Chevret S, Trinchet J C, Mathieu D, Rached A A, Beaugrand M, Chastang C
Département de Biostatistique et Informatique Médicale, Hôpital Saint-Louis, Paris, France.
J Hepatol. 1999 Jul;31(1):133-41. doi: 10.1016/s0168-8278(99)80173-1.
BACKGROUND/AIMS: In patients with hepatocellular carcinoma, prediction of survival is difficult. The aim of this prospective study was to provide a simple classification for predicting survival of patients with hepatocellular carcinoma, based on a multivariable Cox model.
Seven hundred and sixty-one patients who presented with hepatocellular carcinoma from 24 Western medical centers were enrolled over a 30-month period. Patients were randomly assigned to either a training sample (n=506, with 418 deaths) from which a classification system was established, or a test sample (n=255, with 200 deaths) for validating its prognostic significance.
Five prognostic factors were selected at the 0.0001 level: Karnofsky index <80% (relative risk of death=2.2, 95% confidence interval: 1.7-2.7), serum bilirubin >50 micromol/l (relative risk=2.1, 95% confidence interval: 1.7-2.6), serum alkaline phosphatase at least twice the upper limit of normal range (relative risk=1.6, 95% confidence interval: 1.3-2.0), serum alpha-fetoprotein >35 microg/l (relative risk=1.7, 95% confidence interval: 1.4-2.1), and ultrasonographic portal obstruction (relative risk=1.3, 95% confidence interval: 1.1-1.7). Three risk groups with different 1-year survival rates (72%, 34%, 7%) were derived, and independently validated in the test sample (79%, 31%, 4%).
This classification could be useful in the assessment of prognosis from homogeneous groups of patients with respect to their expected outcome.
背景/目的：肝细胞癌患者的生存预测较为困难。本前瞻性研究旨在基于多变量Cox模型为肝细胞癌患者的生存预测提供一种简单的分类方法。
在30个月的时间里，纳入了来自24个西方医学中心的761例肝细胞癌患者。患者被随机分配到用于建立分类系统的训练样本组（n = 506，418例死亡）或用于验证其预后意义的测试样本组（n = 255，200例死亡）。
在0.0001水平上选择了5个预后因素：卡诺夫斯基指数<80%（死亡相对风险=2.2，95%置信区间：1.7 - 2.7）、血清胆红素>50微摩尔/升（相对风险=2.1，95%置信区间：1.7 - 2.6）、血清碱性磷酸酶至少为正常范围上限的两倍（相对风险=1.6，95%置信区间：1.3 - 2.0）、血清甲胎蛋白>35微克/升（相对风险=1.7，95%置信区间：1.4 - 2.1）以及超声门静脉梗阻（相对风险=1.3，95%置信区间：1.1 - 1.7）。得出了1年生存率不同的3个风险组（72%、34%、7%），并在测试样本组中进行了独立验证（79%、31%、4%）。
这种分类方法可能有助于从同组患者的预期结果方面评估预后。
