切换至 "中华医学电子期刊资源库"

中华肝脏外科手术学电子杂志 ›› 2013, Vol. 02 ›› Issue (02) : 95 -100. doi: 10.3877/cma.j.issn.2095-3232.2013.02.006

所属专题: 文献

临床研究

五个不同分期系统对晚期肝癌患者生存的预测价值比较
陈展洪1, 董敏1, 李星1, 魏丽1, 邢艳芳2, 林曲1, 温景芸1, 马小琨1, 吴祥元1,()   
  1. 1. 510630 广州,中山大学附属第三医院肿瘤内科
    2. 广州医学院第三附属医院肾内科
  • 收稿日期:2012-12-06 出版日期:2013-04-10
  • 通信作者: 吴祥元
  • 基金资助:
    广东省科技计划项目(2009B060700024,2011B031800076)

Comparison of five staging systems in predicting the survival rate of patients with advanced hepatocellular carcinoma

Zhan-hong CHEN1, Min DONG1, Xing LI1, Li WEI1, Yan-fang XING2, Qu LIN1, Jing-yun WEN1, Xiao-kun MA1, Xiang-yuan WU1,()   

  1. 1. Department of Medical Oncology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2012-12-06 Published:2013-04-10
  • Corresponding author: Xiang-yuan WU
  • About author:
    Corresponding author: WU Xiang-yuan, Email:
引用本文:

陈展洪, 董敏, 李星, 魏丽, 邢艳芳, 林曲, 温景芸, 马小琨, 吴祥元. 五个不同分期系统对晚期肝癌患者生存的预测价值比较[J]. 中华肝脏外科手术学电子杂志, 2013, 02(02): 95-100.

Zhan-hong CHEN, Min DONG, Xing LI, Li WEI, Yan-fang XING, Qu LIN, Jing-yun WEN, Xiao-kun MA, Xiang-yuan WU. Comparison of five staging systems in predicting the survival rate of patients with advanced hepatocellular carcinoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2013, 02(02): 95-100.

目的

比较进展期肝癌预后系统(ALCPS)、香港中文大学预后指数(CUPI)、奥田邦雄分期系统(OKUDA)、法国肝癌协会(GETCH)分期、巴塞罗那临床肝癌(BCLC)分期5个分期系统对晚期肝细胞肝癌(肝癌)患者3个月生存率和累积生存率的预测价值。

方法

回顾性分析2008年9月1日至2010年6月1日在中山大学附属第三医院就诊,未进行标准抗肿瘤治疗的255例晚期肝癌患者临床资料。其中男220例,女35例;中位年龄56岁。所有患者均签署知情同意书,符合医学伦理学规定。患者初次诊断时按照ALCPS、CUPI、OKUDA、GETCH、BCLC分期系统分别进行评分,并接受随访。应用受试者工作特征(ROC)曲线,获得每条曲线最佳特异度及灵敏度的预测切点;ROC曲线下面积(A)两两比较采用Delong非参数法检验,评价5个分期系统对患者3个月生存率的预测价值。应用Kaplan-Meier生存曲线和Log-rank检验法比较5个分期系统对晚期肝癌患者累积生存率预测情况,应用似然比检验(LRT)法评价其预测价值。

结果

ALCPS的A值为0.823,在5个分期系统中最高,以14分为预测切点,对应灵敏度为0.76,特异度为0.79;其次是CUPI的A值为0.779,以5分为预测切点,对应灵敏度为0.67,特异度为0.78;OKUDA的A值为0.756,1分为预测切点,对应灵敏度为0.79,特异度为0.62;GETCH的A值为0.687,4分为预测切点,对应灵敏度为0.59,特异度为0.67;BCLC的A值为0.615,以C期为预测切点,对应灵敏度为0.49,特异度为0.74。ALCPS的A值与CUPI、OKUDA、GETCH和BCLC比较差异有统计学意义(Z=2.251,2.577,4.600,5.906;P<0.05),CUPI明显优于GETCH和BCLC,OKUDA则优于BCLC(Z=3.059,4.715;P<0.05)。ALCPS、OKUDA及GETCH的各分组或分期生存曲线比较差异有统计学意义(P<0.05),各分组或分期生存曲线无交叉,有较好的区分价值,而CUPI、BCLC各分组或分期生存曲线比较差异有统计学意义(P<0.05),但其生存曲线存在一定的交叉,区分价值欠佳。LRT检验显示ALCPS、CUPI、OKUDA、GETCH和BCLC的似然比(χ2值)分别为75.70、52.82、45.22、16.87、14.36。ALCPS的χ2值最高,其预测晚期肝癌患者累积生存率的价值最高。

