Department of Hepatobiliary Surgery, Sun Yat-sen University Cancer Center, 651 Dongfeng Road East, Guangzhou, 510060, China.
J Cancer Res Clin Oncol. 2013 Oct;139(10):1709-19. doi: 10.1007/s00432-013-1497-y. Epub 2013 Aug 28.
To evaluate the accuracy of the 7th edition of the American Joint Committee on Cancer staging system (TNM-7) for patients undergoing hepatectomy for hepatocellular carcinoma (HCC) and to propose a modified TNM system for better prediction of survival.
Clinico-pathological data for 1,313 patients who underwent hepatectomy as initial treatment for HCC between 2000 and 2008 were retrieved from a prospective database. Overall survival (OS) and disease-free survival (DFS) were analyzed to evaluate the predictive value.
The 1-, 3-, 5-year OS and DFS of 1,313 patients were 79.2, 55.4, 45.5 %, and 52.6, 36.1, 31.8 %, respectively. Multivariate analysis revealed that major vascular invasion was the most important prognostic factor for both OS and DFS, along with tumour number and size. Patients with pT1 and pT2 disease had significantly better OS and DFS than those with pT3 disease (P < 0.001). There was no significant difference between pT3a and pT4 (P = 0.552) but patients with pT3b disease had a worse OS and DFS than those with pT4 disease (P = 0.006 and P < 0.001, respectively). A modified TNM system within the existing framework was proposed to combine the current pT3a and pT4 together as the new pT3 and to change pT3b to the new pT4. Analysis showed that this modified system had a better prognostic power than either TNM-6 or TNM-7.
TNM-7 would seem to be inaccurate for staging advanced HCC. The modified system can improve both the prognostic accuracy and the hazard discrimination of disease to be consistent among subgroups of HCC.
评估第 7 版美国癌症联合委员会分期系统（TNM-7）在接受肝细胞癌（HCC）肝切除术患者中的准确性，并提出一种改良的 TNM 系统，以更好地预测生存。
从 2000 年至 2008 年接受肝切除术作为 HCC 初始治疗的 1313 例患者的临床病理数据从一个前瞻性数据库中检索出来。分析总生存期（OS）和无病生存期（DFS）以评估预测价值。
1313 例患者的 1、3、5 年 OS 和 DFS 分别为 79.2%、55.4%、45.5%和 52.6%、36.1%、31.8%。多因素分析显示，大血管侵犯是 OS 和 DFS 的最重要预后因素，其次是肿瘤数量和大小。pT1 和 pT2 疾病患者的 OS 和 DFS 明显优于 pT3 疾病患者（P <0.001）。pT3a 和 pT4 之间无显著差异（P=0.552），但 pT3b 疾病患者的 OS 和 DFS 明显差于 pT4 疾病患者（P=0.006 和 P<0.001）。在现有框架内提出了一种改良的 TNM 系统，将当前的 pT3a 和 pT4 合并为新的 pT3，并将 pT3b 改为新的 pT4。分析表明，该改良系统比 TNM-6 或 TNM-7 具有更好的预后预测能力。
TNM-7 似乎对晚期 HCC 的分期不准确。改良系统可以提高 HCC 亚组的预后准确性和疾病危险分层能力。
