在一组接受射频消融且完全缓解的肝硬化肝细胞癌患者中，对七种分期系统的比较。

Comparison of seven staging systems in cirrhotic patients with hepatocellular carcinoma in a cohort of patients who underwent radiofrequency ablation with complete response.

作者信息

Guglielmi Alfredo, Ruzzenente Andrea, Pachera Silvia, Valdegamberi Alessandro, Sandri Marco, D'Onofrio Mirko, Iacono Calogero

机构信息

Department of Surgery and Gastroenterology, University of Verona Medical School, Verona, Italy.

出版信息

Am J Gastroenterol. 2008 Mar;103(3):597-604. doi: 10.1111/j.1572-0241.2007.01604.x. Epub 2007 Oct 26.

DOI:10.1111/j.1572-0241.2007.01604.x

PMID:17970836

Abstract

BACKGROUND AND AIMS

Many staging systems for hepatocellular carcinoma (HCC) have been proposed but the best tool for staging of HCC remains controversial. The aim of the present study was to identify the best staging system evaluating the predictive ability for outcome for each of the seven different staging systems applied in a homogeneous group of patients who underwent percutaneous radiofrequency ablation (RFA).

METHODS

We analyzed retrospectively 112 patients with HCC and cirrhosis treated with percutaneous RFA from January, 1998 to April, 2005. Response to treatment after 30 days and for long-term follow-up was evaluated with computed tomography (CT) or magnetic resonance imaging (MRI) and serum alpha-fetoprotein level (AFP). All of the 112 patients were grouped according to each one of the seven different staging systems: Okuda, TNM, BCLC, CLIP, GRETCH, CUPI, JIS.

RESULTS

The mean follow-up time of the 112 patients submitted to RFA was 24 months (range 3-92 months) with survival rates at 1, 3, and 5 yr of 82%, 40%, and 18%, respectively. Univariate and multivariate analyses showed that factors related to survival were Child-Pugh score (P</= 0.01), serum AFP (P</= 0.01), and the response to treatment (P</= 0.01) with hazard ratios of 2.09 (95% CI 1.21-3.61), 2.79 (95% CI 1.59-4.90), and 2.76 (95% CI 1.25-6.09), respectively. The comparison of the results of the different staging systems in all of the 112 patients and in a subgroup of 96 patients with complete response to treatment showed that BCLC had the best discrimination ability, monotonicity of gradient (linear trend chi(2) 6.07, P= 0.01), and homogeneity ability (LR chi(2) test 10.00, P= 0.008).

CONCLUSIONS

The BCLC staging system shows a superior discriminatory power in our cohort of HCC patients who underwent RFA; moreover, it can give important prognostic information after complete response to treatment. Our study confirms the validity of the BCLC staging system in patients with HCC in cirrhosis.

摘要

背景与目的

已提出多种肝细胞癌（HCC）分期系统，但HCC分期的最佳工具仍存在争议。本研究的目的是在一组接受经皮射频消融（RFA）的同质患者中，确定评估七种不同分期系统对预后预测能力的最佳分期系统。

方法

我们回顾性分析了1998年1月至2005年4月期间接受经皮RFA治疗的112例HCC合并肝硬化患者。通过计算机断层扫描（CT）或磁共振成像（MRI）以及血清甲胎蛋白水平（AFP）评估30天后的治疗反应和长期随访情况。112例患者均根据七种不同分期系统中的每一种进行分组：奥田分期、TNM分期、巴塞罗那临床肝癌（BCLC）分期、意大利肝癌计划（CLIP）分期、希腊肝癌分期（GRETCH）、日本综合分期（CUPI）、日本肝癌学会（JIS）分期。

结果

接受RFA治疗的112例患者的平均随访时间为24个月（范围3 - 92个月），1年、3年和5年生存率分别为82%、40%和18%。单因素和多因素分析显示，与生存相关的因素为Child-Pugh评分（P≤0.01）、血清AFP（P≤0.01）和治疗反应（P≤0.01），风险比分别为2.09（95%置信区间1.21 - 3.6）、2.79（95%置信区间1.59 - 4.9）和2.76（95%置信区间1.25 - 6.09）。在全部112例患者以及治疗完全缓解的96例患者亚组中，对不同分期系统的结果进行比较，结果显示BCLC分期系统具有最佳的区分能力、梯度单调性（线性趋势χ² 6.07，P = 0.01）和同质性能力（似然比χ²检验10.00，P = 0.008）。