Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China.
J Surg Res. 2010 Mar;159(1):538-44. doi: 10.1016/j.jss.2008.09.004. Epub 2008 Oct 7.
The 6th edition tumor-node-metastasis (TNM) staging (TNM-6) for hepatocellular carcinoma (HCC) was recommended. Besides, Liver Cancer Study Group of Japan (LCSGJ)-T classification has been recently proposed. However, these newly established staging systems should be further verified in different subgroups of HCC patients. The current study mainly aimed to validate the predictive power of these novel criteria in a cohort of patients with hepatitis B virus-related HCC after radical hepatectomy. As a control, the 5th edition TNM staging (TNM-5) was also evaluated.
Clinicopathological and follow-up data of consecutive 142 patients with HBV-related HCC undergoing radical hepatectomy were reviewed. The impact of variables on prognosis was determined by uni- and multivariate analyses.
By univariate analysis, LCSGJ-T classification, TNM-6, and TNM-5 were almost significantly prognostic, except for TNM-5 for disease-free survival. Meanwhile, tumor size>or=5 cm, alpha-fetoprotein>400 ng/mL, high Edmondson-Steiner grade, presence of microvascular invasion, portal vein tumor thrombosis, satellite nodule, and resection margin<or=1 cm were also associated with decreased overall or disease-free survival. Multivariate analysis, including aforementioned factors, suggested that Edmondson-Steiner grade was the sole independent prognosticator for both overall and disease-free survival, when LCSGJ-T classification, TNM-6, and TNM-5 were entered, respectively. However, all 3 staging systems lost their predictive potentials in multivariate analysis.
LCSGJ-T classification, TNM-6, and TNM-5 were not revealed to be independently prognostic in patients with HBV-related HCC after radical hepatectomy. Therefore, these staging criteria, especially the newly developed ones, call for more support in many subsets of HCC patients.
第六版肿瘤-淋巴结-转移（TNM）分期（TNM-6）被推荐用于肝细胞癌（HCC）。此外，日本肝癌研究组（LCSGJ）-T 分级最近也被提出。然而，这些新建立的分期系统应该在 HCC 患者的不同亚组中进一步验证。本研究主要旨在验证这些新的标准在接受根治性肝切除术后的乙型肝炎病毒相关 HCC 患者队列中的预测能力。作为对照，也评估了第五版 TNM 分期（TNM-5）。
回顾性分析了连续 142 例接受根治性肝切除术的乙型肝炎病毒相关 HCC 患者的临床病理和随访数据。通过单因素和多因素分析确定变量对预后的影响。
单因素分析表明，LCSGJ-T 分级、TNM-6 和 TNM-5 几乎都具有预后意义，除了 TNM-5 对无病生存率无影响。同时，肿瘤直径>或=5cm、甲胎蛋白>400ng/mL、高 Edmondson-Steiner 分级、微血管侵犯、门静脉癌栓、卫星结节和切缘<或=1cm 也与总生存率和无病生存率降低相关。多因素分析，包括上述因素，表明在分别纳入 LCSGJ-T 分级、TNM-6 和 TNM-5 时，Edmondson-Steiner 分级是总生存率和无病生存率的唯一独立预后因素。然而，所有 3 种分期系统在多因素分析中均失去了预测能力。
在接受根治性肝切除术后的乙型肝炎病毒相关 HCC 患者中，LCSGJ-T 分级、TNM-6 和 TNM-5 均未显示出独立的预后能力。因此，这些分期标准，特别是新开发的标准，需要在更多 HCC 患者亚组中得到支持。
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