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中级评分系统对TACE与肝切除术治疗BCLC/B期肝细胞性肝癌患者的预后价值分析

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   

  1. 温州医科大学附属第三医院 浙江 温州 325200,1.介入科,2.胃肠外科,3.放化疗科; 4.浙江省中医院 影像科,浙江 杭州 310006; 5. 温州市人民医院 血管介入科,浙江 温州 325000
  • 收稿日期:2017-02-13 出版日期:2017-07-05 发布日期:2017-07-05
  • 通讯作者: 虞希祥,主任医师,E-mail:yudsa@126.com。
  • 作者简介:施振静(1983-),男,浙江瑞安人,主治医师。
  • 基金资助:
    浙江省医药卫生科技计划项目 (2015KYB369); 瑞安市2015年科技创新专项资金 (MS2015014); 瑞安市2015年科技创新专项资金 (MS2015012); 瑞安市2015年科技创新专项资金 (MS2015020)

The prognostic value of Intermediate Stage Score on patients with sub-classification of intermediate-stage hepatocellular carcinoma undergo liver resection and transarterial chemoembolization

SHI Zhen-jing1, WU Dao-yi2, WU Li-li3, WANG Shu-ting4, ZHENG Bing-ru1, LI Cheng1, SHI Chang-sheng1, YU Xi-xiang5   

  1. 1 Department of Interventional, 2 Department of Gastrointestinal Surgery,,3 Department of Radiochemotherapy,, the Third Affiliated Hospital of Wenzhou Medical University, Ruian, ,Zhejiang 325200, China,.4 Department of Medical Imaging, Zhejiang Chinese Medicine Hospital, Hangzhou, Zhejiang 310006, China,5 Department of Vasointerventional surgery, Wenzhou People's Hospital, Wenzhou, Zhejiang 325699, China
  • Received:2017-02-13 Online:2017-07-05 Published:2017-07-05

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。

关键词: 中度肝细胞癌, 预后, 中级评分, 肝动脉化疗栓塞, 肝切除术

Abstract: Objective To evaluate the prognostic value of the Intermediate Stage Score (ISS) on overall survival (OS) in patients with IHCC treated with TACE or surgery liver resection (LR). Methods Two hundred and sixty BCLC-B HCC patients undergoing liver resection (n = 139) or TACE (n = 121) in the Third Affiliated Hospital of Wenzhou Medical University between Apr. 2009 and Oct. 2011 were retrospectively collected. All cases were followed up by hospitalization or telephone, prognosis and survival analysis were carried out according to clinical data. Propensity score Matching (PSM) was used to remove residual confounding and applied to LR and TACE group to determine the prognostic significance of ISS. Results Of all 260 patients with BCLC-B stage, there were 160 males (61.5%) and 100 females (38.5%), with an average age of (59.1 ± 10.3)years. The median overall survival of patients was altered with different ISS, and the median overall survival was decreased with the ISS increasing: 48 months in ISS 1, 37.5 months in ISS 2, 24 months in ISS 3, 17.5 months in ISS 4, and 10 months in ISS 5, with statistically significant among each group (P < 0.05). The prognosis of patients with ISS 4-5 in the LR group was worse than that of the patients with ISS 1 (HR=2.542, 95% CI= 0.461~8.416), and the prognosis of patients with ISS 4-5 in the TACE group was also worse than that of the patients with ISS 1 (HR=2.542, 95% CI= 0.461~8.416). The likelihood ratio test results showed that ISS was an effective prognostic factor of both the LR and TACE groups (P=0.018 and P=0.003). However, there was no significant difference between the LR and TACE groups in the same ISS (P=0.121). Conclusion ISS optimizes prognostic prediction in IHCC, reduce patient’s heterogeneity, and is a useful prognostic tool for patients treated with TACE or LR.

Key words: intermediate hepatocellular carcinoma, prognosis, intermediate stage score, transarterial chemoembolization, liver resection

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