CAJ | 학술논문

目的探讨HBsAg阳性患者的原发性肝细胞癌(hepatocellular carcinoma,HCC)生存影响因素及评估不同HCC分期系统预测能力.方法回顾性分析川北医学院附属医院2000年1月至2010年2月收治的HBsAg阳性HCC患者的临床资料.COX比例风险模型行生存的单因素和多因素分析.ROC曲线评估各HCC分期系统预测能力.结果本组患者1、2、3和5年总体生存率分别为21.3％(165/775),9.4％(73/775),4.9％(38/775)和1.7％(13/775),中位生存4.2个月(0.1 ～148.6个月).多因素分析显示肝硬化程度(B=4.519)、治疗方式(B=4.888)、ALT≥ 2N(B=4.068)、合并门静脉癌栓(B=0.537)、自发性破裂类型(B =5.033)和合并下腔静脉癌栓(B=7.049)是HBsAg阳性HCC总体生存的影响因素.各HCC分期系统均有预测能力,但NSMCS评分(NorthSichuan Medical College Score,NSMCS)优于其他系统,AUC(Area Under the ROC Curve)为0.801(95％ CI0.761 ～0.840),NSMCS≥-2时,灵敏度78.8％,特异度69.3％.不同风险等级中位生存时间差异明显(13.6、3.4和1.3个月,x2=467.636,P=0.000,Log-rank检验).结论 HBsAg阳性HCC总体生存影响因素众多,现行HCC分期系统仍需改进以提高预测能力.
목적 탐토HBsAg양성환자적원발성간세포암(hepatocellular carcinoma,HCC)생존영향인소급평고불동HCC분기계통예측능력.방법 회고성분석천북의학원부속의원2000년1월지2010년2월수치적HBsAg양성HCC환자적림상자료.COX비례풍험모형행생존적단인소화다인소분석.ROC곡선평고각HCC분기계통예측능력.결과 본조환자1、2、3화5년총체생존솔분별위21.3％(165/775),9.4％(73/775),4.9％(38/775)화1.7％(13/775),중위생존4.2개월(0.1 ～148.6개월).다인소분석현시간경화정도(B=4.519)、치료방식(B=4.888)、ALT≥ 2N(B=4.068)、합병문정맥암전(B=0.537)、자발성파렬류형(B =5.033)화합병하강정맥암전(B=7.049)시HBsAg양성HCC총체생존적영향인소.각HCC분기계통균유예측능력,단NSMCS평분(NorthSichuan Medical College Score,NSMCS)우우기타계통,AUC(Area Under the ROC Curve)위0.801(95％ CI0.761 ～0.840),NSMCS≥-2시,령민도78.8％,특이도69.3％.불동풍험등급중위생존시간차이명현(13.6、3.4화1.3개월,x2=467.636,P=0.000,Log-rank검험).결론 HBsAg양성HCC총체생존영향인소음다,현행HCC분기계통잉수개진이제고예측능력.
Objective Basing on overall survival(OS)of HBsAg-positive hepatocellular carcinoma(HCC)patients we evaluate several currently used HCC staging systems for OS predictivity.Methods This retrospective study included 775 patients with HBsAg-positive HCC treated in our department during 11-year period from Jan.2000 to Feb.2010.Clinicopathologic factors were evaluated for their possible association with OS in univariate and multivariate analysis using Cox proportional hazard model.Receiver operating characteristics(ROC)analysis with calculation of the area under the curve (AUC),sensitivity,and specificity was applied to define cutoff point values where appropriated and to assess HCC staging systems for their predictive ability of OS.Results The 1-,2-,3-and 5-year OS rates were 21.3％(165/775),9.4％(73/775),4.9％(38/775)and 1.7％(13/775),respectively.Multivariate analysis identified that severity of concomitant liver cirrhosis(B =4.519),treatment modality (B =4.888),ALT≥2N(B =4.068),portal vein tumor thrombi(B =0.537),spontaneous rupture(B =5.033)and inferior vena cava tumor thrombi(B =7.049)as independent risk factors influencing OS.NSMCS(North Sichuan Medical College Score)exhibited best performance predicting OS with AUC 0.801 (95％ CI 0.761-0.840),sensitivity of 78.8％,specificity of 69.3％ at NSMCS ≥-2.Median survival time reached statistically significant difference(13.6 mons,3.4 mons vs.1.3 mons,x2 =467.636,P =0.000).Conclusions Multiple factors determine OS in patients with HBsAg-positive HCC.NSMCS staging system demonstrates better predictability for the survival of HBsAg positive HCC patients.