格拉斯哥预后评分预测肝癌患者肝切除术后的生存和复发模式。

Glasgow Prognostic Score Predicts Survival and Recurrence Pattern in Patients With Hepatocellular Carcinoma After Hepatectomy.

机构信息

Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan;

Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan.

出版信息

Anticancer Res. 2023 Feb;43(2):875-882. doi: 10.21873/anticanres.16230.

DOI:10.21873/anticanres.16230

PMID:36697102

Abstract

BACKGROUND/AIM: The prognostic significance of the Glasgow Prognostic Score (GPS) on outcomes of liver resection for hepatocellular carcinoma (HCC) remains unclear; the aim of the study was to assess its significance.

PATIENTS AND METHODS

A total of 480 patients with HCC who underwent liver resection with curative intent at the Yokohama City University Hospital and Medical Center were enrolled in the study. Patients were classified into three groups: GPS-0, C-reactive protein (CRP) ≤1.0 mg/dl serum albumin ≥3.5 g/dl; GPS-1, CRP >1.0 mg/dl or serum albumin <3.5 g/dl; and GPS-2, CRP >1.0 mg/dl, serum albumin <3.5 g/dl. Prognostic factors for overall survival (OS) and disease-free survival (DFS) were analyzed retrospectively. The recurrence pattern was also investigated using GPS.

RESULTS

Of the 480 patients, 382 (79.6%), 81 (16.9%), and 17 (3.5%) were assigned to GPS-0, GPS-1, and GPS-2, respectively. Elevated GPS, indocyanine green retention rate at 15 min, and protein induced by vitamin K antagonist-II (PIVKA-II) were significantly associated with a poor OS. Elevated GPS, alpha-fetoprotein, and PIVKA-II were significantly associated with a poor DFS by multivariate analysis. The number of patients with liver-only recurrence in GPS-0, GPS-1, and GPS-2 was 179 (86.1%), 40 (78.4%), and 9 (69.2%), respectively. The number of patients with four or more intrahepatic metastases in the GPS-0, GPS-1, and GPS-2 groups, was 33 (17.9%), 11 (27.5%), and 8 (88.9%), respectively. The number of patients with four or more intrahepatic metastases in the GPS-2 group was significantly higher (p<0.001).

CONCLUSION

Preoperative GPS is a useful predictor of OS and recurrence pattern after liver resection with a curative intent for HCC.

摘要

背景/目的：格拉斯哥预后评分（GPS）对肝癌（HCC）肝切除术后结局的预后意义尚不清楚；本研究旨在评估其意义。

方法

本研究共纳入在横滨市立大学医院和医疗中心接受根治性肝切除术的 480 例 HCC 患者。患者分为三组：GPS-0，C 反应蛋白（CRP）≤1.0mg/dl 血清白蛋白≥3.5g/dl；GPS-1，CRP＞1.0mg/dl 或血清白蛋白＜3.5g/dl；GPS-2，CRP＞1.0mg/dl，血清白蛋白＜3.5g/dl。回顾性分析总生存（OS）和无病生存（DFS）的预后因素。还使用 GPS 研究了复发模式。

结果

480 例患者中，GPS-0、GPS-1 和 GPS-2 分别为 382（79.6%）、81（16.9%）和 17（3.5%）。升高的 GPS、15 分钟吲哚菁绿滞留率和维生素 K 拮抗剂-II 诱导蛋白（PIVKA-II）与较差的 OS 显著相关。多因素分析显示，升高的 GPS、甲胎蛋白和 PIVKA-II 与较差的 DFS 显著相关。GPS-0、GPS-1 和 GPS-2 组肝内复发患者分别为 179（86.1%）、40（78.4%）和 9（69.2%）。GPS-0、GPS-1 和 GPS-2 组 4 个或更多肝内转移患者分别为 33（17.9%）、11（27.5%）和 8（88.9%）。GPS-2 组 4 个或更多肝内转移患者数量明显更高（p＜0.001）。