Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
HPB (Oxford). 2009 Aug;11(5):382-90. doi: 10.1111/j.1477-2574.2009.00070.x.
Several staging systems for patients with hepatocellular carcinoma (HCC) have been proposed, but studies of their prognostic accuracy have yielded conflicting conclusions. Stratifying patients with early HCC is of particular interest because these patients may derive the greatest benefit from intervention, yet no studies have evaluated the comparative performances of staging systems in patients with early HCC.
A retrospective cohort study was performed using data on 379 patients who underwent liver resection or liver transplantation for HCC at six major hepatobiliary centres in the USA and Europe. The staging systems evaluated were: the Okuda staging system, the International Hepato-Pancreato-Biliary Association (IHPBA) staging system, the Cancer of the Liver Italian Programme (CLIP) score, the Barcelona Clinic Liver Cancer (BCLC) staging system, the Japanese Integrated Staging (JIS) score and the American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC) staging system, 6th edition. A recently proposed early HCC prognostic score was also evaluated. The discriminative abilities of the staging systems were evaluated using Cox proportional hazards models and the bootstrap-corrected concordance index (c).
Overall survival of the cohort was 74% at 3 years and 52% at 5 years, with a median survival of 62 months. Most systems demonstrated poor discriminatory ability (P > 0.05 on Cox proportional hazards analysis, c approximately 0.5). However, the AJCC/UICC system clearly stratified patients (P < 0.001, c = 0.59), albeit only into two groups. The early HCC prognostic score also clearly stratified patients (P < 0.001, c = 0.60) and identified three distinct prognostic groups.
The early HCC prognostic score is superior to the AJCC/UICC staging system (6th edition) for predicting the survival of patients with early HCC after liver resection or liver transplantation. Other major HCC staging systems perform poorly in patients with early HCC.
已经提出了几种用于肝细胞癌 (HCC) 患者的分期系统，但对其预后准确性的研究得出了相互矛盾的结论。对早期 HCC 患者进行分层尤其重要，因为这些患者可能从干预中获得最大的益处，但尚无研究评估分期系统在早期 HCC 患者中的比较性能。
使用美国和欧洲六个主要肝胆中心接受肝切除术或肝移植治疗 HCC 的 379 名患者的数据进行了回顾性队列研究。评估的分期系统包括：Okuda 分期系统、国际肝胆胰协会 (IHPBA) 分期系统、癌症肝脏意大利计划 (CLIP) 评分、巴塞罗那临床肝癌 (BCLC) 分期系统、日本综合分期 (JIS) 评分和美国癌症联合委员会/国际抗癌联盟 (AJCC/UICC) 分期系统，第 6 版。还评估了最近提出的早期 HCC 预后评分。使用 Cox 比例风险模型和 bootstrap 校正一致性指数 (c) 评估分期系统的判别能力。
该队列的总生存率为 3 年时为 74%，5 年时为 52%，中位生存时间为 62 个月。大多数系统的判别能力较差 (Cox 比例风险分析 P > 0.05，c 约为 0.5)。然而，AJCC/UICC 系统明确地对患者进行分层 (P < 0.001，c = 0.59)，尽管仅分为两组。早期 HCC 预后评分也明确地对患者进行分层 (P < 0.001，c = 0.60)，并确定了三个不同的预后组。
早期 HCC 预后评分优于 AJCC/UICC 分期系统 (第 6 版)，可预测肝切除或肝移植后早期 HCC 患者的生存情况。其他主要的 HCC 分期系统在早期 HCC 患者中表现不佳。
