Comparing staging systems for predicting prognosis and survival in patients with hepatocellular carcinoma in Egypt.
Comparing staging systems for predicting prognosis and survival in patients with hepatocellular carcinoma in Egypt.
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DOI：
10.1371/journal.pone.0090929
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发表时间：
2014
期刊：
影响因子：
3.7
通讯作者：
Waked I
中科院分区：
文献类型：
--
作者：
Gomaa AI;Hashim MS;Waked I
有几种肝细胞癌（HCC）分期系统可用。尽管欧洲肝病研究协会（EASL）和美国肝病研究协会（AASLD）推荐使用巴塞罗那临床肝癌（BCLC），但在不同人群中进行的许多研究显示了异质性结果。本研究的目的是比较不同的分期系统，以预测预后和生存，并在埃及国家肝病转诊中心对HCC患者进行分层治疗。2000名患者被纳入本研究。在诊断时确定基线人口统计学、临床、实验室和放射学数据。使用Okuda、BCLC、意大利肝癌计划（CLIP）和日本综合分期（JIS）对患者进行分层。比较各分期系统中不同分期患者的生存情况以及该系统预测生存的有效性。总生存期为15个月。全组1、2、3、4年生存率分别为56%、34%、25%、15%。腹水、多发病灶、肿瘤>5 cm、门静脉血栓形成、肝外播散、AFP≥200 ng/ml和Child评分差是生存的独立预测因素（p<0.001）。在单变量和多变量分析中，所有分期系统在确定总生存率方面都有意义。BCLC是整个队列最具预测性的分期系统（p<0.001）。在提供潜在治愈性治疗的患者亚组中，BCLC是预测患者生存率的最具信息性的系统（p<0.001）。对于不适合特异性治疗的晚期HCC患者，CLIP是预测预后的最佳分期系统（p<0.001）。BCLC分期系统为HCC患者提供了最佳的预后分层。然而，CLIP评分在晚期HCC患者中具有最高的分层能力，突出了将AFP纳入最佳分期系统的重要性。
Several hepatocellular carcinoma (HCC) staging systems are available. Although the European Association for Study of Liver Diseases (EASL) and American Association for the Study of Liver Diseases (AASLD) recommended the use of Barcelona Clinic Liver Cancer (BCLC), many studies in different populations revealed heterogeneous results. The aim of this study was to compare different staging systems for predicting prognosis and survival, and for stratifying HCC patients for treatment at a national referral centre for liver disease in Egypt. 2000 Patients were included in this study. Baseline demographic, clinical, laboratory, and radiological data were determined at diagnosis. Patients were stratified using the Okuda, BCLC, Cancer of the Liver Italian Program (CLIP), and Japan Integrated Staging (JIS). Patients’ survival in different stages within each staging system and the validity of the system in predicting survival were compared. The overall survival was 15 months. The 1-, 2-, 3- and 4-year survival of the entire cohort was 56%, 34%, 25% and 15% respectively. The presence of ascites, multiple focal lesions, large tumour size >5 cm, portal vein thrombosis, extra-hepatic spread, AFP≥200 ng/ml and poor Child score were independent predictors of survival (p<0.001). All staging systems were significant in determining overall survival in univariate and multivariate analyses. BCLC was the most predictive staging system for the whole cohort (p<0.001). Among the subgroup of patients offered potentially curative therapy, BCLC was the most informative system in predicting patient survival (p<0.001). For patients with advanced HCC not amenable for specific therapy, CLIP was the best staging system for predicting prognosis (p<0.001). BCLC staging system provided the best prognostic stratification for HCC patients. However, CLIP score has the highest stratification ability in patients with advanced HCC highlighting the importance of including AFP in best staging system.
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