Pascual Sonia, Zapater Pedro, Such José, García-Herola Antonio, Sempere Laura, Irurzun Javier, Palazón José María, Carnicer Fernando, Pérez-Mateo Miguel
Liver Unit, Hospital General Universitario de Alicante, Alicante, Spain.
Liver Int. 2006 Aug;26(6):673-9. doi: 10.1111/j.1478-3231.2006.01282.x.
Some new staging systems in hepatocellular carcinoma (HCC) have been described in the last years. The aim of this study was to compare the survival-predicting capacity of some variables and the prognostic classifications.
Demographic, clinical, analytical variables and tumour characteristics were collected in a study including 115 patients with HCC. Predictors of survival were identified using the Kaplan-Meier test and the Cox model. Comparison between different staging systems was carried out.
The 1-, 2- and 3-year estimated survival was 65%, 45% and 30%, respectively. Child-Pugh score and alpha-fetoprotein level greater than 400 UI/l were independent predictors of survival in the Cox model. Although all systems correctly differentiated between patients regarding survival (Kaplan-Meier, log rank < 0.05 for all), the Barcelona Clinic Liver Cancer (BCLC) showed a better discriminatory ability than the other evaluated scores. In addition, the independent homogenizing ability and stratification value of BCLC was better than that of other systems. On the contrary, model for end-stage liver disease (MELD) showed the worst results.
Child-Pugh score and alpha-fetoprotein levels were the only independent predictors of survival in patients with HCC. Child-Pugh score showed a better prediction value for survival when compared with MELD. BCLC is more accurate than the other prognostic models evaluated in this investigation.
近年来已描述了一些肝细胞癌（HCC）的新分期系统。本研究的目的是比较一些变量的生存预测能力和预后分类。
在一项纳入115例HCC患者的研究中收集人口统计学、临床、分析变量和肿瘤特征。使用Kaplan-Meier检验和Cox模型确定生存预测因素。对不同分期系统进行比较。
1年、2年和3年的估计生存率分别为65%、45%和30%。Child-Pugh评分和甲胎蛋白水平大于400 UI/l是Cox模型中生存的独立预测因素。尽管所有系统在生存方面都能正确区分患者（Kaplan-Meier检验，所有的对数秩<0.05），但巴塞罗那临床肝癌（BCLC）分期系统的区分能力优于其他评估的评分系统。此外，BCLC的独立同质化能力和分层价值优于其他系统。相反，终末期肝病模型（MELD）的结果最差。
Child-Pugh评分和甲胎蛋白水平是HCC患者生存的唯一独立预测因素。与MELD相比，Child-Pugh评分对生存的预测价值更好。BCLC比本研究中评估的其他预后模型更准确。
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