Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization
Comparison of 7 staging systems for patients with hepatocellular carcinoma undergoing transarterial chemoembolization
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DOI：
10.1002/cncr.23185
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发表时间：
2008-01-15
期刊：
影响因子：
6.2
通讯作者：
Byun, Jong Hoon
中科院分区：
文献类型：
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作者：
Cho, Yun Ku;Chung, Jin Wook;Byun, Jong Hoon
背景许多肝细胞癌患者局部区域治疗后的肝脏分期系统已被提出，但是，争议仍然存在，关于哪个系统是最好的。在这项研究中，作者比较了7种分期系统在接受经动脉化疗栓塞的肝细胞癌患者队列中的表现。在1998年8月至2005年2月期间，共有131例肝细胞癌患者接受了经动脉化疗栓塞。在诊断时和治疗前确定人口统计学、实验室和肿瘤特征。在审查时，109名患者死亡（83.2%）。采用考克斯比例风险模型确定生存预测因子。计算7个预测系统的似然比卡方统计量和赤池信息准则，以评估其区分能力。使用Kaplan-Meier估计和对数秩检验比较每个阶段之间的生存率，以评价梯度的单调性。整个队列的5年生存率为13.6%。生存的独立预测因子是血清白蛋白水平（60 ng/mL），门静脉或肝静脉肿瘤血栓形成（分别为P = 0.001，P = 0.001，P = 0.004和P = 0.000）。肝癌意大利程序分类系统在区分能力和梯度单调性方面上级其他6个预后系统。在许多分期系统的比较中，意大利肝癌计划系统为接受经动脉化疗栓塞的肝细胞癌患者队列提供了最佳预后分层。
BACKGROUND. Many liver staging systems have been proposed for patients with hepatocellular carcinoma after locoregional therapy; however, controversies persist regarding which system is the best. In this study, the authors compared the performance of 7 staging systems in a cohort of patients with hepatocellular carcinoma who underwent transarterial chemoembolization.METHODS. In total, 131 patients with hepatocellular carcinoma who underwent transarterial chemoembolization between August 1998 and February 2005 were included in the study. Demographic, laboratory, and tumor characteristics were determined at diagnosis and before therapy. At the time of censorship, 109 patients had died (83.2%). Predictors of survival were identified by using the Cox proportional hazards model. The likelihood-ratio chi-square statistic and the Akaike Information Criterion were calculated for 7 prognostic systems to evaluate their discriminatory ability. Comparisons of the survival rate between each stage were performed to evaluate the monotonicity of the gradients using Kaplan-Meier estimation and the log-rank test.RESULTS. The 5-year survival rate for the entire cohort was 13.6%. The independent predictors of survival were serum albumin level (60 ng/mL), and portal or hepatic vein tumor thrombosis (P = .001, P = .001, P = .004, and P = .000, respectively). The Cancer of the Liver Italian Program classification system was superior to the other 6 prognostic systems regarding discriminatory ability and the monotonicity of the gradients.CONCLUSIONS. In this comparison of many staging systems, the Cancer of Liver Italian Program system provided the best prognostic stratification for a cohort the patients with hepatocellular carcinoma who underwent transarterial chemoembolization.