Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
J Hepatol. 2010 Jul;53(1):108-17. doi: 10.1016/j.jhep.2010.01.038. Epub 2010 Mar 31.
BACKGROUND & AIMS: The currently used staging systems for hepatocellular carcinoma (HCC) are not satisfactory. The optimal prognostic model for HCC is still under intense debate. This study aimed to propose a new staging system for HCC based on total tumor volume (TTV) and to compare it with the currently used systems.
A total of 2030 HCC patients undergoing different treatment strategies were retrospectively analyzed. TTV was defined as the sum of the volume of each tumor [(4/3)x3.14x(radius of tumor in cm)(3)]. The discriminatory ability of the TTV-based staging system and the four current systems, including the Barcelona Clinic Liver Cancer, Cancer of the Liver Italian Program (CLIP), Japan Integrated Staging system, and Tokyo system, was examined by comparing the Akaike information criterion (AIC) using the Cox proportional hazards model.
A higher TTV correlated well with the decreased survival in HCC patients (p<0.001). Among the 12 TTV-based staging systems, the TTV-Child-Turcotte-Pugh (CTP)-alpha-fetoprotein (AFP) combination provided the lowest AIC value. The TTV-CTP-AFP model consistently showed a better prognostic ability in comparison to the current four staging systems. In 936 HCC patients receiving curative treatment, the TTV-CTP-AFP model provided the second best predictive accuracy following the CLIP score. Alternatively, in 1094 patients undergoing non-curative treatment, the TTV-CTP-AFP model exhibited the smallest AIC value.
TTV may be a feasible tumoral prognostic predictor for HCC. In this single-hospital study that included patients with early to advanced cancer stages, the TTV-CTP-AFP model provides the best prognostic ability among 12 TTV-based and currently used staging systems.
目前用于肝细胞癌（HCC）的分期系统并不令人满意。HCC 的最佳预后模型仍在激烈争论中。本研究旨在提出一种基于总肿瘤体积（TTV）的新 HCC 分期系统，并将其与目前使用的系统进行比较。
回顾性分析了 2030 例接受不同治疗策略的 HCC 患者。TTV 定义为每个肿瘤体积的总和[（4/3）x3.14x（肿瘤半径的立方）（cm）]。使用 Cox 比例风险模型比较赤池信息量准则（AIC），检查基于 TTV 的分期系统和四个当前系统（巴塞罗那临床肝癌、意大利肝癌计划（CLIP）、日本综合分期系统和东京系统）的区分能力。
TTV 越高与 HCC 患者生存率降低密切相关（p<0.001）。在 12 种基于 TTV 的分期系统中，TTV-Child-Turcotte-Pugh（CTP）-甲胎蛋白（AFP）联合提供了最低的 AIC 值。TTV-CTP-AFP 模型与目前的四种分期系统相比，始终显示出更好的预后能力。在 936 例接受根治性治疗的 HCC 患者中，TTV-CTP-AFP 模型仅次于 CLIP 评分，提供了第二好的预测准确性。或者，在 1094 例接受非根治性治疗的患者中，TTV-CTP-AFP 模型表现出最小的 AIC 值。
TTV 可能是 HCC 的一种可行的肿瘤预后预测因子。在这项包括早期至晚期癌症阶段患者的单中心研究中，TTV-CTP-AFP 模型在 12 种基于 TTV 的和目前使用的分期系统中提供了最佳的预后能力。
