New Staging Model for Radiation-based Hepatocellular Carcinoma Treatment: A National Multicenter Study.
New Staging Model for Radiation-based Hepatocellular Carcinoma Treatment: A National Multicenter Study.
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基于放射的肝细胞癌治疗的新分期模型：一项全国多中心研究
DOI：
10.14218/jcth.2022.00002
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发表时间：
2023-04-28
影响因子：
3.6
通讯作者：
Huang, Yong
中科院分区：
文献类型：
--
作者：
Su, Ting-Shi;Liang, Shi-Xiong;Li, Li-Qing;Liu, Qiu-Hua;Duan, Xue-Zhang;Sun, Jing;Zeng, Hai;Zhu, Hai-Sheng;Li, Jian-Xu;Zhu, Xiao-Fei;Zhuang, Hong-Qing;Liang, Ping;Huang, Yong
关键词：
该研究旨在为基于放射治疗的预后肝细胞癌（HCC）分类创建一个新的分期模型。训练队列包括658例接受立体定向体部放疗的患者，外部验证队列包括533例接受三维适形放疗和调强放疗的患者。我们建立了一个改良的分期系统如下：I期，孤立结节无大血管侵犯，或2-3个结节间隔不超过3.0 cm，体能状态（PS）0-2（Ia：ALBI-1级; Ib：ALBI-2或3级）; II期：2-3个结节，其中任何一个结节间距大于3.0 cm，或≥4个结节，体能状态0-2（IIa：ALBI-1级; IIb：ALBI-2级）; III期：大血管侵犯、区域淋巴结转移或远处转移，体能状态0-2（IIIa：ALBI-1级; IIIb：ALBI-2级）; IV期：体能状态3-4，或体能状态0-2伴ALBI-3级。我们分析了基于不同阶段的长期总生存率。该分期模型显示出根据四个阶段和七个亚阶段区分患者的出色能力，在训练和验证队列中具有显著不同的曲线。中位生存期从I期下降到IV期，I期为63.0个月（Ia期未达到，Ib期53.0个月），II期24.0个月（IIa期28.0个月，IIb期22.0个月），III期11.0个月（IIIa期为18.0个月，IIIb期为9.0个月），培训队列中IV期不到9.0个月。改进的分期模型可能为临床放射肿瘤学家提供一种选择。
The study aimed to create a new staging model for radiotherapy-based treatment for prognostic hepatocellular carcinoma (HCC) classification. The training cohort comprised 658 patients receiving stereotactic body radiotherapy and external validation cohort comprised 533 patients receiving three-dimensional conformal radiotherapy and intensity-modulated radiotherapy. We established a modified staging system as follows: stage I, solitary nodule without macrovascular invasion, or 2–3 nodules no more than 3.0 cm apart, and performance status (PS) 0–2 (Ia: ALBI-1 grade; Ib: ALBI-2 or 3 grade); stage II: 2–3 nodules with any one nodule more than 3.0-cm apart, or ≥4 nodules, and performance status 0–2 (IIa: ALBI-1 grade; IIb: ALBI-2 grade); stage III: macrovascular invasion, regional lymph node metastasis or distant metastasis, and performance status 0–2 (IIIa: ALBI-1 grade; IIIb: ALBI-2 grade); stage IV: performance status 3–4, or performance status 0–2 with ALBI-3 grade. We analyzed long-term overall survival based on different stages. The staging model showed an excellent ability to discriminate patients according to four stages and seven substages with notably different curves in the training and validation cohort. The median survival decreased from stages I to IV with 63.0 months in stage I (not reached in Ia, and 53.0 months in Ib), 24.0 months in stage II (28.0 months in IIa, and 22.0 months in IIb), 11.0 months in stage III (18.0 months in IIIa, and 9.0 months in IIIb), and less than 9.0 months in stage IV in the training cohort. The modified staging model may provide an alternative for clinical radiation oncologists.