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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2013, Vol. 07 ›› Issue (02) : 147 -152. doi: 10.3877/cma.j.issn.1647-0793.2013.02.017

所属专题： 专题评论； 文献；

循证医学

五个不同预后评估系统预测进展肝癌生存率研究
陈展洪1, 魏丽1, 李星1, 钟翔1, 邢艳芳2, 林曲1, 董敏1, 温景芸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:2012-12-05 出版日期:2013-04-01
  • 通信作者: 吴祥元
  • 基金资助:
    广东省科技计划项目(2009B060700024，2011B031800076)

Prognostic assessment of five scoring systems for survival rate of advanced hepatocellular carcinoma

Zhan-Hong CHEN1, Li WEI1, Xing LI1, Xiang ZHONG1, Yan-fang XING2, Qu LIN1, Min DONG1, Jing-yun WEN1, Xiang-Yuan WU1,†()   

  1. 1. Department of Medical Oncology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
  • Received:2012-12-05 Published:2013-04-01
  • Corresponding author: Xiang-Yuan WU
  • About author:
    Corresponding author: WU Xiang-yuan, Email:
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陈展洪, 魏丽, 李星, 钟翔, 邢艳芳, 林曲, 董敏, 温景芸, 吴祥元. 五个不同预后评估系统预测进展肝癌生存率研究[J]. 中华普通外科学文献(电子版), 2013, 07(02): 147-152.

Zhan-Hong CHEN, Li WEI, Xing LI, Xiang ZHONG, Yan-fang XING, Qu LIN, Min DONG, Jing-yun WEN, Xiang-Yuan WU. Prognostic assessment of five scoring systems for survival rate of advanced hepatocellular carcinoma[J]. Chinese Archives of General Surgery(Electronic Edition), 2013, 07(02): 147-152.

目的

探讨CLIP、NCCN、JIS、TOKYO、MELD 5个预后评估系统对晚期肝细胞肝癌患者3月生存率、6月生存率和总生存率的预测价值。

方法

回顾性研究2008年9月至2010年5月253例进展期肝癌患者，使用CLIP、NCCN、JIS、TOKYO、MELD 5个不同的预后评估系统对进展期肝癌患者初次诊断时进行评分，并进行随访。应用接受者工作特征（ROC）曲线分析每个预后评估系统，评价各个预后评估系统对3月生存率、6月生存率预测的特异度及灵敏度的预测价值。应用Kaplan-Meier生存曲线和Log-rank检验比较各个预后评估系统的晚期肝癌总生存率，应用似然比检验（LRT）评价各个预后评估系统对晚期肝癌总生存率的预测价值。

结果

在预测3月生存率时，CLIP、JIS及TOKYO评分系统对于3月生存率的预后价值相似。CLIP的A值与MELD、TNM对比差异有显著的统计学意义（均P < 0.05）。在预测6月生存率时CLIP、JIS及Tokyo评分系统对于6月生存率的预后价值相似。CLIP的A值与JIS、TOKYO、TNM、MELD比较差异有显著的统计学意义（均P < 0.05）。LRT检验发现CLIP的预测总生存率能力最好。

结论

CLIP对晚期肝癌3月生存率、6月生存率及总生存率预测的能力最好。

关键词: 进展期肝癌, 3月生存率, 6月生存率, 意大利肝癌项目
Objective

To evaluated the value of five current prognostic scoring systems, i.e. CLIP(Cancer of the Liver Italian Program), TNM, JIS(Japanese integrated score), TOKYO, MELD(model for end-stage liver disease) in predicting the 3-month mortality, 6-month mortality and overall survival for advanced liver cancer patients.

Methods

Data of 253 patients were collected. They were classified according to CLIP, TNM, JIS, TOKYO and MELD scoring systems respectively at their first diagnosis and were followed up afterwards. Relative operating characteristic (ROC) curve analysis and The Delong. et al test was used to compare A (Area under curve) of ROC curve, in order to evaluate the sensitivity and specificity of 3-month mortality and 6-month mortality predicting value of different scoring systems. Kaplan-Meier survival curve and log-rank test were used to compare the advanced HCC's overall survival rate of different scoring systems, and likelihood ratio test (LRT) was used to evaluate different scoring systems' predicting value of advanced HCC's overall survival.

Results

For 3-month mortality, the prognostic values in predicting 3-month mortality of CLIP, JIS and Tokyo were similar. A of CLIP was significantly higher than that of MELD, TNM in predicting 3-month mortality (P < 0.05) . For 6-month mortality, the prognostic values in predicting 6-month mortality of CLIP, JIS and Tokyo were similar. A of CLIP was significantly higher than that of JIS, TOKYO, MELD, TNM in predicting 6-month mortality (P < 0.05) .χ2 of CLIP was the highest and CLIP scoring system's predicting value of overall survival is best.

Conclusion

CLIP is the best scoring system in predicting 3-month mortality, 6-month mortality and overall survival of advanced HCC.

Key words: Advanced hepatocellular carcinoma, 3-month mortality, 6-month mortality, CLIP (Cancer of the Liver Italian Program)
表1 3月生存率不同预后评估系统ROC曲线两两比较
预后评估系统 预后评估系统 P值
CLIP JIS 0.087
CLIP TOKYO 0.058
CLIP MELD 0.014
CLIP TNM < 0.0001
JIS MELD 0.15
JIS TNM < 0.01
JIS TOKYO 0.67
TOKYO TNM < 0.01
TOKYO MELD 0.26
表2 6月生存率不同预后评估系统ROC曲线两两比较
预后评估系统 预后评估系统 P值
CLIP JIS < 0.01
CLIP TOKYO < 0.01
CLIP MELD < 0.0001
CLIP TNM < 0.0001
JIS MELD < 0.01
JIS TNM < 0.01
JIS TOKYO 0.256
TYKYO TNM 0.04
TOKYO MELD < 0.01
图1 不同预后评估系统预测3月生存率（图1A）及6月生存率（图1B）的ROC曲线图
图2 不同预后评估系统的Kaplan-Meier生存曲线
表3 5个评分预后系统Kaplan-Meier生存曲线似然比检验
预后评估系统 χ2值 P值
CLIP 102.36 < 0.001
JIS 65.05 < 0.001
TOKYO 50.88 < 0.001
TNM 30.71 < 0.001
MELD 9.16 < 0.001
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[1] 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.
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