中国普外基础与临床杂志

中国普外基础与临床杂志

不同分期系统对晚期肝癌肝切除患者生存的预测价值比较

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目的对比中国分期、UICC/AJCC的TNM分期及意大利肿瘤计划(CLIP)3个不同分期系统对晚期肝癌肝切除患者生存率的预测价值。 方法回顾性分析2004年1月至2008年12月期间我院收治的伴浸润转移的肝癌肝切除患者的临床资料,分别按照中国分期、TNM分期和CLIP评分系统进行分期或评分,采用Kaplan-Meier法绘制生存曲线并行log-rank检验,应用受试者工作特征(ROC)曲线评价3个分期系统对生存率的预测价值。 结果共55例患者纳入本研究,其中男48例,女7例;中位年龄47岁;总体中位生存期7个月。中国分期:ⅡB期25例,ⅢA期30例;TNM分期:ⅢA期39例,ⅢB期5例,ⅣA期7例,ⅣB期4例;CLIP评分:0~1分16例,2~3分26例,≥4分13例。Log-rank检验提示,不同中国分期间及不同TNM分期间的累积生存率差异有统计学意义(P<0.05),而不同CLIP评分间的累积生存率差异无统计学意义(P>0.05)。ROC曲线结果提示,在预测伴浸润转移的肝癌肝切除患者预后的敏感性,中国分期优于TNM分期,TNM分期优于CLIP评分。 结论从本组有限的数据初步得出,在3个分期系统中,中国分期对伴浸润转移的肝癌肝切除患者生存率的预测能力最好,可考虑将其作为中晚期肝癌患者术后生存率的预测指标。

ObjectiveTo compare three staging systems for predicting the prognosis of patients with advanced hepatocellular carcinoma (HCC) after hepatectomy. MethodsThe clinical data of advanced HCC patients who underwent hepatectomy from January 2004 to December 2008 in this hospital were retrospectively analyzed.Tumor stage was evaluated following the Chinese staging system, tumor node metastasis (TNM) staging system, and cancer of the liver Italian program (CLIP) scoring system, respectively.Survival curves for the HCC patients were plotted using the Kaplan-Meier method and difference was compared by the log-rank test.The accuracy of each staging system for predicting survival of HCC patients was evaluated by calculating the area under curve of the receiver operating characteristic. ResultsFifty-five patients were included in this study, including 48 males and 7 females.The median age was 47 years and the median overall survival was 7 months.The clinical staging of HCC patients was 25 cases ofⅡB and 30 cases ofⅢA using Chinese staging system; 39 cases ofⅢA, 5 cases ofⅢB, 7 cases ofⅣA, and 4 cases ofⅣB using TNM staging system.The score of 0-1 was 16 cases, the score of 2-3 was 26 cases, and the score≥4 was 13 cases using CLIP scoring system.Log-rank test showed that the cumulative survival rate had a significant difference for the HCC patients betweenⅡB andⅢA of Chinese staging system (P < 0.05) and amongⅢA toⅣB of TNM staging system (P < 0.05).However, there was no significant difference in the HCC patients among score of 0-4 of CLIP scoring system (P > 0.05).The accuracy of Chinese staging system was higher than that of the TNM staging system and CLIP scoring system for predicting the survival rate of HCC patients (P > 0.05). ConclusionAccording to this limited preliminary data, Chinese staging system for strati-fying and predicting the prognosis of advanced HCC patients after hepatectomy is better than that of TNM staging system and CLIP scoring system.

关键词: 肝癌; 肝切除; 分期; 生存率

Key words: Hepatocellular carcinoma; Hepatectomy; Staging; Survival

引用本文: 许磊波, 王捷, 刘超. 不同分期系统对晚期肝癌肝切除患者生存的预测价值比较. 中国普外基础与临床杂志, 2014, 21(2): 138-141. doi: 10.7507/1007-9424.20140032 复制

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