Proposal of a modified cancer of the liver Italian program staging system based on the model for end-stage liver disease for patients with hepatocellular carcinoma undergoing loco-regional therapy
Proposal of a modified cancer of the liver Italian program staging system based on the model for end-stage liver disease for patients with hepatocellular carcinoma undergoing loco-regional therapy
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DOI：
10.1111/j.1572-0241.2006.00462.x
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发表时间：
2006-05-01
影响因子：
9.8
通讯作者：
Lee, Shou-Dong
中科院分区：
文献类型：
--
作者：
Huo, Teh-Ia;Huang, Yi-Hsiang;Lee, Shou-Dong
背景：意大利肝癌计划（CLIP）系统被认为是肝细胞癌（HCC）的主要分期系统。与child - turcote - pugh （CTP）系统相比，终末期肝病（MELD）模型是肝硬化患者更好的预后预测器，child - turcote - pugh是CLIP模型中使用的一个参数。目的：研究改良的基于meld的CLIP系统的性能。方法：将CLIP模型中的CTP分级替换为MELD评分（< 10、10-14、> 14；改良的CLIP-1），或对MELD评分为10-14或> 14的患者分别给予1分或2分（改良的CLIP-2）。在343例接受局部-区域治疗的HCC患者中，将改良的CLIP系统与原始系统进行了比较。结果：所有患者的原始CLIP评分为1.2 +/- 1.1（范围0-5），而改良的CLIP-1模型为1.4 +/- 1.2（范围0-5），改良的CLIP-2模型为1.7 +/- 1.4（范围0-6）（p < 0.001）。以死亡率为终点，12个月时改良CLIP-2系统的受试者工作特征曲线下面积为0.858，改良CLIP-1系统为0.812 (p = 0.013)，原始CLIP系统为0.782 (p < 0.001)；24个月时，面积分别为0.879、0.830、0.762 （p均< 0.001）。生存分析表明，改良的CLIP系统对不同评分组具有更好的长期区分能力。结论：CLIP模型可用于预测接受局部-区域治疗的HCC患者的预后。基于meld的改良CLIP系统可能比原始的癌症分期模型具有更好的预测能力。
BACKGROUND: The Cancer of Liver Italian Program (CLIP) system was suggested as the primary staging system for hepatocellular carcinoma (HCC). The model for end-stage liver disease (MELD) is a better prognostic predictor for cirrhotic patients compared to Child-Turcotte-Pugh (CTP) system, which is a parameter used in the CLIP model.AIM: To investigate the performance of the modified MELD-based CLIP systems.METHODS: The CTP class in the CLIP model was replaced with MELD score (< 10, 10-14, > 14; modified CLIP-1), or additional 1 or 2 points were given to patients with MELD score 10-14 or > 14, respectively (modified CLIP-2). The modified CLIP systems were compared with the original system in 343 HCC patients undergoing loco-regional therapy.RESULTS: The original CLIP score in all patients was 1.2 +/- 1.1 (range 0-5), compared with 1.4 +/- 1.2 (range 0-5) for modified CLIP-1 and 1.7 +/- 1.4 (range 0-6) for modified CLIP-2 models (p < 0.001). Using mortality as the endpoint, the area under receiver operating characteristic curve for modified CLIP-2 system was 0.858 compared with 0.812 for modified CLIP-1 (p = 0.013) and 0.782 for original CLIP system (p < 0.001) at 12 months; the area was 0.879, 0.830, and 0.762, respectively (p all < 0.001) at 24 months. Survival analysis showed that the modified CLIP systems had a better long-term discriminatory ability for different score groups.CONCLUSIONS: The CLIP model is useful to predict the outcome in HCC patients undergoing loco-regional therapy. The MELD-based modified CLIP systems may have a better predictive ability than the original model for cancer staging.