Department of Hepatobiliary Surgery, Clinical Medical College, Yangzhou University, Yangzhou, China.
Turk J Gastroenterol. 2021 Aug;32(8):667-677. doi: 10.5152/tjg.2021.20617.
The prognosis for patient survival using the tumor-node-metastasis (TNM) staging system may be imperfect, as it based only on biological factors and does not include the socioeconomic factors (SEFs). We integrated the SEFs into the TNM system (TNMSEF), and evaluated whether the novel TNM-SEF staging system showed better prediction capacity and improved clinical guidance in hepatocellular carcinoma (HCC).
We selected data of 12 514 cases with HCC between 2010 and 2015 from the SEER database. The Kaplan-Meier survival curves and Cox proportional hazards regression were used to analyze cancer-specific survival (CSS) among the TNM-SEF stages.
Multivariate Cox analyses showed that insurance status, marital status, year of diagnosis, and income were prominent prognostic SEFs (all P < .05). When compared with the SEF0 stage, the SEF1 stage was significantly associated with a 36.1% increased risk of cancer-specific mortality in HCC overall, a 22.2% increased risk of metastatic HCC, and a 41.8% increased risk of non-metastatic HCC (all P < .001). The concordance index of the TNM-SEF stage (0.768) was better than that of the TNM stage (0.764). Furthermore, patients with SEF0 stage showed higher 5-year CSS than those with SEF1 stage (I: 48.7% vs. 28.1%; II: 41.0% vs. 25.1%; IIIA: 12.8% vs. 5.0%; IIIB: 7.8% vs. 6.0%; IIIC: 6.4% vs. 6.7%; IVA: 8.4% vs. 2.5%; IVB: 2.1% vs. 0.8%; all P < .05).
We have proved that the SEF stage is an independent predictor for HCC. The combined SEF stage with TNM staging warrants more clinical attention, for improved prognostic prediction and clinical guidance.
肿瘤-淋巴结-转移（TNM）分期系统对患者生存的预测可能并不完善，因为它仅基于生物学因素，不包括社会经济因素（SEFs）。我们将 SEFs 纳入 TNM 系统（TNMSEF），并评估新的 TNM-SEF 分期系统在肝细胞癌（HCC）中是否具有更好的预测能力和改善临床指导。
我们从 SEER 数据库中选择了 2010 年至 2015 年期间 12514 例 HCC 患者的数据。使用 Kaplan-Meier 生存曲线和 Cox 比例风险回归分析 TNM-SEF 分期之间的癌症特异性生存（CSS）。
多变量 Cox 分析显示，保险状况、婚姻状况、诊断年份和收入是显著的预后 SEFs（均 P <.05）。与 SEF0 期相比，SEF1 期 HCC 整体癌症特异性死亡率风险增加 36.1%，转移性 HCC 风险增加 22.2%，非转移性 HCC 风险增加 41.8%（均 P <.001）。TNM-SEF 分期的一致性指数（0.768）优于 TNM 分期（0.764）。此外，SEF0 期患者的 5 年 CSS 高于 SEF1 期患者（I 期：48.7% vs. 28.1%；II 期：41.0% vs. 25.1%；IIIA 期：12.8% vs. 5.0%；IIIB 期：7.8% vs. 6.0%；IIIC 期：6.4% vs. 6.7%；IVA 期：8.4% vs. 2.5%；IVB 期：2.1% vs. 0.8%；均 P <.05）。
我们已经证明 SEF 分期是 HCC 的独立预测因素。将 SEF 分期与 TNM 分期相结合值得更多的临床关注，以提高预后预测和临床指导。
