Edeline J, Blanc J-F, Campillo-Gimenez B, Ma Y-T, King J, Faluyi O, Mathurin J, Ghazi S, Palmer D H, Meyer T
Oncology, Centre Eugène Marquis, Rennes, France.
Hepatology, CHU Hôpital Saint André, Bordeaux, France.
Eur J Cancer. 2017 Nov;86:135-142. doi: 10.1016/j.ejca.2017.08.036. Epub 2017 Oct 4.
No prognostic classification is currently used for patients treated with systemic therapies for Hepatocellular Carcinoma (HCC).
We retrospectively analysed data from patients treated with sorafenib for HCC from five centres in France and in the United Kingdom (UK). The training set comprised data from two centres and the validation set from three. Variables independently associated with Overall Survival (OS) in the training set were used to build the SAP (Sorafenib Advanced HCC Prognosis) score. The score was tested in the validation set, then compared with other prognostication systems.
The training set and validation set included 370 and 468 patients respectively. In the training set, variables independently associated with OS in multivariable analysis were: performance status (PS) >0, alpha-fetoprotein (AFP) >400 ng/ml, tumour size >7 cm, bilirubin >17 μmol/l and albumin <36 g/l. The SAP score was built giving one point to each abnormal variable, and three classes were constructed. The SAP score was significantly associated with OS in the training set, with median OS of 14.9 months for SAP A, 7.2 months for SAP B and 2.5 months for SAP C (P < 0.001). In the validation set, the SAP score was significantly associated with OS, and showed greater discriminative abilities than Barcelona Clinic Liver Cancer (BCLC) and albumin-bilirubin (ALBI) scores. However, the hepatoma arterial embolisation prognostic (HAP) score showed greater discriminative abilities than the SAP score.
In European patients treated with sorafenib, the HAP was the most discriminant prognostic score and may facilitate stratification in trials and inform clinical decision making.
目前，肝细胞癌（HCC）接受全身治疗的患者尚无预后分类方法。
我们回顾性分析了法国和英国五个中心接受索拉非尼治疗的HCC患者的数据。训练集包括两个中心的数据，验证集包括三个中心的数据。使用训练集中与总生存期（OS）独立相关的变量构建索拉非尼晚期HCC预后（SAP）评分。该评分在验证集中进行测试，然后与其他预后系统进行比较。
训练集和验证集分别包括370例和468例患者。在训练集中，多变量分析中与OS独立相关的变量为：体能状态（PS）>0、甲胎蛋白（AFP）>400 ng/ml、肿瘤大小>7 cm、胆红素>17 μmol/l和白蛋白<36 g/l。构建SAP评分，每个异常变量计1分，并分为三类。SAP评分在训练集中与OS显著相关，SAP A的中位OS为14.9个月，SAP B为7.2个月，SAP C为2.5个月（P<0.001）。在验证集中，SAP评分与OS显著相关，且比巴塞罗那临床肝癌（BCLC）和白蛋白-胆红素（ALBI）评分具有更强的鉴别能力。然而，肝癌动脉栓塞预后（HAP）评分比SAP评分具有更强的鉴别能力。
在接受索拉非尼治疗的欧洲患者中，HAP是最具鉴别力的预后评分，可能有助于试验分层并为临床决策提供依据。
