预测肝癌患者术后预后的新型评分系统  

The new scoring system predicting the prognosis of patients with hepatocellular carcinoma after hepatectomy

作　　者：黄黎峰 夏勇[1] 李俊[1] 雷正清 沈锋[1] 

机构地区：[1]第二军医大学东方肝胆外科医院肝外四科,上海200438

出　　处：《肝胆外科杂志》2014年第2期94-97,共4页Journal of Hepatobiliary Surgery

摘　　要：目的 建立一个基于临床病理特征的预测肝癌术后预后的评分系统.方法 回顾性的观察2003年至2009年于东方肝胆外科医院肝外四科行肝癌根治性切除术的793例病例,以死亡及复发作为终点,以Kaplan-meier和COX回归确定肝癌术后预后的独立危险因素.以最小加权法建立肝癌术后预后预测的评分系统,并用一致性指数（C-index）来评价该评分系统的准确性.之后我们根据这一评分系统将患者分为高危、中危和低危三个组,比较这三组人群的生存和复发情况.结果 单、多因素分析表明,肝癌术后预后的独立危险因素为肿瘤直径,肿瘤数目,微血管侵犯以及手术切缘情况.用上述4个因素依据各自权重建立新的术后预测评分系统：微血管侵犯（有=2,无=0）＋直径（＞5cm =4,≤5cm=0）＋肿瘤数目（多发=2,单发=0）＋手术切缘（≤1cm=1,＞1cm =0）.该评分系统的C-index为0.747（95％ CI,0.720～0.774）.应用该评分系统将患者分成三个不同风险组,三组之间生存和复发情况的差异均有统计学意义（P ＜0.001）.结论 这一评分系统能够准确预测肝癌患者术后的预后,可进一步为肝癌术后预防复发提供重要参考.Objective Establishing a score system based on the clinical pathological features of HCC to predict the prognosis of patients underwent hepatectomy. Methods 793 consecutive patients who underwent R0 resection were retrospectively observed from 2003 to 2009 at IVdepartment of Eastern Hepatobiliary Surgery. The death and recurrence were treated as the endpoint. Risk factors associated with prognosis since hepatectomy were analyzed by using Kaplan-meier method and COX regression. Using the weighted sum method, scoring system was established after hepatectomy risk prediction, the accuracy of scoring system was estimated by concord- ance-index （C-index）. Then according to the scoring system, the patients were divided into 3 risk group （high-risk, intermediate-risk and low-risk）, the overall survival and recurrence rate were compared between these groups. Results Univariate and multivariate a- nalysis showed that the independent risk factors were the tumor diameter, tumor number, micro-vascular invasion and surgical margin. We use these 4 independent factors to establish the system, according to their respective weight ： micro-vascular invasion （ present = 2, absent =0） ＋ tumor diameter （ 〉5cm =4, ≤5cm =0） ＋ the number of tumor （muhiple =2, single=0） ＋ surgical margin （ ≤ lcm = 1, 〈 1cm =0）. The C-index of this system in prediction of postoperative survival was O. 747（95% CI, 0.720-0. 774）. Patients were divided into 3 risk groups, both survival and recurrence rates showed statistical significance between these groups （ P 〈 0.001 ）. Conclusions the scoring system can accurately predict the prognosis of patients with hepatocellular carcinoma after hepatectomy and provides an important reference for prevention of recurrence of hepatocellular carcinoma after hepatectomy.

关 键 词：评分系统 肝切除术 肝细胞癌 预后评估 

分 类 号：R735.7[医药卫生—肿瘤]