Nanashima Atsushi, Sumida Yorihisa, Abo Takafumi, Shindou Hisakazu, Fukuoka Hidetoshi, Takeshita Hiroaki, Hidaka Shigekazu, Tanaka Kenji, Sawai Terumitsu, Yasutake Toru, Nagayasu Takeshi, Omagari Katsuhisa, Mine Mariko
Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
J Gastroenterol. 2006 Mar;41(3):250-6. doi: 10.1007/s00535-005-1751-4.
We previously reported the effectiveness of the modified Cancer of the Liver Italian Program (CLIP) score in hepatocellular carcinoma (HCC) staging. To determine the best predictive staging system for HCC patients, we conducted a comparative analysis of prognosis using multivariate analysis in 230 Japanese HCC patients following hepatic resection.
We compared overall survival as predicted by different staging systems: the tumor node metastasis (TNM) system by the Liver Cancer Study Group of Japan, the Japan Integrated Staging (JIS) score (Japanese TNM and Child-Pugh classification), the modified JIS score using liver damage grade, the CLIP score, and our modified CLIP score using protein induced by vitamin K absence or the antagonist II (PIVKA-II).
By a univariate analysis the PIVKA-II level (cut-off level, 400 mAU/ml) was significantly associated with patient survival (P = 0.031); however, alpha-fetoprotein level was not related to survival. Liver damage grade was significantly associated with patient survival (P = 0.039), although Child-Pugh classification was not related to survival. Univariate analysis showed that prediction of survival, according to disease stage, was better with the modified JIS score than with the TNM system, CLIP, modified CLIP, or JIS score. Multivariate analysis showed the modified JIS score showed the best ability to predict overall survival according to disease stage (Hazard ratio, 1.77; P = 0.002), and its Akaike information criteria statistic was the lowest (634.3).
The modified JIS score, a staging system that combines tumor factors and hepatic function, is a better predictor of prognosis than other systems in HCC patients who have undergone hepatic resection.
我们之前报道了改良的意大利肝癌项目（CLIP）评分在肝细胞癌（HCC）分期中的有效性。为了确定HCC患者最佳的预测分期系统，我们对230例日本HCC患者肝切除术后的预后进行了多因素分析比较。
我们比较了不同分期系统预测的总生存期：日本肝癌研究组的肿瘤淋巴结转移（TNM）系统、日本综合分期（JIS）评分（日本TNM和Child-Pugh分级）、使用肝损伤分级的改良JIS评分、CLIP评分以及我们使用维生素K缺乏或拮抗剂II诱导蛋白（PIVKA-II）的改良CLIP评分。
单因素分析显示，PIVKA-II水平（临界值，400 mAU/ml）与患者生存率显著相关（P = 0.031）；然而，甲胎蛋白水平与生存率无关。肝损伤分级与患者生存率显著相关（P = 0.039），尽管Child-Pugh分级与生存率无关。单因素分析表明，根据疾病分期，改良JIS评分预测生存率的效果优于TNM系统、CLIP、改良CLIP或JIS评分。多因素分析显示，改良JIS评分在根据疾病分期预测总生存期方面能力最佳（风险比，1.77；P = 0.002），其赤池信息准则统计量最低（634.3）。
改良JIS评分是一种结合肿瘤因素和肝功能的分期系统，在接受肝切除的HCC患者中，它比其他系统更能准确预测预后。
