A prognostic score for patients with intermediate-stage hepatocellular carcinoma treated with transarterial chemoembolization.
A prognostic score for patients with intermediate-stage hepatocellular carcinoma treated with transarterial chemoembolization.
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DOI：
10.1371/journal.pone.0125244
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Yokosuka O
中科院分区：
文献类型：
--
作者：
Ogasawara S;Chiba T;Ooka Y;Kanogawa N;Motoyama T;Suzuki E;Tawada A;Azemoto R;Shinozaki M;Yoshikawa M;Yokosuka O
根据巴塞罗那临床肝癌（BCLC）分期系统定义的中期肝细胞癌（HCC）是一种异质性疾病，经动脉化疗栓塞（TACE）的临床获益不同。本研究旨在根据TACE治疗的中期HCC患者的生存预测因素开发一种简单有效的预后评分。纳入了在千叶大学医院（培训队列; n = 187）和两家附属医院（验证队列; n = 163）接受初始TACE的350例中期HCC患者。将以下变量输入单变量和多变量考克斯回归模型，以建立基于积分的临床评分系统：性别、年龄、病因、治疗前、Child-Pugh评分、天冬氨酸转氨酶、肌酐、C反应蛋白、甲胎蛋白、最大病变大小以及病变数量和位置。在训练队列中，病变数量和Child-Pugh评分被确定为独立的预后因素。0-7分预后评分的发展，称为千叶HCC中期预后（CHIP）评分，基于三个子量表评分的总和（Child-Pugh评分分别为0、1、2或3，病变数量分别为0、2或3，HCV-RNA阳性分别为0或1）。然后根据中位生存时间（分别为65.2、29.2、24.3、13.1和8.4个月; p < 0.0001）将生成的评分分为5组（0-2分、3分、4分、5分和6-7分）。这些结果在外部验证队列中得到证实（p < 0.0001）。CHIP评分易于使用，可能有助于为中期HCC找到适当的治疗策略。
Intermediate-stage hepatocellular carcinoma (HCC), defined according to the Barcelona Clinic Liver Cancer (BCLC) staging system, is a heterogeneous condition with variable clinical benefits from transarterial chemoembolization (TACE). This study aimed to develop a simple validated prognostic score based on the predictive factors for survival in patients with intermediate-stage HCC treated with TACE. Three-hundred and fifty patients with intermediate-stage HCC undergoing initial TACE at Chiba University Hospital (training cohort; n = 187) and two affiliated hospitals (validation cohort; n = 163) were included. Following variables were entered into univariate and multivariate Cox regression models to develop a points-based clinical scoring system: gender, age, etiology, pretreatment, Child–Pugh score, aspartate aminotransferase, creatinine, C-reactive protein, alfa-fetoprotein, size of the largest lesion, and number and location of lesions. The number of lesions and the Child–Pugh score were identified as independent prognostic factors in the training cohort. The development of a 0–7-point prognostic score, named the Chiba HCC in intermediate-stage prognostic (CHIP) score, was based on the sum of three subscale scores (Child–Pugh score = 0, 1, 2, or 3, respectively, number of lesions = 0, 2, or 3, respectively, HCV-RNA positivity = 0 or 1, respectively). The generated scores were then differentiated into five groups (0–2 points, 3 points, 4 points, 5 points, and 6–7 points) by the median survival time (65.2, 29.2, 24.3, 13.1, and 8.4 months, respectively; p < 0.0001). These results were confirmed in the external validation cohort (p < 0.0001). The CHIP score is easy-to-use and may assist in finding an appropriate treatment strategy for intermediate-stage HCC.
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4.1
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通讯作者：
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通讯作者：
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