Staging systems in hepatocellular carcinoma.
Staging systems in hepatocellular carcinoma.
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DOI：
10.1080/13651820410024058
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发表时间：
2005-01-01
期刊：
影响因子：
--
通讯作者：
Llovet, Josep M
中科院分区：
文献类型：
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作者：
Pons, Fernando;Varela, Maria;Llovet, Josep M
分期系统是预测癌症患者预后的关键，根据临床试验中的预后变量对患者进行分层，允许研究人员之间交换信息，并最终指导治疗方法。然而，目前对这种疾病的认识，阻止了一个可以在世界范围内使用的分期系统的推荐。肝细胞癌（HCC）的传统分期系统，如Okuda分期或TNM分期，在对患者进行分类时显示出重要的局限性。最近提出了几个新系统，目前只有三个得到了验证。BCLC分期分类将疾病的阶段与特定的治疗策略联系起来。JIS评分已在日本提出并使用，但需要西方的验证。CLIP评分用于晚期肿瘤患者。确定一个世界性的系统之所以困难，有几个原因。首先，HCC是一种复杂的肿瘤，位于癌前病变的肝脏上，因此应考虑导致死亡的两种疾病的变量。第二，该疾病在世界各地差异很大，这反映了不同的潜在流行病学背景和风险因素。第三，肝细胞癌是唯一一种在小部分患者中通过移植治疗的癌症。第四，目前只有大约20%的病例通过手术治疗，因此排除了广泛使用基于病理学的系统，如TNM。最后，在结果预测方面鉴定的分子特征的潜在相关性是未知的，并且需要进一步的研究来获得可能有助于对患者进行分类的这种有价值的生物学信息。
Staging systems are key to predict the prognosis of patients with cancer, to stratify the patients according to prognostic variables in the setting of clinical trials, to allow the exchange of information among researchers, and finally to guide the therapeutic approach. The current knowledge of the disease, however, prevents recommendation of a staging system that can be used world-wide. The conventional staging systems for hepatocellular carcinoma (HCC), such as the Okuda stage or the TNM stage have shown important limitations in classifying patients. Several new systems have been proposed recently, and only three of them have been validated at this point. The BCLC staging classification links the stage of the disease to a specific treatment strategy. The JIS score has been proposed and used in Japan, although it needs Western validation. The CLIP score is used in patients with advanced tumors. Several reasons explain the difficulty in identifying a world-wide system. First, HCC is a complex neoplasm inserted on a pre-neoplastic cirrhotic liver, and thus variables of both diseases leading to death should be taken into account. Second, the disease is very heterogeneous around the world, and this reflects different underlying epidemiological backgrounds and risk factors. Third, HCC is the sole cancer treated by transplantation in a small proportion of patients. Fourth, only around 20% of the cases are currently treated by surgery, thus precluding the wide use of pathology-based systems, such as TNM. Finally, the potential relevance of a molecular signature identified in terms of outcome prediction is unknown, and further research is needed to obtain this valuable biological information that may aid in classifying the patients.