Mondazzi L, Bottelli R, Brambilla G, Rampoldi A, Rezakovic I, Zavaglia C, Alberti A, Idèo G
Crespi Division of Medicine, Niguarda Cà Granda Hospital, Milan, Italy.
Hepatology. 1994 May;19(5):1115-23.
A total of 84 patients with hepatocellular carcinoma and cirrhosis were analyzed retrospectively to investigate prognostic factors. All patients received transarterial oily chemoembolization as the only anticancer therapy. The follow-up range was 1 to 39 mo (median, 9.5 mo). The overall actuarial survival rates at 12, 24 and 30 mo were 62%, 31% and 24%, respectively. According to univariate analysis, variables significantly associated with survival were age, Child-Pugh grade, total serum bilirubin, Okuda stage, tumor size, degree of labeling of the tumor with Lipiodol, gelatin foam use, changes with treatment in tumor size and changes with treatment in alpha-fetoprotein concentration. Two multivariate analyses were performed. When pretreatment and treatment variables were considered, parameters with independent prognostic value were age, Child-Pugh grade, total serum bilirubin, tumor size and degree of Lipiodol labeling of the tumor. When follow-up variables were also considered, we (a) confirmed the prognostic significance of all these parameters (age, Child-Pugh grade, total serum bilirubin, tumor size) and (b) found the independent prognostic value of the change in tumor size (or change in alpha-fetoprotein concentration). Both models yielded different risk coefficients for each class of each variable. Two simple prognostic indexes, based on these coefficients, are proposed: an "initial" index (including pretreatment and treatment variables) and a "follow-up" index (also including follow-up variables). According to the two indexes, the patients were classified into three groups with different prognoses: good (93% and 100% actuarial survival at 1 yr for the initial and follow-up indexes, respectively), intermediate (65% and 53%, respectively) and poor (27% for both indexes).
对84例肝细胞癌合并肝硬化患者进行回顾性分析，以探讨预后因素。所有患者均接受经动脉油性化疗栓塞作为唯一的抗癌治疗。随访时间为1至39个月（中位数为9.5个月）。12个月、24个月和30个月的总精算生存率分别为62%、31%和24%。单因素分析显示，与生存显著相关的变量包括年龄、Child-Pugh分级、总血清胆红素、奥田分期、肿瘤大小、碘油对肿瘤的标记程度、明胶海绵的使用、治疗后肿瘤大小的变化以及治疗后甲胎蛋白浓度的变化。进行了两项多因素分析。当考虑治疗前和治疗变量时，具有独立预后价值的参数为年龄、Child-Pugh分级、总血清胆红素、肿瘤大小和碘油对肿瘤的标记程度。当同时考虑随访变量时，我们（a）证实了所有这些参数（年龄、Child-Pugh分级、总血清胆红素、肿瘤大小）的预后意义，（b）发现了肿瘤大小变化（或甲胎蛋白浓度变化）的独立预后价值。两个模型对每个变量的每个类别都产生了不同的风险系数。基于这些系数，提出了两个简单的预后指标：一个“初始”指标（包括治疗前和治疗变量）和一个“随访”指标（也包括随访变量）。根据这两个指标，将患者分为预后不同的三组：良好（初始指标和随访指标1年的精算生存率分别为93%和100%）、中等（分别为65%和53%）和较差（两个指标均为27%）。
