六种分期系统预测AFP阴性肝细胞癌患者术后预后价值的比较  

Comparison of six staging systems for predicting the postoperative prognostic value of patients with AFP-negative hepatocellular carcinoma

作　　者：胡啸吟 张杰[1] 赵婧菲 詹国华 李远宽 向邦德[1] HU Xiaoyin;ZHANG Jie;ZHAO Jingfei;ZHAN Guohua;LI Yuankuan;XIANG Bangde(Department of Hepatobiliary Surgery,Guangxi Medical University Cancer Hospital,Nanning 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院肝胆胰脾外科,南宁530021

出　　处：《中国癌症防治杂志》2021年第2期190-194,共5页CHINESE JOURNAL OF ONCOLOGY PREVENTION AND TREATMENT

基　　金：国家自然科学基金项目(81960450);广西重点研发计划项目(桂科AA18221001);区域性高发肿瘤早期防治研究教育部重点实验室/广西重点实验室2019年度自主课题(GKE2019-07)。

摘　　要：目的比较巴塞罗那肝癌分期(BCLC)、中国肝癌分期(CNLC)、TNM分期系统、日本整体分期评分系统(JIS)、意大利肝脏肿瘤评分(CLIP)和奥田邦雄分期系统(Okuda)在血清甲胎蛋白(AFP)阴性肝细胞癌(HCC)患者术后预后预测中的价值。方法回顾性分析2012年1月至2017年12月在广西医科大学附属肿瘤医院肝胆胰脾外科行肝切除术治疗并符合入组标准的AFP阴性HCC患者临床病理资料。患者按照BCLC、CNLC、TNM、JIS、CLIP、Okuda分期系统进行分期,并接受随访。采用时间依赖的受试者工作特征(ROC)曲线、log-rank检验、似然比检验比较6个分期系统的区分度、分层能力及预测价值。结果CNLC预测HCC患者术后总生存率的ROC曲线下面积(AUC)为0.682,以Ⅱb期为切点,对应的灵敏度为0.655,特异度为0.691;CNLC分期预测1、3、5年生存率的AUC分别为0.670(95%CI:0.603~0.738)、0.575(95%CI:0.441~0.708)、0.689(95%CI:0.407~0.971),优于其他分期系统(均P<0.05)。Log-rank检验显示,6个分期系统均有较好的危险分层能力。似然比检验显示,CNLC预测总生存率的价值最高(χ^(2)=39.575,P=0.011)。结论在6个分期系统中,CNLC分期是预测AFP阴性HCC患者术后预后的最佳分期系统。ObjectiveTo compare the values of Barcelona clinic liver cancer(BCLC),China liver cancer staging(CNLC),TNM staging system,Japanese integrated staging score(JIS),cancer of the liver Italian program(CLIP)and Okuda kunio staging system(Okuda)in the postoperative prognosis prediction of patients with serum alpha-fetoprotein(AFP)-negative hepatocellular carcinoma(HCC).MethodsThe clinicopathological data of AFP-negative HCC patients were retrospectively analyzed,who underwent hepatectomy at the Department of Hepatobiliary Surgery,Guangxi Medical University Cancer Hospital,from January 2012 to December2017 and met the inclusion criteria.The patients were staged according to the BCLC,CNLC,TNM,JIS,CLIP,and Okuda staging systems and followed up.The discrimination,stratification ability,and predictive value of the six staging systems were compared based on time-dependent receiver operating characteristic(ROC)curves,log-rank test,and likelihood ratio test.ResultsThe area under ROC curves(AUC)of CNLC to predict the overall survival of HCC patients after surgery was 0.682,corresponding to a sensitivity of 0.655 and a specificity of 0.691 using stageⅡb as the cut point;the AUCs of CNLC staging to predict the survival at 1-,3-,and 5-year were 0.670(95%CI:0.603-0.738),0.575(95%CI:0.441-0.708),and 0.689(95%CI:0.407-0.971),respectively,which was better than those of other staging systems(all P<0.05).The log-rank test showed that all the six staging systems had a good risk stratification ability.The likelihood ratio test showed that CNLC had the highest value in predicting the overall survival(χ^(2)=39.575,P=0.011).ConclusionsAmong the six staging systems,CNLC staging is the best staging system in predicting the prognosis of AFP-negative HCC patients after surgery.

关 键 词：肝细胞癌 巴塞罗那肝癌分期 中国肝癌分期 TNM分期系统 日本整体分期评分系统 意大利肝脏肿瘤评分 奥田邦雄分期系统 

分 类 号：R735.7[医药卫生—肿瘤]