King's score as a novel prognostic model for patients with hepatitis B-associated hepatocellular carcinoma
King's score as a novel prognostic model for patients with hepatitis B-associated hepatocellular carcinoma
复制标题
DOI：
10.1097/meg.0000000000000452
复制
发表时间：
2015-11-01
影响因子：
2.1
通讯作者：
Liu, Chang
中科院分区：
文献类型：
--
作者：
Pang, Qing;Bi, Jian-Bin;Liu, Chang
背景和目的King评分（KS）已被开发用于预测慢性肝病患者中肝硬化和肝细胞癌（HCC）的存在。我们的目的是探讨KS在乙型肝炎相关的HCC的预后意义。患者和方法我们回顾性分析了319例乙型肝炎相关的HCC患者。收集术前数据以计算KS（年龄x天冬氨酸转氨酶x国际标准化比值/血小板计数）。主要结局为总生存期（OS）和无病生存期（DFS），采用Kaplan-Meier方法估计。然后，我们进行了多变量考克斯分析，以评估KS的独立意义。进行额外的分析后，患者分层的基础上肝硬化的状态和治疗方法，以探讨KS在不同subgroup.Results的意义，在中位随访期为44个月，199（62.4%）患者死亡，144（45.1%）复发。KS的临界值确定为33.31，灵敏度为56.8%，特异性为66.7%。与低KS组相比，高KS组肝硬化发生率高，Child-Pugh分级差（均P < 0.05）。多变量分析确定年龄较大、肿瘤大小5或以上、姑息治疗、巴塞罗那临床肝癌分期高和KS高是预测OS和DFS较差的重要因素。KS与肿瘤大小联合应用对生存期的判别能力优于Barcelona Clinic肝癌分期。结论KS是预测乙肝相关性肝癌OS和DFS的有效指标。需要更大的队列来验证我们的发现。版权所有（C）2015威科医疗集团All rights reserved.
Background and objectives King's score (KS) has been developed to predict the presence of cirrhosis and hepatocellular carcinoma (HCC) in patients with chronic liver diseases. We aimed to investigate the prognostic significance of the KS in hepatitis B-associated HCC.Patients and methods We retrospectively analyzed 319 hepatitis B-associated HCC patients. Preoperative data were collected to calculate the KS (age x aspartate aminotransferase x international normalized ratio/platelet count). The primary outcomes were overall survival (OS) and disease-free survival (DFS), which was estimated using the Kaplan-Meier method. Then, we carried out a multivariate Cox analysis to assess the independent significance of the KS. Additional analyses were carried out after patients were stratified on the basis of cirrhosis status and therapy methods to investigate the significance of KS in different subgroups.Results During a median follow-up period of 44 months, 199 (62.4%) patients died and 144 (45.1%) experienced recurrence. The cut-off value for the KS was determined to be 33.31 with 56.8% sensitivity and 66.7% specificity. Compared with patients with low KS, the high group showed a higher probability of cirrhosis and worse Child-Pugh class (both P < 0.05). Multivariate analysis identified older age, tumor size 5 or more, palliative therapy, high Barcelona Clinic Liver Cancer stage, and high KS as significant factors for predicting poor OS and DFS. A combination of the KS and tumor size showed better discrimination ability for survival than Barcelona Clinic Liver Cancer stage.Conclusion The KS is an effective index for predicting OS and DFS in hepatitis B-associated HCC. Larger cohorts are needed to validate our finding. Copyright (C) 2015 Wolters Kluwer Health, Inc. All rights reserved.