Is the pathologic TNM staging system for patients with hepatoma predictive of outcome?
Is the pathologic TNM staging system for patients with hepatoma predictive of outcome?
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DOI：
10.1002/(sici)1097-0142(20000201)88:3
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发表时间：
2000-02-01
期刊：
影响因子：
6.2
通讯作者：
Iwatsuki, S
中科院分区：
文献类型：
--
作者：
Marsh, JW;Dvorchik, I;Iwatsuki, S
背景。病理 TNM (pTNM) 分期系统旨在帮助确定癌症患者的预后以及规划和评估其治疗。目前的 pTNM 分类系统无法预测患有肝细胞癌 (HCC) 的情况下接受原位肝移植 (OLTx) 的患者。因此，作者检查了当前的系统，以确定改进是否可以开发出更具预测性的系统。方法。 1981 年至 1997 年间，307 名 HCC 患者接受了 OLTx。使用 Kaplan-Meier 方法和对数秩检验确定了复发的危险因素。 Cox 比例风险模型用于识别独立预测复发的因素，然后用于创建新的分期系统。 结果。当前的 pTNM 系统与无瘤生存率之间既没有直接相关性，也没有当前某些 pTNM 类别中患者的结果的同质性。研究发现，血管侵犯深度、肺叶分布、淋巴结状况和最大肿瘤大小是无瘤生存的独立预测因素；在多变量分析中未发现肿瘤数量显着。提出了一种新的分期系统，该系统考虑了多变量分析的结果，其中无瘤生存与分期直接相关。结论。所提出的分期系统在预测 HCC OLTx 后的无瘤生存期方面优于当前的 pTNM 分期系统。进一步的研究将确定该系统对肝次全切除术后 HCC 分期的适用性。 (C) 2000 年美国癌症协会。
BACKGROUND. The pathologic TNM (pTNM) staging system was designed to aid in determining the prognosis of cancer patients and in planning and evaluating their treatment. The current pTNM classification system was not found to be predictive for patients undergoing orthotopic liver transplantation (OLTx) in the presence of hepatocellular carcinoma (HCC). Therefore, the authors examined the current system to determine whether improvements would allow the development of a more predictive system.METHODS. Three hundred seven patients with HCC underwent OLTx between 1981 and 1997. Risk factors for recurrence were identified using the Kaplan-Meier method with the log rank test. The Cox proportional hazards model was used to identify factors independently predictive of recurrence which were then used to create a new staging system.RESULTS. There was neither a direct correlation between the current pTNM system and tumor free survival nor homogeneity in outcomes for patients within certain current pTNM categories. Depth of vascular invasion, lobar distribution, lymph node status, and largest tumor size were found to be independent predictors of tumor free survival; tumor number was not found to be significant in multivariate analysis. A new staging system is proposed, which takes into account the results of the multivariate analysis in which tumor free survival correlates directly with stage.CONCLUSIONS. The proposed staging system is superior to the current pTNM staging system in predicting tumor free survival following OLTx with HCC. Further studies will determine the appropriateness of this system for staging HCC after subtotal hepatic resection. (C) 2000 American Cancer Society.