Prospective validation of the Chinese University Prognostic Index and comparison with other staging systems for hepatocellular carcinoma in an Asian population
Prospective validation of the Chinese University Prognostic Index and comparison with other staging systems for hepatocellular carcinoma in an Asian population
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DOI：
10.1111/j.1440-1746.2010.06329.x
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发表时间：
2011-02-01
影响因子：
4.1
通讯作者：
Yeo, Winnie
中科院分区：
文献类型：
--
作者：
Chan, Stephen L.;Mo, Frankie K. F.;Yeo, Winnie
背景和目的：在亚洲，B型肝炎病毒（HBV）感染是肝细胞癌（HCC）的主要病因。我们的研究小组先前报道了一个被称为中国大学预后指数（CUPI）的肝癌分期系统，其中HBV感染是主要病因。本研究的目的是验证CUPI和其他已发表的分期system.Methods比较：我们分析了2003年至2005年新诊断的肝癌患者的前瞻性队列。所有患者在诊断时均采用CUPI、巴塞罗那临床肝癌分类（BCLC）、肝癌意大利程序评分（CLIP）、肿瘤淋巴结转移（TNM）和Okuda系统进行分期。结果：共分析了595例慢性HBV感染患者（80.2%），其中100例患者的生存率为100%。中位随访41.4个月，中位生存期6.6个月。多因素分析确定有症状的疾病、腹水、血管受累、Child-Pugh分期、甲胎蛋白和治疗是独立的预后因素。CUPI可区分三组，生存率差异有统计学意义（P < 0.0001）。CUPI和CLIP在区分能力、同质性和单调性方面的表现最好。CUPI在预测3个月生存率方面表现最好，而CLIP在预测6个月和12个月生存率方面表现更好。BCLC是劣于CLIP和CUPI的整体performance.Conclusion：我们已经验证了CUPI在人口组成的主要HBV相关的肝癌。CUPI是HBV相关HCC的一个合适的分期系统。在晚期HCC患者中，CUPI和CLIP均提供了良好的风险分层。
Background and Aim:Hepatitis B viral (HBV) infection is the predominant etiology of hepatocellular carcinoma (HCC) in Asia. Our group previously reported a staging system known as the Chinese University Prognostic Index (CUPI) for HCC populations of which HBV infection is the predominant etiology. This study aims to validate CUPI and compare with other published staging systems.Methods:We analyzed a prospective cohort of patients with newly diagnosed HCC from 2003 to 2005. All patients were staged with CUPI, Barcelona Clinic Liver Cancer Classification (BCLC), Cancer of the Liver Italian Program score (CLIP), tumor-node-metastasis (TNM) and Okuda systems at diagnosis. They were followed with survival data and the performance of each staging system (in terms of homogeneity, discriminatory ability and monotonicity of gradient) were analyzed and compared.Results:A total of 595 patients (80.2% with chronic HBV infection) were analyzed. The median follow-up was 41.4 months and the median survival was 6.6 months. Multivariate analyses identified symptomatic disease, ascites, vascular involvement, Child-Pugh-stage, alpha-fetoprotein and treatment to be the independent prognostic factors. CUPI could identify three groups with statistically significant survival difference (P < 0.0001). Both CUPI and CLIP had the most favorable performance in terms of discriminatory ability, homogeneity and monotonicity. CUPI performed the best in predicting 3-month survival while CLIP performed better in predicting the outcome of 6- and 12-month survival rate. BCLC was inferior to CLIP and CUPI in the overall performance.Conclusion:We have validated CUPI in a population composed of predominant HBV-related HCC. CUPI is an appropriate staging system for HBV-related HCC. In patients with advanced HCC, both CUPI and CLIP offer good risk stratification.