结论

在5个分期系统中,ALCPS对晚期肝癌患者3个月生存率预测能力最好,可作为晚期肝癌患者入组临床试验的选择指标。ALCPS对晚期肝癌患者累积生存率预测价值亦最高,亦可作为晚期肝癌患者长期预后的预测指标。

Objective

To evaluate the five current staging systems, including Advanced Liver Cancer Prognostic System (ALCPS), Chinese University Prognostic Index (CUPI) , OKUDA staging system, Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire (GETCH) and Barcelona Clinic Liver Cancer (BCLC) in predicting the 3-month survival rate and cumulative survival rate of patients with advanced hepatocellular carcinoma (HCC).

Methods

The subjects of this retrospective study were 255 patients (220 males and 35 females with the median age of 56 years old who did not receive any standard anti-cancer treatment in the Third Affiliated Hospital of Sun Yat-sen University from September 1, 2008 to June 1, 2010. The informed consents of all patients were obtained and the ethical committee approval was received. All the patients were scored according to ALCPS, CUPI, OKUDA, GETCH and BCLC staging system at their first diagnosis and were followed up afterwards. Receiver operating characteristic (ROC) curve analysis was carried out to find out the cut-off point of each scoring curve with best sensitivity and specificity. Nonparametric method Delong test was used to compare Area under curve (A) of ROC in order to evaluate different staging systems in predicting the patients' 3-month survival rate. Kaplan-Meier survival curve and Log-rank test were used to compare the cumulative survival rate of advanced HCC patients’ of different staging systems and the likelihood ratio test (LRT) was used to assess the prediction value of 5 systems.

Results

The A value of ALCPS was 0.823, which was the highest among the 5 staging systems. The cut-off point is 14 with the corresponding sensitivity of 0.76 and specificity of 0.79. The A value of CUPI was 0.779. The cut-off point was 5 with the corresponding sensitivity of 0.67 and specificity of 0.78. The A value of OKUDA was 0.756. The cut-off point was 1 with the corresponding sensitivity of 0.79 and specificity of 0.62. The A value of GETCH was 0.687. The cut-off point was 4 with the corresponding sensitivity of 0.59 and specificity of 0.67. The A value of BCLC was 0.615. The cut-off point was stage C with the corresponding sensitivity of 0.49 and specificity of 0.74. There were significant differences between the A value of ALCPS and that of CUPI, OKUDA, GETCH and BCLC (Z=2.251, 2.577, 4.600, 5.906; P<0.05). The A value of CUPI was significantly higher than GETCH and BCLC and that of OKUDA was significantly higher than BCLC (Z=3.059, 4.715; P<0.05). There were significant differences for the survival curve among the subgroups of ALCPS, OKUDA and GETCH (P<0.05) . There was no cross among the subgroups survival curves with distinguishable value. The differences among the subgroups survival curve of CUPI and BCLC are statistically significant(P<0.05) . Some crosses were observed among the subgroups survival curve of CUPI and BCLC and the distinguishable value was poor. The LRT result showed that the χ2 value of ALCPS, CUPI, OKUDA, GETCH and BCLC were 75.70, 52.82, 45.22, 16.87, 14.36 respectively. The χ2 value of ALCPS was the highest, which indicated the best predicting value of cumulative survival.

Conclusions

The ALCPS staging system is the best in predicting 3-month survival rate of advanced HCC and can serve as an inclusion criteria for clinical trials of advanced HCC. The ALCPS staging system is also the best in predicting cumulative survival rate of advanced HCC and can be used as a prognostic index for patient's long-term outcome.

