Huang Sha, Huang Gui-Qian, Zhu Gui-Qi, Liu Wen-Yue, You Jie, Shi Ke-Qing, Wang Xiao-Bo, Che Han-Yang, Chen Guo-Liang, Fang Jian-Feng, Zhou Yi, Zhou Meng-Tao, Chen Yong-Ping, Braddock Martin, Zheng Ming-Hua
Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; School of the First Clinical Medical Sciences, Wenzhou Medical University, Wenzhou 325000, China.
Department of Infection and Liver Diseases, Liver Research Center, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Renji School of Wenzhou Medical University, Wenzhou 325000, China.
PLoS One. 2015 Jun 9;10(6):e0129000. doi: 10.1371/journal.pone.0129000. eCollection 2015.
There is no prognostic model that is reliable and practical for patients who have received curative liver resection (CLR) for hepatocellular carcinoma (HCC). This study aimed to establish and validate a Surgery-Specific Cancer of the Liver Italian Program (SSCLIP) scoring system for those patients.
668 eligible patients who underwent CLR for HCC from five separate tertiary hospitals were selected. The SSCLIP was constructed from a training cohort by adding independent predictors that were identified by Cox proportional hazards regression analyses to the original Cancer of the Liver Italian Program (CLIP). The prognostic performance of the SSCLIP at 12 and 36-months was compared with data from existing models. The patient survival distributions at different risk levels of the SSCLIP were also assessed.
Four independent predictors were added to construct the SSCLIP, including age (HR = 1.075, 95%CI: 1.019-1.135, P = 0.009), albumin (HR = 0.804, 95%CI: 0.681-0.950, P = 0.011), prothrombin time activity (HR = 0.856, 95%CI: 0.751-0.975, P = 0.020) and microvascular invasion (HR = 19.852, 95%CI: 2.203-178.917, P = 0.008). In both training and validation cohorts, 12-month and 36-month prognostic performance of the SSCLIP were significantly better than those of the original CLIP, model of end-stage liver disease-based CLIP, Okuda and Child-Turcotte-Pugh score (all P < 0.05). The stratification of risk levels of the SSCLIP showed an enhanced ability to differentiate patients with different outcomes.
A novel SSCLIP to predict survival of HCC patients who received CLR based on objective parameters may provide a refined, useful prognosis algorithm.
对于接受肝细胞癌（HCC）根治性肝切除术（CLR）的患者，尚无可靠且实用的预后模型。本研究旨在为这些患者建立并验证一种肝脏手术特异性意大利癌症项目（SSCLIP）评分系统。
选取了来自五家不同三级医院的668例接受CLR治疗HCC的合格患者。通过将Cox比例风险回归分析确定的独立预测因子添加到原始的意大利肝脏癌症项目（CLIP）中，从训练队列构建了SSCLIP。将SSCLIP在12个月和36个月时的预后性能与现有模型的数据进行比较。还评估了SSCLIP不同风险水平下患者的生存分布情况。
添加了四个独立预测因子来构建SSCLIP，包括年龄（HR = 1.075，95%CI：1.019 - 1.135，P = 0.009）、白蛋白（HR = 0.804，95%CI：0.681 - 0.950，P = 0.011）、凝血酶原时间活性（HR = 0.856，95%CI：0.751 - 0.975，P = 0.020）和微血管侵犯（HR = 19.852，95%CI：2.203 - 178.917，P = 0.008）。在训练队列和验证队列中，SSCLIP在12个月和36个月时的预后性能均显著优于原始CLIP、基于终末期肝病的CLIP模型、奥田和Child - Turcotte - Pugh评分（所有P < 0.05）。SSCLIP风险水平的分层显示出区分不同预后患者的能力增强。
一种基于客观参数预测接受CLR的HCC患者生存情况的新型SSCLIP可能提供一种精确、有用的预后算法。
