Prognostic value and clinical relevance of the 6th edition 2002 American Joint Committee on Cancer staging system in patients with resectable hepatocellular carcinoma
Prognostic value and clinical relevance of the 6th edition 2002 American Joint Committee on Cancer staging system in patients with resectable hepatocellular carcinoma
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DOI：
10.1016/j.jamcollsurg.2006.06.030
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发表时间：
2006-10-01
影响因子：
5.2
通讯作者：
Wu, Chew-Wun
中科院分区：
文献类型：
--
作者：
Lei, Hao-Jan;Chau, Gar-Yang;Wu, Chew-Wun
背景：2002年提出了简化的美国癌症联合委员会(AJCC)肝细胞癌(HCC)TNM分期系统(第6版)。在这项研究中，我们验证了分期系统在接受肝切除并进行长期随访的患者队列中的预后价值。研究设计：从前瞻性数据库中，研究队列包括从1991年7月至1999年1月期间接受根治性肝切除的440名患者。中位随访时间为66个月。采用多因素分析确定与术后生存相关的独立预后因素。结果：大血管侵犯、微血管侵犯、手术切缘<1 cm、15分钟吲哚青绿滞留率10%、多发肿瘤、肿瘤破裂、男性、血清天冬氨酸氨基转移酶90U/L是影响患者预后的独立因素。IVA分期87例(19.8%)，TNM-6分期：I期120例(27.3%)，II期170例(38.6%)，III期150例(34.1%)。当按TNM-5系统分层时，II期和IIIA期(P<；0.001)、IIIA期和IVA期(P<；0.001)之间的存活率差异显著，但I期和11期之间的存活率差异不显著(P>；0.05)。根据TNM-6分期，I期与II期(P<；0.01)、II期与III期(P<；0.001)、I期与III期(P<；0.001)之间的生存率差异显著。结论：总的来说，TNM-6分期系统似乎为肝癌患者提供了一个可靠的预后分类，而且比TNM-5分期系统更易于使用。
BACKGROUND: A simplified American joint Committee on Cancer (AJCC) TNM staging system for hepatocellular carcinoma (HCC) (the 6th edition) was proposed in 2002. In this study, we validated the prognostic value of the staging system in a patient cohort undergoing hepatic resection with longterm followup.STUDY DESIGN: From a prospective database, the study cohort consisted of 440 patients who underwent curative hepatic resection for HCC between July 1991 and January 1999. Median followup time was 66 months. Multivariate analysis was performed to identify the independent prognostic factors related to postoperative survival. Patients were staged according to both the 5th edition (TNM-5) and 6th edition (TNM-6) AJCC TNM staging criteria.RESULTS: The independent prognostic factors included major vascular invasion, microvascular invasion, surgical margin < 1 cm, indocyanine green retention rate at 15 minutes > 10%, multiple tumors, tumor rupture, male, and serum aspartate aminotransferase > 90 U/L. The breakdown by TNM-5 staging: I, 27 (6.1%); II, 108 (24.5%); III, 218 (49.5%); and IVA, 87 (19.8%) and by TNM-6 staging: I, 120 (27.3%); II, 170 (38.6%); and III, 150 (34.1%). When stratified according to the TNM-5 system, difference in survival was notable between stages II and IIIA (p < 0.001), between stages IIIA and IVA (p < 0.001), but not between stages I and 11 (p > 0.05). When stratified according to the TNM-6 system, difference in survival was considerable between stages I and II (p < 0.01), stages II and III (p < 0.001), and stages I and III (p < 0.001).CONCLUSIONS: Overall, the TNM-6 staging system appears to provide a reliable prognostic classification of HCC patients and is simpler to use than the TNM-5 staging system.