图1 255例晚期肝癌患者采用不同分期系统预测术后3个月生存率的ROC曲线图
表1 5个分期系统对255例晚期肝癌患者3个月生存率的预测情况
表2 不同分期系统预测255例晚期肝癌患者3个月生存率的价值比较
图2 255例晚期肝癌患者5个肝癌分期系统不同分组或分期的Kaplan-Meier生存曲线
表3 255例晚期肝癌患者5个分期系统Kaplan-Meier生存曲线似然比检验结果
[1]
Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med, 2008, 359(4):378-390.
[2]
Cheng AL, Kang YK, Chen Z, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase Ⅲ randomised, double-blind, placebo-controlled trial. Lancet Oncol, 2009, 10(1):25-34.
[3]
Zhu AX. Molecularly targeted therapy for advanced hepatocellular carcinoma in 2012: current status and future perspectives. Semin Oncol, 2012, 39(4):493-502.
[4]
Spangenberg HC, Thimme R, Blum HE. Targeted therapy for hepatocellular carcinoma. Nat Rev Gastroenterol Hepatol, 2009, 6(7):423-432.
[5]
Villanueva A, Llovet JM. Targeted therapies for hepatocellular carcinoma. Gastroenterology, 2011, 140(5):1410-1426.
[6]
Tanaka S, Arii S. Molecular targeted therapies in hepatocellular carcinoma. Semin Oncol, 2012, 39(4):486-492.
[7]
Wiedmann MW, Mössner J. Molecular targeted therapy of hepatocellular carcinoma-results of the first clinical studies. Curr Cancer Drug Targets, 2011, 11(6):714-733.
[8]
Yau T, Yao TJ, Chan P, et al. A new prognostic score system in patients with advanced hepatocellular carcinoma not amendable to locoregional therapy: implication for patient selection in systemic therapy trials. Cancer, 2008, 113(10):2742-2751.
[9]
Leung TW, Tang AM, Zee B, et al. Construction of the Chinese University Prognostic Index for hepatocellular carcinoma and comparison with the TNM staging system, the Okuda staging system, and the Cancer of the Liver Italian Program staging system: a study based on 926 patients. Cancer, 2002, 94(6):1760-1769.
[10]
Okuda K, Ohtsuki T, Obata H, et al. Natural history of hepatocellular carcinoma and prognosis in relation to treatment. study of 850 patients. Cancer, 1985, 56(4):918-928.
[11]
Chevret S, Trinchet JC, Mathieu D, et al. A new prognostic classification for predicting survival in patients with hepatocellular carcinoma: Groupe d’Etude et de Traitement du Carcinome Hépatocellulaire. J Hepatol, 1999, 31(1):133-141.
[12]
Llovet JM, Brú C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis, 1999, 19(3):329-338.
[13]
Huo TI, Huang YH, Lin HC, et al. Proposal of a modified Cancer of the Liver Italian Program staging system based on the model for end-stage liver disease for patients with hepatocellular carcinoma undergoing loco-regional therapy. Am J Gastroenterol,2006, 101(5):975-982.
[14]
Daniele B, Annunziata M, Barletta E, et al. Cancer of the Liver Italian Program (CLIP) score for staging hepatocellular carcinoma. Hepatol Res, 2007, 37(Suppl 2):S206-S209.
[15]
Toyoda H, Kumada T, Osaki Y, et al. Staging hepatocellular carcinoma by a novel scoring system (BALAD score) based on serum markers. Clin Gastroenterol Hepatol, 2006, 4(12):1528-1536.
[16]
Morimoto M, Numata K, Moriya S, et al. Inflammation-based prognostic score for hepatocellular carcinoma patients on sorafenib treatment. Anticancer Res, 2012, 32(2):619-623.
