Huang Yi-Hsiang, Chen Chien-Hung, Chang Ting-Tsung, Chen Shinn-Cherng, Wang Shen-Yung, Lee Hsuan-Shu, Lin Pin-Wen, Huang Guan-Tarn, Sheu Jin-Chuan, Tsai Hong-Ming, Lee Pui-Ching, Chau Gar-Yang, Lui Wing-Yiu, Lee Shou-Dong, Wu Jaw-Ching
Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
J Gastroenterol Hepatol. 2005 May;20(5):765-71. doi: 10.1111/j.1440-1746.2005.03746.x.
An accurate staging system is required to assess hepatocellular carcinoma (HCC) patients in order to benefit from hepatic resection before surgery. Cancer of the Liver Italian Program (CLIP) score was considered to be better than the Okuda staging system to predict survival. Japan Integrated Staging Score (JIS score) includes tumor, nodes, metastases (TNM) stage and Child-Pugh grade as a new staging system for HCC. The purpose of the present paper was to compare the CLIP, Okuda, TNM and JIS staging systems for HCC patients undergoing surgery.
From 1991 to 1995, 599 patients undergoing hepatic resection for HCC from four medical centers in Taiwan were evaluated. All patients were classified by Okuda, CLIP, TNM and JIS systems. Factors associated survivals were analyzed.
There was no statistical difference in survival between CLIP 0 and 1 patients, or among CLIP 2-4 patients. The prognostic validation of the Okuda and CLIP scoring systems in discriminating survival in HCC patients undergoing surgery was not satisfied. The TNM system was successful in predicting survival for HCC patients undergoing surgery. The JIS score could also differentiate survivals for those patients except for JIS 3. By multivariate analysis, age > or =60 years old, serum albumin <3.5 g/dL, tumor size >5 cm and TNM stage were associated with survival.
Both the Okuda and CLIP systems are not superior to TNM staging for HCC patients who undergo surgical resection. Whether JIS score is feasible for those patients with advanced HCC needs further evaluation.
为了使肝细胞癌（HCC）患者在手术前从肝切除术中获益，需要一种准确的分期系统来评估患者。意大利肝癌项目（CLIP）评分被认为在预测生存率方面优于奥田分期系统。日本综合分期评分（JIS评分）包括肿瘤、淋巴结、转移（TNM）分期和Child-Pugh分级，是一种新的HCC分期系统。本文的目的是比较CLIP、奥田、TNM和JIS分期系统在接受手术的HCC患者中的应用。
1991年至1995年，对台湾四个医疗中心的599例接受HCC肝切除术的患者进行了评估。所有患者均按照奥田、CLIP、TNM和JIS系统进行分类。分析与生存相关的因素。
CLIP 0和1级患者之间以及CLIP 2 - 4级患者之间的生存率无统计学差异。奥田和CLIP评分系统在区分接受手术的HCC患者生存率方面的预后验证不令人满意。TNM系统成功预测了接受手术的HCC患者的生存率。JIS评分除JIS 3外也能区分患者的生存率。多因素分析显示，年龄≥60岁、血清白蛋白<3.5 g/dL、肿瘤大小>5 cm和TNM分期与生存相关。
对于接受手术切除的HCC患者，奥田和CLIP系统均不优于TNM分期。JIS评分对于晚期HCC患者是否可行需要进一步评估。
