BCLC和HKLC肝癌分期系統(tǒng)在臨床應(yīng)用中的價值比較
發(fā)布時間：2018-10-26 08:58
【摘要】：目的:肝細胞性肝癌(Hepatocellular Carcinoma,HCC)是我國常見的惡性腫瘤之一,患者發(fā)病隱匿,預(yù)后差,因此,尋找適合我國國情的肝癌分期系統(tǒng)以評估預(yù)后和指導(dǎo)治療是十分重要的。通過研究分析肝細胞癌患者的獨立預(yù)后因素,同時進行BCLC和HKLC肝細胞癌分期系統(tǒng)的預(yù)后評估能力和指導(dǎo)治療價值的比較,從而選擇更適合我國的肝癌分析系統(tǒng),指導(dǎo)臨床治療策略的應(yīng)用。方法:1、收集2009年8月至2011年3月廣西醫(yī)科大學(xué)附屬腫瘤醫(yī)院收治并具有完整隨訪記錄的709例肝細胞癌初發(fā)病例,隨訪時間截止至2016年12月31日。歸納并依據(jù)患者首次就診時臨床資料,采用Kaplan-Meier法和Log-rank法對各項指標進行單因素分析篩選初始預(yù)后影響因素,并對上述因素進行COX回歸分析,得到獨立預(yù)后因素。所有病例按照BCLC和HKLC分期系統(tǒng)進行臨床分期,使用ROC曲線對2個分期系統(tǒng)進行單一趨勢性分析,比較其預(yù)后評估能力。對2個分期接受治療方式的不同進行分組,采用Kaplan-Meier法繪制生存曲線,以Log-rank法比較各分期指導(dǎo)治療價值。2、分析709例肝癌患者中首次行手術(shù)治療或TACE治療的患者資料(580例),分別按BLCL和HKLC進行分期,以Kaplan-Meier法繪制生存曲線,采用Log-rank法檢驗生存曲線差異,評估各分期對于治療方法的指導(dǎo)價值,從而明確肝切除術(shù)的應(yīng)用范圍。結(jié)果:1、截止2016年12月31日,共507例患者死亡,202例患者存活,失訪率9.4%(n=67)。中位生存期為17.8月,1、3、5年生存率分別為59±1.9%、34±1.7%、26±1.6%。COX回歸分析提示:腫瘤直徑大小、有無血管膽管栓、有無淋巴結(jié)或肝外轉(zhuǎn)移、AFP、總膽紅素、白蛋白、Child-pugh分級、治療方式為原發(fā)性肝癌患者獨立預(yù)后因素。Kaplan-Meier生存曲線和Log-rank法比較結(jié)果顯示:2個分期系統(tǒng)均與患者預(yù)后相關(guān),分期越晚,預(yù)后則越差(P值均0.0001)。ROC曲線提示隨訪截止日期的判別力和單一趨勢性較好的分期系統(tǒng)為HKLC(AUC=0.840),1年、3年、5年ROC曲線下面積為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對于首次確診患者,是否接受手術(shù)治療或TACE治療更有指導(dǎo)性,比HKLC IIb、BCLC B分期更早分期的患者,手術(shù)治療累積生存率優(yōu)于TACE治療,也顯示出了其指導(dǎo)治療的價值。結(jié)論:HKLC較BCLC具有更優(yōu)的預(yù)后評估能力;HKLC、BCLC均可指導(dǎo)治療方案的選擇,且HKLC更優(yōu)。BCLC治療建議不完全適用于我國肝細胞癌治療,肝切除術(shù)應(yīng)用范圍過于嚴苛,對于部分BCLC B期甚至少部分C期病人也可考慮行手術(shù)治療;HKLC作為一個“年輕”的分期系統(tǒng),兼?zhèn)湓u估預(yù)后和指導(dǎo)治療兩方面作用,在一定程度上優(yōu)于BCLC分期,但仍尚需更多大樣本的臨床驗證。
[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 鹵1.9and the survival rate was 34 鹵1.726 鹵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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7
本文編號：2295215
[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 鹵1.9and the survival rate was 34 鹵1.726 鹵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.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R735.7
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