Comparison of five models for end-stage liver disease in predicting the survival rate of patients with advanced hepatocellular carcinoma
Comparison of five models for end-stage liver disease in predicting the survival rate of patients with advanced hepatocellular carcinoma
复制标题
五种终末期肝病模型预测晚期肝细胞癌患者生存率的比较
DOI：
10.1007/s13277-015-4366-2
复制
发表时间：
2016-04-01
期刊：
影响因子：
--
通讯作者：
Wu, Xiang-Yuan
中科院分区：
文献类型：
--
作者：
Hong, Ying-Fen;Chen, Zhan-Hong;Wu, Xiang-Yuan
晚期肝细胞癌（HCC）患者的预后是不可预期的。预期寿命超过3个月是分子靶向药物临床试验的入选标准之一。本研究的主要目的是比较终末期肝病模型（MELD）和四种基于MELD的预后模型在预测晚期肝癌患者生存率方面的差异。回顾性分析了183例无法接受标准抗肿瘤治疗的晚期HCC患者。收集数据，根据MELD、血清钠掺入的终末期肝病模型（MELD-NA）、终末期肝病腹水和钠模型（MELD-AS）、终末期肝病综合模型（iMELD）和诊断时终末期肝病钠模型（MESO）评分对患者进行分类。1个月、3个月和6个月生存率是分析中使用的终点。在预测1个月生存率时，MELD-AS、MELD和MESO是排名前3位的分期系统。在预测3个月生存期时，MELD-AS模型的受试者工作特征曲线下面积（AUC）显著高于其他模型（P< 0.05）。在预测6个月生存期时，MELD-AS和MELD-NA模型的AUC显著高于其他模型（P< 0.05）。MELD-AS的临界点为23.11，1个月时灵敏度为40.5%，特异性为93.8%，3个月时为9.5，灵敏度为76.9%，特异性为59.5%，6个月时为18.5，灵敏度为27.0%，特异性为89.1%。死亡组MELD评分明显高于存活组（P< 0.001）。多变量分析确定的独立预后因素包括持续性腹水、血清钠和血栓形成。MELD-AS是中国晚期肝癌患者中短期和中期生存预测的五种终末期肝病模型中最好的模型。
Prognosis of patients with advanced hepatocellular carcinoma (HCC) is under expectation. Life expectancy more than 3 months is one inclusion criteria for molecular targeted drugs in clinical trials. The main purpose of this research is to compare Model for End-Stage Liver Disease (MELD) and four MELD-based prognostic models in predicting the survival rate of advanced HCC patients. One hundred eighty-three patients with advanced HCC who were not amendable to standard anti-tumor therapy were retrospectively analyzed. Data were collected to classify patients according to MELD, Model for End-Stage Liver Disease with the incorporation of serum sodium (MELD-NA), Model for End-Stage Liver Disease to ascites and sodium (MELD-AS), integrated Model for End-Stage Liver Disease (iMELD), and Model for End-Stage Liver Disease to sodium (MESO) scores at diagnosis. 1-, 3-, and 6-month survivals were the end points used in the analysis. When predicting 1-month survival, MELD-AS, MELD, and MESO were the top 3 ranking staging systems. When predicting 3-month survival, area under the receiver operating characteristic curve (AUC) of MELD-AS is significantly higher than that of the other models (P< 0.05). When predicting 6-month survival, AUCs of MELD-AS and MELD-NA are significantly higher than those of the other models (P< 0.05). Cutoff point of MELD-AS is 23.11 with 40.5 % sensitivity and 93.8 % specificity at 1 month, 9.5 with 76.9 % sensitivity and 59.5 % specificity at 3 months, and 18.5 with 27.0 % sensitivity and 89.1 % specificity at 6 months. MELD-based scores of death group are significantly higher than those of survivors within 1 and 3 months (P< 0.001). Independent prognostic factors identified by multivariate analysis included persistent ascites, serum sodium, and thrombosis. MELD-AS is the best model in the prediction of short and intermediate survival among the five models for end-stage liver disease analyzed for Chinese advanced HCC patients.