Prognostic indicators in hepatocellular carcinoma: a systematic review of 72 studies.
Prognostic indicators in hepatocellular carcinoma: a systematic review of 72 studies.
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DOI：
10.1111/j.1478-3231.2008.01957.x
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发表时间：
2009-04
期刊：
影响因子：
--
通讯作者：
Garcia-Tsao G
中科院分区：
文献类型：
--
作者：
Tandon P;Garcia-Tsao G
尽管有许多关于肝细胞癌（HCC）死亡预测因素的研究，但大多数将合并和不合并肝硬化的患者合并，许多将合并代偿性和失代偿性肝硬化的患者合并。对评价肝硬化和HCC患者死亡预测因素的文献进行系统回顾，并评估代偿性肝硬化和失代偿性肝硬化患者的预测因素是否存在差异。纳入标准：(i)以英文发表，（ii）成年患者，(c) 80%的患者有肝硬化，（iv）随访6个月，(v)多变量分析。质量以预后研究的公认质量标准为基础。在获得的1106篇文献中，947篇因不符合纳入标准而被排除。72项研究共纳入23968例患者（中位数为177例/项研究）；77%为男性，中位年龄64岁，55%为Child-Pugh a级。最可靠的死亡预测因子为门静脉血栓形成、肿瘤大小、α-胎蛋白和Child-Pugh分级。仅使用15项“良好”研究和22项所有患者都患有肝硬化的研究进行敏感性分析，得出相同的变量。在包括大多数代偿或失代偿患者的研究中，预测因子都与肝脏和肿瘤相关。然而，这些研究很少，结果也不可靠。对72项研究的系统回顾显示，肝硬化和HCC患者最可靠的死亡预测因子是肿瘤相关和肝脏相关。未来的预后研究应包括这些预测因素，并应在特定的患者人群中进行，以确定特定的预后指标是否在肝硬化的不同阶段更相关。
Although there are many studies of the predictors of death in hepatocellular carcinoma (HCC), most combine patients with and without cirrhosis and many combine those with compensated and decompensated cirrhosis. To perform a systematic review of the literature evaluating the predictors of death in patients with cirrhosis and HCC and to evaluate whether the predictors differ between patients with compensated and decompensated cirrhosis. Inclusion criteria: (i) publication in English, (ii) adult patients, (c) >80% of the patients had cirrhosis, (iv) follow-up >6 months and (v) multivariable analysis. Quality was based on the accepted quality criteria for prognostic studies. Of the 1106 references obtained, 947 were excluded because they did not meet the inclusion criteria. A total of 23 968 patients were included in 72 studies (median, 177/study); 77% male, median age 64, 55% Child–Pugh class A. The most robust predictors of death were portal vein thrombosis, tumour size, α-foetoprotein and Child–Pugh class. Sensitivity analysis using only 15 ‘good’ studies and 22 studies in which all patients had cirrhosis yielded the same variables. In the studies including mostly compensated or decompensated patients, the predictors were both liver and tumour related. However, these studies were few and the results were not robust. This systematic review of 72 studies shows that the most robust predictors of death in patients with cirrhosis and HCC are tumour related and liver related. Future prognostic studies should include these predictors and should be performed in specific patient populations to determine whether specific prognostic indicators are more relevant at different stages of cirrhosis.
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影响因子：
29.4
作者：
Bruix, J;Castells, A;Rodes, J
通讯作者：
Rodes, J
影响因子：
13.5
作者：
CALVET, X;BRUIX, J;RODES, J
通讯作者：
RODES, J
影响因子：
25.7
作者：
Cillo, U;Vitale, A;D'Amico, DF
通讯作者：
D'Amico, DF
影响因子：
25.7
作者：
Chevret, S;Trinchet, JC;Chastang, C
通讯作者：
Chastang, C
DOI：
10.1111/j.1440-1746.2003.03306.x
发表时间：
2004-08-01
影响因子：
4.1
作者：
Dohmen, K;Shirahama, M;Ishibashi, H
通讯作者：
Ishibashi, H