A new prognostic classification for predicting survival in patients with hepatocellular carcinoma
A new prognostic classification for predicting survival in patients with hepatocellular carcinoma
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DOI：
10.1016/s0168-8278(99)80173-1
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发表时间：
1999-07-01
影响因子：
25.7
通讯作者：
Chastang, C
中科院分区：
文献类型：
--
作者：
Chevret, S;Trinchet, JC;Chastang, C
背景/目的：肝细胞癌患者的生存预测是困难的。本前瞻性研究的目的是提供一个简单的分类预测生存的肝细胞癌患者，多变量考克斯模型的基础上，方法：761例肝细胞癌患者从24个西方医学中心参加了30个月的时间。患者被随机分配到一个训练样本，（n=506，418例死亡），根据其建立分类系统，或测试样本结果：在0.0001水平上选择了5个预后因素：Karnofsky指数50 μ mol/l（相对风险= 2.1，95%置信区间：1.7-2.6），血清碱性磷酸酶至少为正常范围上限的两倍（相对危险度= 1.6，95%置信区间：1.3-2.0），血清甲胎蛋白>35 μ g/l（相对危险度= 1.7，95%置信区间：1.4-2.1）和超声门静脉阻塞（相对风险= 1.3，95%置信区间：1.1-1.7），具有不同1年生存率的三个风险组（72%，34%，7%）是衍生的，并在测试样本中独立验证结论：该分型可用于评估同质组患者的预期预后。
Background/Aims: In patients with hepatocellular carcinoma, prediction of survival is difficult. The aim of this prospective study was to provide a simple classification for predicting survival of patients with hepatocellular carcinoma, based on a multivariable Cox model,Methods: Seven hundred and sixty-one patients who presented with hepatocellular carcinoma from 24 Western medical centers were enrolled over a 30-month period. Patients were randomly assigned to either a training sample (n=506, with 418 deaths) from which a classification system was established, or a test sample (n=255, with 200 deaths) for validating its prognostic significance.Results: Five prognostic factors were selected at the 0.0001 level: Karnofsky index 50 mu mol/l (relative risk = 2.1, 95% confidence interval: 1.7-2.6), serum alkaline phosphatase at least twice the upper limit of normal range (relative risk = 1.6, 95% confidence interval: 1.3-2.0), serum alpha-fetoprotein >35 mu g/l (relative risk = 1.7, 95% confidence interval: 1.4-2.1), and ultrasonographic portal obstruction (relative risk = 1.3, 95% confidence interval: 1.1-1.7), Three risk groups with different 1-year survival rates (72%, 34%, 7%) were derived, and independently validated in the test sample (79%, 31%, 4%),Conclusion: This classification could be useful in the assessment of prognosis from homogeneous groups of patients with respect to their expected outcome.