CAJ | 학술논문

目的比较CLIP评分、JIS评分、2001年中国肝癌分期对肝细胞癌肝切除术后患者预后的判断能力,探讨其在我国肝癌患者人群中的临床应用价值.方法回顾性分析2000年1月至2005年7月经手术切除的肝细胞癌病例的临床病理及随访资料.利用病例构成比、Kaplan-Meier生存曲线分别比较各种分期方法的病例分层能力、组间生存差异识别能力和对早期患者的鉴别能力.采用似然比卡方检验(LR x2)和线性趋势卡方检验(line trend x2)评估各分期系统的同质性、判别力和梯度单一性.利用COX比例风险模型计算不同分期对模型预后预测价值的贡献大小.结果病例构成比:中国分期Ⅰ a、Ⅰ b、Ⅱ a、Ⅱ b、Ⅲa组病例分别占全部病例的14.3%、17.4%、21.9%、31.7%、14.7%,各期分布均匀、分层能力突出.CLIP评分中0-2分占全部病例数的81.6%,早期患者比例较大,分层能力不足.JIS评分中0分组仅有3.1%,提示病例分层能力不足.生存曲线比较:CLIP评分2分与3分间的生存率差异无统计学意义.JIS评分和中国分期各分组间生存率两两比较,差异均有统计学意义.JIS评分和中国分期对早期患者的鉴别能力较强.而CLIP评分对预后较差患者的识别能力较强.分期的同质性、单调性、梯度单一性比较:中国分期>CLIP评分>JIS评分.对模型预后预测价值的独立贡献大小比较:中国分期>CLIP评分>JIS评分.结论在我国肝癌肝切除患者人群中,2001年肝癌中国分期的预后价值优于CLIP评分和JIS评分.CLIP评分对中晚期肝癌患者的识别能力优于JIS评分和中国分期.
목적 비교CLIP평분、JIS평분、2001년중국간암분기대간세포암간절제술후환자예후적판단능력,탐토기재아국간암환자인군중적림상응용개치.방법 회고성분석2000년1월지2005년7월경수술절제적간세포암병례적림상병리급수방자료.이용병례구성비、Kaplan-Meier생존곡선분별비교각충분기방법적병례분층능력、조간생존차이식별능력화대조기환자적감별능력.채용사연비잡방검험(LR x2)화선성추세잡방검험(line trend x2)평고각분기계통적동질성、판별력화제도단일성.이용COX비례풍험모형계산불동분기대모형예후예측개치적공헌대소.결과 병례구성비:중국분기Ⅰ a、Ⅰ b、Ⅱ a、Ⅱ b、Ⅲa조병례분별점전부병례적14.3%、17.4%、21.9%、31.7%、14.7%,각기분포균균、분층능력돌출.CLIP평분중0-2분점전부병례수적81.6%,조기환자비례교대,분층능력불족.JIS평분중0분조부유3.1%,제시병례분층능력불족.생존곡선비교:CLIP평분2분여3분간적생존솔차이무통계학의의.JIS평분화중국분기각분조간생존솔량량비교,차이균유통계학의의.JIS평분화중국분기대조기환자적감별능력교강.이CLIP평분대예후교차환자적식별능력교강.분기적동질성、단조성、제도단일성비교:중국분기>CLIP평분>JIS평분.대모형예후예측개치적독립공헌대소비교:중국분기>CLIP평분>JIS평분.결론 재아국간암간절제환자인군중,2001년간암중국분기적예후개치우우CLIP평분화JIS평분.CLIP평분대중만기간암환자적식별능력우우JIS평분화중국분기.
Objective To compare the CLIP score, the JIS score, and the China staging system (CS) in the prediction of survival of patients with resectable hepatocellular carcinoma (HCC). Methods The Clinicopathologic and follow-up data of 224 patients who underwent hepatic resection for HCC from January 2000 to July 2005 were retrospectively studied. The patient distribution and the survival curve of each staging system were used to compare the ability to stratify and to discriminate prognosis. The likelihood ratio, chi-square test and the linear trend chi-square test were used to compare the homogeneity and the monotonicity of the relationship between stage and mortality rate of each staging system. The increase in the -2 log likelihood statistic on removal of any one staging system was in turn used as a means of ranking the individual staging systems according to their importance within the regression model. The statistical package used was SPSS version 16. 0 and Stata SE version 8.0. Results Based on the China staging system, the percentages of patients categorized as Ⅰa, Ⅰ b, Ⅱa,Ⅱb and Ⅲ a were 14. 3%, 17.4%, 21.9%, 31.7% and 14. 7% respectively, showing excellent stratification ability. However, nearly 81. 6% of the patients were classified as a CLIP score of 0-2, which showed poor stratification ability, and only 3. 1 % of the patients were classified as score 0 category of the JIS scoring system. In the follow-up period, the log-rank test and the corresponding Kaplan-Meier survival curves confirmed each staging system to be able to differentiate patient survival in the different stages. Individual pairwise comparisons revealed inconsistencies across the different staging systems. In particular, using the log-rank test, the JIS scoring system and the China staging system showed significant differences in patient survival on all pairwise comparisons. By contrast, the CLIP scoring system failed to differentiate significantly between score 2 and score 3 patients. The JIS scoring system could identify the best prognostic group who would benefit from curative and aggressive treatments, whereas the discriminatory value of the CLIP score was noted in the intermediate- and advanced-phase HCC patients. The China staging system was shown to have the best homogeneity, overall discriminatory capacity and monotonicity of gradient. The change in the -2 log likelihood statistic on removal of any staging system revealed that for this cohort of patients, the appropriate importance in the ranking of the independent contribution of each factor to the regression model was: CS> CLIP>JIS. Conclusion Among three clinical staging systems, the China staging system had the highest prognostic value, with better stratification and higher discriminatory capacity than the CLIP scoring system and the JIS scoring system for this cohort of patients who received partial hepatectomy for HCC. The CLIP scoring system performed better in identifying the worst prognostic patients.