五个不同预后评估系统预测进展肝癌生存率研究  

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

作　　者：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] 

机构地区：[1]中山大学附属第三医院肿瘤内科,广州510630 [2]广州医学院第三附属医院肾内科

出　　处：《中华普通外科学文献（电子版）》2013年第2期58-61,共4页Chinese Archives of General Surgery(Electronic Edition)

基　　金：广东省科技计划项目(2009B060700024;2011B031800076)

摘　　要：目的探讨CLIP、NCCN、JIS、TOKYO、MELD5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、MELD5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。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.

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 

分 类 号：R735.7[医药卫生—肿瘤]