Selecting an Optimal Staging System for Hepatocellular Carcinoma
Selecting an Optimal Staging System for Hepatocellular Carcinoma
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DOI：
10.1002/cncr.25044
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发表时间：
2010-06-15
期刊：
影响因子：
6.2
通讯作者：
Lee, Shou-Dong
中科院分区：
文献类型：
--
作者：
Hsu, Chia-Yang;Hsia, Cheng-Yuan;Lee, Shou-Dong
背景：选择适当的分期系统对于预测肝细胞癌（HCC）患者的结局至关重要。HCC的最佳预后模型正在激烈的争论中。本研究调查了目前使用的5种分期系统（巴塞罗那临床肝癌（BCLC）、意大利肝癌计划（CLIP）、日本综合评分（JIS）系统、肿瘤淋巴结转移（TNM）和东京评分）对HCC的预后能力。方法：在2002年至2008年期间，1713例前瞻性入组的HCC患者的长期生存进行了比较，根据这5个模型的分期或评分方法，使用Akaike信息标准（AIC）。结果：平均和中位随访时间分别为18个月和14个月。在所有患者中，CLIP分期系统与考克斯比例风险模型中的其他系统相比具有最低的AIC值，其次是东京评分、JIS评分、BCLC分期系统和TNM分期系统。与接受非治愈性治疗的患者相比，接受治愈性治疗的患者的生存率明显更高（P <0.001）。当根据治疗策略分析分期系统的预测准确性时，CLIP分期系统具有最低的AIC值，并且在接受治愈性（801例患者）和非治愈性（912例患者）治疗的患者中仍然是最佳预后模型。结论：CLIP分期系统是早期至晚期HCC患者队列中HCC的最佳长期预后模型。其预测准确性与治疗策略无关。选择最佳的分期系统有助于改善未来临床试验的设计。Cancer 2010;116：3006-14. (C)2010年美国癌症协会
BACKGROUND: Selecting an appropriate staging system is crucial to predict the outcome of patients with hepatocellular carcinoma (HCC). The optimal prognostic model for HCC is under intense debate. This study investigated the prognostic ability of the 5 currently used staging systems, Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), Japan Integrated Scoring (JIS) system, tumor-node-metastasis (TNM), and Tokyo score, for HCC. METHODS: Between 2002 and 2008, 1713 prospectively enrolled HCC patients were compared for their long-term survival by using the Akaike information criterion (AIC) according to the staging or scoring methods of these 5 models. RESULTS: The mean and median follow-up duration was 18 and 14 months, respectively. Among all patients, the CLIP staging system had the lowest AIC value in comparison with other systems in the Cox proportional hazards model, followed by the Tokyo score, JIS score, BCLC staging system, and TNM staging system. Patients undergoing curative treatment had a significantly better survival in comparison with patients undergoing noncurative treatment (P < .001). When the predictive accuracy of the staging systems was analyzed according to treatment strategy, the CLIP staging system had the lowest AIC value and remained the best prognostic model in patients undergoing curative (801 patients) and noncurative (912 patients) treatment. CONCLUSIONS: The CLIP staging system is the best long-term prognostic model for HCC in a cohort of patient with early to advanced stage of HCC. Its predictive accuracy is independent of the treatment strategy. Selecting an optimal staging system is helpful in improving the design of future clinical trials. Cancer 2010;116:3006-14. (C) 2010 American Cancer Society