Reassessing hepatocellular carcinoma staging in a changing patient population.
Reassessing hepatocellular carcinoma staging in a changing patient population.
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重新评估不断变化的患者群体中的肝细胞癌分期。
DOI：
10.1159/000356573
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发表时间：
2014
期刊：
影响因子：
3.5
通讯作者：
Hassan,ManalM
中科院分区：
文献类型：
--
作者：
Kaseb,AhmedO;Shah,NeerajN;Hassabo,HeshamM;Morris,JeffreyS;Xiao,Lianchun;Abaza,YasminM;Soliman,Khalid;Lee,Ju-Seog;Vauthey,Jean-Nicholas;Wallace,Michael;Aloia,ThomasA;Curley,Steven;Abbruzzese,JamesL;Hassan,ManalM
目的：肝细胞癌（HCC）分期系统主要是利用肝炎和肝硬化患者的数据开发的。鉴于最近的变化，病毒性肝炎和肝硬化的患病率在肿瘤中心，这改变了肝癌的自然史，我们的目的是在比较肝癌分期系统的准确性，或没有肝炎和肝硬化的患者。前瞻性收集所有患者的基线临床病理参数、巴塞罗那临床肝癌分期、肝癌意大利计划评分、TNM（第6版）分期、Okuda分期和中国大学预后指数评分，并进行回顾性分析。Kaplan-Meier分析用于确定总生存期（OS），进行考克斯回归分析，Harrell对应指数比较分期系统预测OS持续时间的能力。亚组分析有或无肝炎或肝硬化的患者carried.Results：中位患者OS为13.9个月，165例（37.7%）没有肝硬化和256例（58.4%）没有肝炎。总的来说，所有分期系统的OS的预测显着减少没有肝硬化或hepatitis.Conclusion：我们的研究结果主张需要进一步分层肝硬化和肝炎状态的基础上，这可能会改变患者的风险分层，并最终，治疗决策的肝细胞癌。
Objective:Hepatocellular carcinoma (HCC) staging systems were developed using data predominantly from patients who had hepatitis and cirrhosis. Given the recent change in prevalence of viral hepatitis and cirrhosis at oncology centers, which has altered the natural history of HCC, we aimed at comparing the accuracy of HCC staging systems in patients with or without hepatitis and cirrhosis.Methods:A total of 438 patients were enrolled. Baseline clinicopathologic parameters, Barcelona Clinic Liver Cancer stage, Cancer of the Liver Italian Program score, TNM (6th edition) stage, Okuda stage, and Chinese University Prognostic Index score were prospectively obtained for all patients, and retrospectively analyzed. Kaplan-Meier analysis was used to determine overall survival (OS), Cox regression analyses were performed, and Harrell's Correspondence Index compared the staging systems' ability to predict OS duration. Subgroup analyses of patients with or without hepatitis or cirrhosis were performed.Results:Median patient OS was 13.9 months; 165 patients (37.7%) had no cirrhosis and 256 patients (58.4%) had no hepatitis. Overall, all staging systems were significantly less predictive of OS in patients who did not have cirrhosis or hepatitis.Conclusion:Our results advocate the need to further stratify HCC based on cirrhosis and hepatitis status, which may change patient risk-stratification and, ultimately, treatment decisions.