients with different HKLC or BCLC stages. The Cox proportional hazards model was used to calculate the likelihood ratios (LR χ 2 ) of the two systems. The area under the receiver operating characteristic curve (AUC) and C-index were used to analyze the discriminability and trend of the HKLC and BCLC staging systems. ResultsThere was a significant difference in survival rate between the patients with adjacent HKLC stages (all P <0.05), and there was also a significant difference in survival rate between all patients with adjacent BCLC stages (all P <0.001), except between those with stage 0 and stage A HCC. The Cox proportional hazards model showed that the HKLC system (LR χ 2 =131.14) had a better homogeneity than the BCLC system (LR χ 2 =100.69). The C-index of the BCLC and HKLC systems was 0.703 (95% confidence interval [CI]: 0.675-0.731) and 0.720 (95% CI: 0.692-0.748), respectively, and there was a significant difference in C-index between the two systems ( P <0.001). There was a significant difference in the AUC of 1-year cumulative survival rate between the BCLC system and the HKLC system [0.783 (95% CI: 0.745-0.821) vs 0.811 (95% CI: 0.774-0.849), P= 0.026]. ConclusionBoth BCLC and HKLC staging systems have a good value in predicting the prognosis of HCC patients, but the HKLC staging system has a higher value than the BCLC staging system.