Department of Gastroenterology, Hepatology Unit, Federal University of Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.
Department of Surgery, Liver Transplant Unit, Federal University of Sao Paulo (Unifesp), Sao Paulo, SP, Brazil.
PLoS One. 2018 Apr 4;13(4):e0194922. doi: 10.1371/journal.pone.0194922. eCollection 2018.
There are several prognostic systems that address different aspects of the patient and the tumour and can guide the management of patients with hepatocellular carcinoma (HCC). This study aimed to evaluate and compare the eight staging systems for a group of patients in a public service in Brazil.
Patients with HCC were retrospectively analysed between 2000 and 2012. The prognostic systems Okuda, The Cancer of the Liver Italian Program (CLIP), the Chinese University Prognostic Index (CUPI), Groupe d'Etude et de Traitément du Carcinome Hepatocellulaire (GRETCH), the modified TNM-based Japan Integrated Score (JIS) combined with alpha-fetoprotein and Child-Turcotte-Pugh (CTP), the TNM system, and the Barcelona Clinic Liver Cancer Classification (BCLC) were applied to these patients and compared through model fit measurements, likelihood scores, and the Akaike Information Criterion (AIC).
A total of 247 patients were studied. The average survival time was 60 months. The TNM, Okuda, CLIP, GRETCH, modified JIS, and BCLC systems were well correlated with one another and individually important to the prediction of survival among the patients studied. However, in the statistical analysis, the CUPI delivered the best predictive performance (AIC = 566; log-likelihood = -281,240).
Although the CUPI system was demonstrated to be the most appropriate HCC staging system for the studied population, the choice of an ideal system is a controversial subject, and future studies with larger numbers of patients are necessary for the validation of the CUPI system as the method of choice for other populations.
有几个预后系统可以解决患者和肿瘤的不同方面，并可以指导肝细胞癌（HCC）患者的管理。本研究旨在评估和比较巴西一家公共服务机构的一组患者的八种分期系统。
回顾性分析 2000 年至 2012 年间的 HCC 患者。对 Okuda、意大利肝癌计划（CLIP）、中国大学预后指数（CUPI）、Groupe d'Etude et de Traité du Carcinome Hepatocellulaire（GRETCH）、改良基于 TNM 的日本综合评分（JIS）结合甲胎蛋白和 Child-Turcotte-Pugh（CTP）、TNM 系统和巴塞罗那临床肝癌分类（BCLC）进行了这些患者，并通过模型拟合测量、似然评分和赤池信息量准则（AIC）进行比较。
共研究了 247 例患者。平均生存时间为 60 个月。TNM、Okuda、CLIP、GRETCH、改良 JIS 和 BCLC 系统相互之间相关性良好，并且对研究患者的生存预测具有重要意义。然而，在统计分析中，CUPI 提供了最佳的预测性能（AIC=566；对数似然=-281,240）。
尽管 CUPI 系统被证明是研究人群中最适合 HCC 分期的系统，但选择理想的系统是一个有争议的问题，需要进一步进行更多患者的研究来验证 CUPI 系统是否适合其他人群。
