Luo Kai-Zhong, Itamoto Toshiyuki, Amano Hironobu, Oshita Akihiko, Ushitora Yuichiro, Tanimoto Yoshisato, Ohdan Hideki, Tashiro Hirotaka, Asahara Toshimasa
Department of Surgery, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
J Gastroenterol. 2008;43(5):369-77. doi: 10.1007/s00535-008-2164-y. Epub 2008 Jul 1.
The purpose of the study was to compare the abilities of the JIS and modified JIS (m-JIS) scores to predict survival after hepatectomy for hepatocellular carcinoma (HCC).
Data for patients who underwent hepatectomy for HCC at Hiroshima University Hospital between 1986 and 2006 were included. The overall survival and disease-free survival were calculated by the Kaplan-Meier method, and differences between groups were tested by the log-rank test. The statistics of the Akaike information criterion (AIC) were used to show the more appropriate model.
A total of 626 patients were included (male/female, 468/158; mean age, 63.4+/-9.6 years; Child-Pugh class A/B, 524/102; liver damage grade A/B/C, 356/261/9). Mean survival and disease-free survival were 8.04+/-0.39 and 4.69+/-0.32 years, respectively. There was a significant difference in the overall survival rate between JIS scores 1 and 2, and 2 and 3 (P<0.05), but not between scores 0 and 1, or 3 and 4 (P>0.05). Except between m-JIS scores 0 and 1, there was excellent discriminatory ability in overall survival rate between other consecutive groups. Concerning disease-free survival, a significant difference was found only between JIS scores 1 and 2. However, the disease-free survival rate could be well differentiated between m-JIS scores 1 and 2, and 3 and 4. The m-JIS score had a higher discriminatory ability, indicated by a linear trend analysis, and a higher homogeneity likelihood ratio, and lower AIC statistics, than the original JIS score in predicting both overall and disease-free survival.
The modified-JIS scoring system using liver damage grade is better than the original JIS scoring system in predicting survival after hepatectomy for HCC in Japan.
本研究旨在比较日本综合评分系统（JIS）和改良日本综合评分系统（m-JIS）预测肝细胞癌（HCC）肝切除术后生存率的能力。
纳入1986年至2006年在广岛大学医院接受HCC肝切除术患者的数据。采用Kaplan-Meier法计算总生存率和无病生存率，组间差异采用对数秩检验。使用赤池信息准则（AIC）统计量来显示更合适的模型。
共纳入626例患者（男/女，468/158；平均年龄，63.4±9.6岁；Child-Pugh A/B级，524/102；肝损伤分级A/B/C级，356/261/9）。平均总生存期和无病生存期分别为8.04±0.39年和4.69±0.32年。JIS评分1与2、2与3之间的总生存率存在显著差异（P<0.05），但0与1、3与4之间无显著差异（P>0.05）。除m-JIS评分0与1之间外，其他连续组间的总生存率具有良好的区分能力。关于无病生存期，仅在JIS评分1与2之间发现显著差异。然而，m-JIS评分1与2、3与4之间的无病生存率可以很好地区分。线性趋势分析表明，m-JIS评分在预测总生存期和无病生存期方面比原始JIS评分具有更高的区分能力、更高的同质性似然比和更低的AIC统计量。
在日本，使用肝损伤分级的改良JIS评分系统在预测HCC肝切除术后生存率方面优于原始JIS评分系统。