[17]
Ishizuka M, Kubota K, Kita J, et al. Impact of an inflammation-based prognostic system on patients undergoing surgery for hepatocellular carcinoma: a retrospective study of 398 Japanese patients. Am J Surg, 2012, 203(1):101-106.
[18]
Chang ML, Lin SM, Yeh CT. HURP expression-assisted risk scores identify prognosis distinguishable subgroups in early stage liver cancer. PLoS One, 2011, 6(10):e26323.
[19]
Cedo MB, Catharine JA. Models of hepatocellular carcinoma and biomarker strategy. Cancer, 2010, 2(3):1441-1452.
[20]
Qi P, Cheng SQ, Wang H, et al. Serum microRNAs as biomarkers for hepatocellular carcinoma in Chinese patients with chronic hepatitis B virus infection. PLoS One 2011, 6(12):e28486
[21]
Ji J, Shi J, Budhu A, et al. MicroRNA expression, survival, and response to interferon in liver cancer. N Engl J Med, 2009, 361(15):1437-1447.
[22]
Xiong Y, Fang JH, Yun JP, et al. Effects of microRNA-29 on apoptosis, tumorigenicity, and prognosis of hepatocellular carcinoma. Hepatology, 2010, 51(3):836-845.
[23]
Zhang J, Yang Y, Yang T, et al. MicroRNA-22, downregulated in hepatocellular carcinoma and correlated with prognosis, suppresses cell proliferation and tumourigenicity. Br J Cancer, 2010, 103(8):1215-1220.
[1] 王兴, 张峰伟. 腹腔镜肝切除联合断面射频消融治疗伴微血管侵犯肝细胞癌的临床研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(05): 580-583.
[2] 魏小勇. 原发性肝癌转化治疗焦点问题探讨[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 602-607.
[3] 张其坤, 商福超, 李琪, 栗光明, 王孟龙. 联合脾切除对肝癌合并门静脉高压症患者根治性切除术后的生存获益分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 613-618.
[4] 严庆, 刘颖, 邓斐文, 陈焕伟. 微血管侵犯对肝癌肝移植患者生存预后的影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 624-629.
[5] 张文华, 陶焠, 胡添松. 不同部位外生型肝癌临床病理特点及其对术后肝内复发和预后影响[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 651-655.
[6] 韩宇, 张武, 李安琪, 陈文颖, 谢斯栋. MRI肝脏影像报告和数据系统对非肝硬化乙肝患者肝细胞癌的诊断价值[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 669-673.
[7] 张维志, 刘连新. 基于生物信息学分析IPO7在肝癌中的表达及意义[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 694-701.
[8] 陈安, 冯娟, 杨振宇, 杜锡林, 柏强善, 阴继凯, 臧莉, 鲁建国. 基于生物信息学分析CCN4在肝细胞癌中表达及其临床意义[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 702-707.
[9] 叶文涛, 吴忠均, 廖锐. 癌旁组织ALOX15表达与肝癌根治性切除术后预后的关系[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 708-712.
[10] 吴晨瑞, 廖锐, 贺强, 潘龙, 黄平, 曹洪祥, 赵益, 王永琛, 黄俊杰, 孙睿锐. MDT模式下肝动脉灌注化疗联合免疫靶向治疗肝细胞癌多处转移一例[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 713-716.
[11] 杜锡林, 谭凯, 贺小军, 白亮亮, 赵瑶瑶. 肝细胞癌转化治疗方式[J]. 中华肝脏外科手术学电子杂志, 2023, 12(06): 597-601.
[12] 王峰杰, 王礼光, 廖珊, 刘颖, 符荣党, 陈焕伟. 腹腔镜右半肝切除术治疗肝癌的安全性与疗效[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 517-522.
[13] 张海涛, 贾哲, 马超, 张其坤, 武聚山, 郭庆良, 曾道炳, 栗光明, 王孟龙. 手术切除与射频消融治疗血管周围型单发小肝癌临床疗效分析[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 523-527.
[14] 吕瑶, 张婵, 陈建华, 张鸣青. 压力控制容量保证通气模式在腹腔镜肝细胞癌切除术中的应用[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 528-533.
[15] 杨秀君, 崔梦莹, 张丹, 曲仙智, 苗云皓, 盛基尧, 郑戈, 刘水, 张学文. 信迪利单抗联合仑伐替尼成功转化治疗不可切除肝癌一例[J]. 中华肝脏外科手术学电子杂志, 2023, 12(05): 581-584.
阅读次数
全文


摘要