Adhoute Xavier, Pénaranda Guillaume, Raoul Jean Luc, Edeline Julien, Blanc Jean-Frédéric, Pol Bernard, Campanile Manuela, Perrier Hervé, Bayle Olivier, Monnet Olivier, Beaurain Patrick, Muller Cyril, Castellani Paul, Le Treut Yves Patrice, Bronowicki Jean Pierre, Bourlière Marc
Xavier Adhoute, Hervé Perrier, Paul Castellani, Marc Bourlière, Department of Hepato-Gastroenterology, Hôpital Saint-Joseph Marseille, 13008 Marseille, France.
World J Gastroenterol. 2017 Apr 14;23(14):2545-2555. doi: 10.3748/wjg.v23.i14.2545.
To compare the performances of the Barcelona clinic liver cancer (BCLC) nomogram and others systems (BCLC, HKLC, CLIP, NIACE) for survival prediction in a large hepatocellular carcinoma (HCC) French cohort.
Data were collected retrospectively from 01/2007 to 12/2013 in five French centers. Newly diagnosed HCC patients were analyzed. The discriminatory ability, homogeneity ability, prognostic stratification ability Akaike information criterion (AIC) and C-index were compared among scoring systems.
The cohort included 1102 patients, mostly men, median age 68 [60-74] years with cirrhosis (81%), child-Pugh A (73%), alcohol-related (41%), HCV-related (27%). HCC were multinodular (59%) and vascular invasion was present in 41% of cases. At time of HCC diagnosis BCLC stages were A (17%), B (16%), C (60%) and D (7%). First line HCC treatment was curative in 23.5%, palliative in 59.5%, BSC in 17% of our population. Median OS was 10.8 mo [4.9-28.0]. Each system distinguished different survival prognosis groups ( < 0.0001). The nomogram had the highest discriminatory ability, the highest C-index value. NIACE score had the lowest AIC value. The nomogram distinguished sixteen different prognosis groups. By classifying unifocal large HCC into tumor burden 1, the nomogram was less powerful.
In this French cohort, the BCLC nomogram and the NIACE score provided the best prognostic information, but the NIACE could even help treatment strategies.
在一个大型法国肝细胞癌（HCC）队列中比较巴塞罗那临床肝癌（BCLC）列线图与其他系统（BCLC、HKLC、CLIP、NIACE）对生存预测的性能。
回顾性收集2007年1月至2013年12月期间法国五个中心的数据。对新诊断的HCC患者进行分析。比较各评分系统之间的鉴别能力、同质性能力、预后分层能力、赤池信息准则（AIC）和C指数。
该队列包括1102例患者，大多数为男性，中位年龄68岁[60 - 74岁]，伴有肝硬化（81%），Child-Pugh A级（73%），酒精相关性（41%），丙型肝炎病毒相关性（27%）。HCC为多结节性（59%），41%的病例存在血管侵犯。在HCC诊断时，BCLC分期为A期（17%）、B期（16%）、C期（60%）和D期（7%）。一线HCC治疗中，23.5%为根治性治疗，59.5%为姑息性治疗，17%为最佳支持治疗（BSC）。中位总生存期为10.8个月[4.9 - 28.0个月]。每个系统都区分出了不同的生存预后组（<0.0001）。列线图具有最高的鉴别能力和最高的C指数值。NIACE评分的AIC值最低。列线图区分出了16个不同的预后组。通过将单灶性大HCC归类为肿瘤负荷1，列线图的效能较低。
在这个法国队列中，BCLC列线图和NIACE评分提供了最佳的预后信息，但NIACE甚至有助于制定治疗策略。
