BCLC和HKLC肝癌分期系统在临床应用中的价值比较

发布时间：2018-10-26 08:58

【摘要】：目的:肝细胞性肝癌(Hepatocellular Carcinoma,HCC)是我国常见的恶性肿瘤之一,患者发病隐匿,预后差,因此,寻找适合我国国情的肝癌分期系统以评估预后和指导治疗是十分重要的。通过研究分析肝细胞癌患者的独立预后因素,同时进行BCLC和HKLC肝细胞癌分期系统的预后评估能力和指导治疗价值的比较,从而选择更适合我国的肝癌分析系统,指导临床治疗策略的应用。方法:1、收集2009年8月至2011年3月广西医科大学附属肿瘤医院收治并具有完整随访记录的709例肝细胞癌初发病例,随访时间截止至2016年12月31日。归纳并依据患者首次就诊时临床资料,采用Kaplan-Meier法和Log-rank法对各项指标进行单因素分析筛选初始预后影响因素,并对上述因素进行COX回归分析,得到独立预后因素。所有病例按照BCLC和HKLC分期系统进行临床分期,使用ROC曲线对2个分期系统进行单一趋势性分析,比较其预后评估能力。对2个分期接受治疗方式的不同进行分组,采用Kaplan-Meier法绘制生存曲线,以Log-rank法比较各分期指导治疗价值。2、分析709例肝癌患者中首次行手术治疗或TACE治疗的患者资料(580例),分别按BLCL和HKLC进行分期,以Kaplan-Meier法绘制生存曲线,采用Log-rank法检验生存曲线差异,评估各分期对于治疗方法的指导价值,从而明确肝切除术的应用范围。结果:1、截止2016年12月31日,共507例患者死亡,202例患者存活,失访率9.4%(n=67)。中位生存期为17.8月,1、3、5年生存率分别为59±1.9%、34±1.7%、26±1.6%。COX回归分析提示:肿瘤直径大小、有无血管胆管栓、有无淋巴结或肝外转移、AFP、总胆红素、白蛋白、Child-pugh分级、治疗方式为原发性肝癌患者独立预后因素。Kaplan-Meier生存曲线和Log-rank法比较结果显示:2个分期系统均与患者预后相关,分期越晚,预后则越差(P值均0.0001)。ROC曲线提示随访截止日期的判别力和单一趋势性较好的分期系统为HKLC(AUC=0.840),1年、3年、5年ROC曲线下面积为HKLC(AUC=0.812)BCLC(AUC=0.786)、HKLC(AUC=0.830)BCLC(AUC=0.820)、BCLC(AUC=0.739)HKLC(AUC=0.729)。2、HKLC对于首次确诊患者,是否接受手术治疗或TACE治疗更有指导性,比HKLC IIb、BCLC B分期更早分期的患者,手术治疗累积生存率优于TACE治疗,也显示出了其指导治疗的价值。结论:HKLC较BCLC具有更优的预后评估能力;HKLC、BCLC均可指导治疗方案的选择,且HKLC更优。BCLC治疗建议不完全适用于我国肝细胞癌治疗,肝切除术应用范围过于严苛,对于部分BCLC B期甚至少部分C期病人也可考虑行手术治疗;HKLC作为一个“年轻”的分期系统,兼备评估预后和指导治疗两方面作用,在一定程度上优于BCLC分期,但仍尚需更多大样本的临床验证。
[Abstract]:Objective: hepatocellular carcinoma (Hepatocellular Carcinoma,HCC) is one of the most common malignant tumors in China. By studying and analyzing the independent prognostic factors of patients with hepatocellular carcinoma (HCC) and comparing the prognostic evaluation ability and guiding therapeutic value of BCLC and HKLC HCC staging system, we can select a liver cancer analysis system that is more suitable for our country. To guide the application of clinical treatment strategy. Methods: 1. From August 2009 to March 2011, 709 patients with hepatocellular carcinoma (HCC) who were admitted to the affiliated Cancer Hospital of Guangxi Medical University and had complete follow-up records were collected and followed up until December 31, 2016. According to the clinical data of the first visit to the hospital, the Kaplan-Meier method and Log-rank method were used to screen the initial prognostic factors by univariate analysis, and the independent prognostic factors were obtained by COX regression analysis of the above factors. All the patients were staging according to the BCLC and HKLC staging systems, and ROC curve was used to carry out a single trend analysis of the two staging systems to compare their prognostic evaluation ability. The survival curve was drawn by Kaplan-Meier method, and the value of different stages was compared by Log-rank method. The data of 709 patients with liver cancer who were treated with operation or TACE for the first time (580 cases) were analyzed. The survival curves were drawn by Kaplan-Meier and Kaplan-Meier, and the difference of survival curves was examined by Log-rank. To evaluate the guiding value of different stages for treatment, and to determine the scope of hepatectomy. Results: 1. As of December 31, 2016, 507 patients died and 202 patients survived. The lost visit rate was 9.4% (nong67). The median survival time was 17.8 months, the 3-year survival rate was 59 卤1.9and the survival rate was 34 卤1.726 卤1.6%.COX regression analysis showed that: tumor diameter, vascular bile duct embolus, lymph node or extrahepatic metastasis, total bilirubin of AFP,. Albumin, Child-pugh grading and treatment were independent prognostic factors in patients with primary liver cancer. The results of Kaplan-Meier survival curve and Log-rank method showed that the two staging systems were related to the prognosis of the patients, and the later the stage was, the later the prognosis was. The worse the prognosis was (P = 0.0001). ROC curve, P = 0.0001), it was suggested that HKLC (AUC=0.840), 1 year and 3 years was the best staging system for judging the cut-off date and single tendency of follow-up. The area under the 5-year ROC curve is HKLC (AUC=0.812) BCLC (AUC=0.786), HKLC (AUC=0.830) BCLC (AUC=0.820), BCLC (AUC=0.739) HKLC (AUC=0.729). Whether or not to receive surgical treatment or TACE therapy is more instructive, and the cumulative survival rate of patients with earlier stage than HKLC IIb,BCLC B stage is better than that of TACE treatment, which also shows the value of guiding treatment. Conclusion: HKLC has better prognostic evaluation ability than BCLC. HKLC,BCLC can guide the choice of treatment plan, and HKLC is better. BCLC is not completely suitable for the treatment of hepatocellular carcinoma in China, and the scope of hepatectomy is too strict. For some patients with BCLC stage B or even a small number of patients in stage C, surgical treatment can be considered. As a "young" staging system, HKLC plays both roles in evaluating prognosis and guiding treatment. To some extent, HKLC is better than BCLC staging, but it still needs more clinical verification.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.7

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