Varotti G, Ramacciato G, Ercolani G, Grazi G L, Vetrone G, Cescon M, Del Gaudio M, Ravaioli M, Ziparo V, Lauro A, Pinna A
Liver and Multiorgan Transplant Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy.
Eur J Surg Oncol. 2005 Sep;31(7):760-7. doi: 10.1016/j.ejso.2005.04.008.
To compare the prognostic efficacy of the 5th and 6th edition of the TNM staging system for HCC.
We retrospectively applied the old and the new systems to 393 resected patients, comparing the efficacy of both in prognostic evaluation.
The 1-, 3- and 5-year overall survival rates were 89.7, 71.1 and 56.3%, respectively. The 1-, 3- and 5-year disease-free survival rates were 79.4, 54.6 and 39.4%, respectively. Among the factors evaluated, Child's grade B and C (p=0.001) and presence of multiple nodules (p=0.01) were found to be related either to a worse long-term survival or to a worse disease-free survival. Stratifying patient survivals according to the old TNM system, we found significant differences only between stages II and IIIA (p=0.001); otherwise stages I and II (p=0.9) as well as stages IIIA and IVA (p=0.9) showed similar survival rates. Analysing the new TNM system, we found a more homogeneous staging stratification, with significant differences both between stage I and II (p=0.02) and between stage II and IIIA (p=0.05).
In the present multicentric study, long term overall and disease-free survival after liver resection for HCC was strongly affected by the number of tumours and the underlying liver disease. Our results suggest that the new classification appears to achieve an accurate stratification of patients, simpler than the previous edition, as well as a more reliable comparative analysis of outcome after hepatic resection for HCC.
比较肝癌TNM分期系统第5版和第6版的预后评估效能。
我们对393例接受手术切除的患者进行回顾性分析，应用旧版和新版分期系统比较两者在预后评估中的效能。
1年、3年和5年总生存率分别为89.7%、71.1%和56.3%。1年、3年和5年无病生存率分别为79.4%、54.6%和39.4%。在评估的因素中，发现Child B级和C级（p = 0.001）以及存在多个结节（p = 0.01）与较差的长期生存率或较差的无病生存率相关。根据旧版TNM系统对患者生存率进行分层，我们发现仅II期和IIIA期之间存在显著差异（p = 0.001）；否则I期和II期（p = 0.9）以及IIIA期和IVA期（p = 0.9）的生存率相似。分析新版TNM系统时，我们发现分期分层更均匀，I期和II期之间（p = 0.02）以及II期和IIIA期之间（p = 0.05）均存在显著差异。
在本多中心研究中，肝癌肝切除术后的长期总生存率和无病生存率受肿瘤数量和潜在肝脏疾病的强烈影响。我们的结果表明，新分类法似乎能实现对患者的准确分层，比上一版更简单，并且对肝癌肝切除术后的预后进行更可靠的比较分析。
