施振静1, 吴道义2, 吴丽丽3, 王舒婷4, 郑冰汝1, 李成1, 施昌盛1, 虞希祥5
SHI Zhen-jing1, WU Dao-yi2, WU Li-li3, WANG Shu-ting4, ZHENG Bing-ru1, LI Cheng1, SHI Chang-sheng1, YU Xi-xiang5
摘要: 目的 探讨中级评分系统(intermediate stage score, ISS)在中度肝细胞肝癌患者接收受肝动脉化疗栓塞(transarterial chemoembolization ,TACE)和肝切除(liver resection, LR)术后对预后评估的判断价值及指导意义。方法 回顾性分析2009年4月至2011年10月温州医科大学附属第三医院行TACE或LR治疗的260例BCLC/B期IHCC患者的临床资料。其中,LR组139例,TACE组121例,共260例,所有病例均经住院或电话随访,根据患者临床病例及随访资料进行统计学分析。采用倾向性评分匹配(propensity score matching, PSM) 法去除混杂因素后,判断ISS在LR组和TACE组中的预后判断价值。结果 所有260例BCLC-B分期患者中,男160例(61.5%),女100例(38.5%),平均年龄为(59.1±10.3)岁。不同ISS分级患者的中位生存时间存在差异,随ISS评级增高,中位生存时间降低,分别为:1级48个月,2级37.5个月,3级24个月,4级17.5个月,和5级10个月,各组差异具有统计学意义(P < 0.05)。LR组中ISS 4~5级患者预后差于ISS 1级患者(HR=2.542, 95% CI= 0.461~8.416),同样在TACE组中ISS 4~5级患者预后也比ISS 1级患者更差(HR=2.542, 95% CI= 0.461~8.416),经似然比检验,ISS在LR及TACE组均是一个有效的预后预测因子(P = 0.018和P = 0.003)。进一步比较TACE和LR两治疗组间ISS的预后价值差异,结果显示,两组的相同ISS分级间预后并无差异(P = 0.121)。结论 ISS可预测BCLC-B期IHCC患者的预后,减少患者异质性,是临床选择TACE和LR治疗方案的患者的有效预后判断工具。
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