Zhang Yu, Chen Shu-Wei, Liu Li-Li, Yang Xia, Cai Shao-Hang, Yun Jing-Ping
Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, People's Republic of China,
Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, People's Republic of China,
Cancer Manag Res. 2018 Sep 20;10:3707-3715. doi: 10.2147/CMAR.S175303. eCollection 2018.
Hepatocellular carcinoma (HCC) recurrence is a clinical challenge. An accurate prediction system for patients with HCC is needed, since the choice of HCC treatment strategies is very important.
A total of 804 patients with HCC who underwent curative resection at Sun Yat-sen University Cancer Center were included in this study. Demographics, clinicopathological data, and follow-up information were collected.
A logistic regression analysis was conducted to investigate the relationships between clinical features and HCC recurrence. Tumor size (OR=1.454, 95% CI: 1.047-2.020, =0.026) and TNM stage (OR=1.360, 95% CI: 1.021-1.813, =0.036) were independent predictors of HCC recurrence after curative resection. Therefore, the following equation was established to predict HCC recurrence: 0.308×TNM+0.374×tumor size-0.639. The equation score was 0.53±0.23 in patients who experienced HCC recurrence compared with 0.47±0.24 in other patients. A similar trend was observed in patients who survived after the last follow-up, compared with those who did not, with scores of 0.37±0.26 vs 0.52±0.22, respectively (<0.001). The Kaplan-Meier analysis showed that patients with HCC with equation values >0.5 had significantly worse outcomes than those with equation values ≤0.5 (<0.001) for overall survival (OS) and recurrence (=0.043). Multivariate Cox analyses showed that tumor multiplicity (=0.039), involucrum (=0.029), vascular invasion (<0.001), and equation value (<0.001) were independent prognostic variables for OS, whereas tumor multiplicity (=0.01), tumor differentiation (=0.007), vascular invasion (<0.001), involucrum (=0.01), and equation value (<0.001) were independent prognostic variables for HCC recurrence.
We established a novel and effective equation for predicting the probability of recurrence and OS after curative resection. Patients with a high recurrence score, based on this equation, should undergo additional high-end imaging examinations.
肝细胞癌（HCC）复发是一项临床挑战。由于HCC治疗策略的选择非常重要，因此需要一个针对HCC患者的准确预测系统。
本研究纳入了804例在中山大学肿瘤防治中心接受根治性切除的HCC患者。收集了人口统计学、临床病理数据及随访信息。
进行逻辑回归分析以研究临床特征与HCC复发之间的关系。肿瘤大小（OR=1.454，95%CI：1.047 - 2.020，P=0.026）和TNM分期（OR=1.360，95%CI：1.021 - 1.813，P=0.036）是根治性切除术后HCC复发的独立预测因素。因此，建立了以下预测HCC复发的方程：0.308×TNM + 0.374×肿瘤大小 - 0.639。HCC复发患者的方程得分是0.53±0.23，而其他患者为0.47±0.24。与末次随访后未存活的患者相比，存活患者也观察到类似趋势，得分分别为0.37±0.26和0.52±0.22（P<0.001）。Kaplan-Meier分析显示，方程值>0.5的HCC患者总生存（OS）和复发情况（P=0.043）显著差于方程值≤0.5的患者（P<0.001）。多因素Cox分析显示，肿瘤多灶性（P=0.039）、包膜（P=0.029）、血管侵犯（P<0.001）和方程值（P<0.001）是OS的独立预后变量，而肿瘤多灶性（P=0.01）、肿瘤分化程度（P=0.007）、血管侵犯（P<0.001）、包膜（P=0.01）和方程值（P<0.001）是HCC复发的独立预后变量。
我们建立了一个用于预测根治性切除术后复发概率和OS的新型有效方程。基于该方程复发评分高的患者应接受额外的高端影像学检查。
