Total tumor volume predicts survival following liver resection in patients with hepatocellular carcinoma
Total tumor volume predicts survival following liver resection in patients with hepatocellular carcinoma
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DOI：
10.1007/s13277-016-4794-7
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发表时间：
2016-07-01
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影响因子：
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通讯作者：
Cai, Jian-qiang
中科院分区：
文献类型：
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作者：
Li, Mu-xing;Zhao, Hong;Cai, Jian-qiang
通过肿瘤的数量和大小来评估肝细胞癌患者的预后有时是困难的。本研究的主要目的是评价综合两个因素的总肿瘤体积(TTV)对接受肝切除术的肝细胞癌患者的预后价值。我们回顾了2001年1月至2008年12月在我们中心的521例肝细胞癌患者。根据TTV的三分位数对患者进行分类。评估TTV的预后价值。中位随访116个月，1、3、5年总生存率分别为93.1%、69.9%、46.3%。TTV三组间的OS有显著差异，TTV值越高，OS越短(P<；0.001)。多因素分析显示，TTV是OS的独立预后因素。较大的TTV与较高的甲胎蛋白水平、大血管侵犯、多个肿瘤病变、较大的肿瘤大小和晚期肿瘤分期显著相关(均P<；0.05)。在TTV73.5 cm(3)范围内，符合和超出米兰标准的患者的OS差异无统计学意义(P=0.183)。在被测试的分期系统中，基于TTV的意大利肝癌计划(CLIP)评分获得了最低的Akaike信息标准值，最高的似然比检验的X(2)值，以及最高的C指数。我们的结果表明，TTV是反映肝细胞癌患者肿瘤负担的良好指标。需要进一步的研究来验证TTV的预后价值。
Assessing the prognosis of patients with hepatocellular carcinoma (HCC) by the number and size of tumors is sometimes difficult. The main purpose of the study was to evaluate the prognostic value of total tumor volume (TTV), which combines the two factors, in patients with HCC who underwent liver resection. We retrospectively reviewed 521 HCC patients from January 2001 to December 2008 in our center. Patients were categorized using the tertiles of TTV. The prognostic value of TTV was assessed. With a median follow-up of 116 months, the 1-, 3-, and 5-year overall survival (OS) rates of the patients were 93.1 , 69.9, and 46.3 %, respectively. OS was significantly differed by TTV tertile groups, and higher TTV was associated with shorter OS (P < 0.001). Multivariate analysis revealed that TTV was an independent prognostic factor for OS. Larger TTV was significantly associated with higher alpha-fetoprotein level, presence of macrovascular invasion, multiple tumor lesions, larger tumor size, and advanced tumor stages (all P < 0.05). Within the first and second tertiles of TTV (TTV aecurrency sign 73.5 cm(3)), no significant differences in OS were detected in patients within and beyond Milan criteria (P = 0.183). TTV-based Cancer of the Liver Italian Program (CLIP) score gained the lowest Akaike information criterion value, the highest chi (2) value of likelihood ratio test, and the highest C-index among the tested staging systems. Our results suggested that TTV is a good indicator of tumor burden in patients with HCC. Further studies are warranted to validate the prognostic value of TTV.