Kee Kwong-Ming, Wang Jing-Houng, Lee Chuan-Mo, Chen Chao-Long, Changchien Chi-Sin, Hu Tsung-Hui, Cheng Yu-Fan, Hsu Hsuan-Chih, Wang Chih-Chi, Chen Tai-Yi, Lin Chih-Yun, Lu Sheng-Nan
Division of Hepatogastroenterology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Int J Cancer. 2007 Jun 15;120(12):2650-5. doi: 10.1002/ijc.22616.
This study was aimed to validate the 5th and 6th editions of tumor-node-metastasis (TNM) system for patients with hepatocellular carcinoma (HCC), and attempted to improve prognostic stratification by modifying the 6th edition according to vascular invasion and tumor size. From 1986 to 2002, a total of 5,613 HCC cases from Kaohsiung Chang Gung Memorial Hospital in southern Taiwan were enrolled. The 6th edition was modified by dividing stage I into stages IA (single tumor, < or =2cm) and IB (single tumor, >2cm), and by dividing stage II into IIA (multiple tumors, none >5cm) and IIB (tumor with segmental macro vascular invasion). The Akaike information criteria (AIC), within a Cox proportional hazard regression model were used; lower AIC value indicated a better discriminatory ability for staging system. The 1-, 3-, 5-, and 7-year overall survival rates were 45.6, 25.9, 17.9, and 13.4%, respectively. Significant differences in survival curve existed in the 5th, 6th, and modified 6th edition TNM systems. For the modified 6th edition TNM, survival differed significantly between stages IA and IB, and between stage IIA and IIB. The AIC values of 5th (72,328), 6th (72,188), modified 6th (71,991) edition TNM system were decreasing. This investigation demonstrated better prognostic stratifications for the 6th edition than the 5th edition TNM staging system. Moreover, the modified 6th edition staging system demonstrated better prognostic prediction than the former two. Pretreatment staging and simple classification of current modified 6th edition TNM staging can be applied to all HCC patients and are clinically useful.
本研究旨在验证肝细胞癌（HCC）患者的第5版和第6版肿瘤-淋巴结-转移（TNM）系统，并尝试根据血管侵犯情况和肿瘤大小对第6版进行修改以改善预后分层。1986年至2002年，共纳入了台湾南部高雄长庚纪念医院的5613例HCC病例。第6版的修改包括将I期分为IA期（单个肿瘤，≤2cm）和IB期（单个肿瘤，>2cm），将II期分为IIA期（多个肿瘤，均≤5cm）和IIB期（肿瘤伴有节段性大血管侵犯）。在Cox比例风险回归模型中使用赤池信息准则（AIC）；AIC值越低表明分期系统的鉴别能力越好。1年、3年、5年和7年总生存率分别为45.6%、25.9%、17.9%和13.4%。第5版、第6版和修改后的第6版TNM系统的生存曲线存在显著差异。对于修改后的第6版TNM，IA期和IB期之间以及IIA期和IIB期之间的生存率有显著差异。第5版（72328）、第6版（72188）、修改后的第6版（71991）TNM系统的AIC值逐渐降低。本研究表明，第6版TNM分期系统的预后分层优于第5版。此外，修改后的第6版分期系统的预后预测优于前两者。当前修改后的第6版TNM分期的治疗前分期和简单分类可应用于所有HCC患者，且具有临床实用性。
