A comparison of clinical manifestations and prognoses between patients with hepatocellular carcinoma and Child-Pugh scores of 5 or 6.
A comparison of clinical manifestations and prognoses between patients with hepatocellular carcinoma and Child-Pugh scores of 5 or 6.
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DOI：
10.1097/md.0000000000000348
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发表时间：
2014-12
期刊：
影响因子：
1.6
通讯作者：
Wu JC
中科院分区：
文献类型：
--
作者：
Hung HH;Chao Y;Chiou YY;Li CP;Lee RC;Huo TI;Huang YH;Chau GY;Su CW;Yeh YC;Lin HC;Lee SD;Wu JC
本研究的目的是比较Child-Pugh评分5（A5组）和Child-Pugh评分6（A6组）的肝细胞癌（HCC）患者的结局。A5和A6组HCC患者是否有不同的预后尚不清楚。我们从2007年至2012年连续招募了2462例未经治疗的HCC患者。其中Child-Pugh A级1486例，其中A5组1016例，A6组470例。采用多因素分析法对影响因素进行分析。与A6组相比，A5组的患者更年轻，米兰标准内的肿瘤比例更高，并且更多的患者接受了根治性治疗。A5和A6组患者的5年累积生存率分别为51.3%和37.1%（P <0.001）。 多因素分析显示，与总生存率低相关的独立危险因素为非丙型肝炎病毒携带者、血清白蛋白≤4 g/dL、天冬氨酸氨基转移酶>45 U/L、甲胎蛋白>20 ng/mL、多结节、肿瘤大小>3 cm、血管侵犯和非治愈性治疗，而非Child-Pugh数值评分。 Child-Pugh数值评分仅在肿瘤超出米兰标准且接受非治愈性治疗的患者中具有显著的预后影响。A5组肝癌患者的总生存率高于A6组，因为A5组肿瘤分期较早，接受根治性治疗的比例较高。肿瘤因素和治疗方式比Child-Pugh数值评分更重要。
The objective of this work is to compare the outcomes between the Child–Pugh score 5 (A5 group) and Child–Pugh score 6 (A6 group) in patients with hepatocellular carcinoma (HCC). Whether HCC patients with A5 and A6 groups have different prognoses is still obscure. We enrolled 2462 consecutive treatment-naive HCC patients from 2007 to 2012. Among them, 1486 patients had Child–Pugh grade A, including 1016 in the A5 group and 470 in the A6 group. Factors in the prognoses were analyzed by multivariate analysis. Compared with those in the A6 group, patients in the A5 group were younger, had higher proportions of tumors within the Milan criteria, and more of them underwent curative therapies. The cumulative survival rates at 5 years were 51.3% and 37.1% for patients in the A5 and A6 groups, respectively (P < 0.001). Multivariate analysis showed that the independent risk factors associated with poor overall survival were nonhepatitis C virus carrier, serum albumin ≤4 g/dL, aspartate aminotransferase >45 U/L, α-fetoprotein >20 ng/mL, multinodularity, tumor size >3 cm, vascular invasion, and noncurative therapies, but not the Child–Pugh numeric score. The Child–Pugh numeric score had a significant prognostic effect only in patients who had tumors beyond the Milan criteria and received noncurative therapies. HCC patients with A5 group had a better overall survival rate than those with A6 group due to the early tumor stage and higher rate of receiving curative treatments. Tumor factors and treatment modalities were more important than the Child–Pugh numeric score.