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开发一种临床评分模型以预测肝癌肝切除术后患者的总生存期和无复发生存期。

Development of a clinical scoring model to predict the overall and relapse‑free survival of patients with hepatocellular carcinoma following a hepatectomy.

作者信息

Deng Wanyu, Chen Fu, Li Yuanxiang, Xu Leibo

机构信息

College of Life Science, Shangrao Normal University, Shangrao, Jiangxi 334001, P.R. China.

Department of Pancreato-Biliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510120, P.R. China.

出版信息

Mol Clin Oncol. 2023 Sep 21;19(5):87. doi: 10.3892/mco.2023.2683. eCollection 2023 Nov.

Abstract

Hepatocellular carcinoma (HCC) is a highly lethal disease, and surgical resection is one of the major treatment methods used. However, to date, at least to the best of our knowledge, there is no effective prognostic scoring system for the overall survival (OS) and relapse-free survival (RFS) of patients following hepatectomy. The present study developed a low-cost and easy-to-use model based on the clinicopathological characteristics of patients with HCC for assessment of outcome prediction and risk stratification. A total of 690 patients with HCC undergoing surgery were included and randomly divided into two cohorts (n=345). Cox regression analysis was conducted to investigate the association between the clinicopathological and treatment features, and patient survival. Multivariate analysis revealed that ascites, vascular tumor thrombus, low tumor differentiation and extrahepatic metastasis were independent risk factors for OS. Extrahepatic metastasis and multiple tumors were independent risk factors to predict tumor recurrence. These variables were weighted to construct the ascites, vascular tumor thrombus, low tumor differentiation, extrahepatic metastasis and multiple tumors (AVLEM) score based on the cumulative incidence (CuI) of the aforementioned variables, and the patients were classified into grade 0 (CuI=0), grade 1 (CuI=1 for OS and CuI ≥1 for RFS), and grade 2 (CuI ≥2) subgroups, respectively. Kaplan-Meier analysis revealed that the OS and RFS differed significantly among the subgroups; however, the survival rate between the two cohorts did not exhibit any marked differences. On the whole, the present study demonstrates that with this AVLEM scoring system, patients with HCC with a high score had a poor OS and RFS; thus, it is suggested that such patients undergo imaging examinations following a hepatectomy more frequently.

摘要

肝细胞癌(HCC)是一种致死率很高的疾病,手术切除是主要的治疗方法之一。然而,迄今为止,至少就我们所知,尚无针对肝切除术后患者总生存期(OS)和无复发生存期(RFS)的有效预后评分系统。本研究基于HCC患者的临床病理特征开发了一种低成本且易于使用的模型,用于评估预后预测和风险分层。总共纳入了690例行手术的HCC患者,并随机分为两个队列(n = 345)。进行Cox回归分析以研究临床病理和治疗特征与患者生存之间的关联。多变量分析显示,腹水、血管内肿瘤血栓、低肿瘤分化和肝外转移是OS的独立危险因素。肝外转移和多发肿瘤是预测肿瘤复发的独立危险因素。根据上述变量的累积发生率(CuI)对这些变量进行加权,构建腹水、血管内肿瘤血栓、低肿瘤分化、肝外转移和多发肿瘤(AVLEM)评分,并将患者分别分为0级(CuI = 0)、1级(OS时CuI = 1且RFS时CuI≥1)和2级(CuI≥2)亚组。Kaplan-Meier分析显示,亚组之间的OS和RFS有显著差异;然而,两个队列之间的生存率没有明显差异。总体而言,本研究表明,使用这种AVLEM评分系统,高分的HCC患者的OS和RFS较差;因此,建议此类患者肝切除术后更频繁地进行影像学检查。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1b27/10580259/fc0c1c211022/mco-19-05-02683-g00.jpg

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