CAJ | 학술논문

　　目的探讨CLIP、NCCN、JIS、TOKYO、MELD 5个预后评估系统对晚期肝细胞肝癌患者3月生存率、6月生存率和总生存率的预测价值。方法回顾性研究2008年9月至2010年5月253例进展期肝癌患者，使用CLIP、NCCN、JIS、TOKYO、MELD 5个不同的预后评估系统对进展期肝癌患者初次诊断时进行评分，并进行随访。应用接受者工作特征（ROC）曲线分析每个预后评估系统，评价各个预后评估系统对3月生存率、6月生存率预测的特异度及灵敏度的预测价值。应用Kaplan-Meier生存曲线和Log-rank检验比较各个预后评估系统的晚期肝癌总生存率，应用似然比检验（LRT）评价各个预后评估系统对晚期肝癌总生存率的预测价值。结果在预测3月生存率时，CLIP、JIS及TOKYO评分系统对于3月生存率的预后价值相似。CLIP的A值与MELD、TNM对比差异有显著的统计学意义（均P <0.05）。在预测6月生存率时CLIP、JIS及Tokyo评分系统对于6月生存率的预后价值相似。CLIP的A值与JIS、TOKYO、TNM、MELD比较差异有显著的统计学意义（均P <0.05）。LRT检验发现CLIP的预测总生存率能力最好。结论CLIP对晚期肝癌3月生存率、6月生存率及总生存率预测的能力最好。
　　목적탐토CLIP、NCCN、JIS、TOKYO、MELD 5개예후평고계통대만기간세포간암환자3월생존솔、6월생존솔화총생존솔적예측개치。방법회고성연구2008년9월지2010년5월253례진전기간암환자，사용CLIP、NCCN、JIS、TOKYO、MELD 5개불동적예후평고계통대진전기간암환자초차진단시진행평분，병진행수방。응용접수자공작특정（ROC）곡선분석매개예후평고계통，평개각개예후평고계통대3월생존솔、6월생존솔예측적특이도급령민도적예측개치。응용Kaplan-Meier생존곡선화Log-rank검험비교각개예후평고계통적만기간암총생존솔，응용사연비검험（LRT）평개각개예후평고계통대만기간암총생존솔적예측개치。결과재예측3월생존솔시，CLIP、JIS급TOKYO평분계통대우3월생존솔적예후개치상사。CLIP적A치여MELD、TNM대비차이유현저적통계학의의（균P <0.05）。재예측6월생존솔시CLIP、JIS급Tokyo평분계통대우6월생존솔적예후개치상사。CLIP적A치여JIS、TOKYO、TNM、MELD비교차이유현저적통계학의의（균P <0.05）。LRT검험발현CLIP적예측총생존솔능력최호。결론CLIP대만기간암3월생존솔、6월생존솔급총생존솔예측적능력최호。
Objective To evaluated the value of five current prognostic scoring systems, i.e. CLIP(Cancer of the Liver Italian Program), TNM, JIS(Japanese integrated score), TOKYO, MELD(model for end-stage liver disease) in predicting the 3-month mortality, 6-month mortality and overall survival for advanced liver cancer patients. Methods Data of 253 patients were collected. They were classified according to CLIP, TNM, JIS, TOKYO and MELD scoring systems respectively at their first diagnosis and were followed up afterwards. Relative operating characteristic (ROC) curve analysis and The Delong. et al test was used to compare A (Area under curve) of ROC curve, in order to evaluate the sensitivity and specificity of 3-month mortality and 6-month mortality predicting value of different scoring systems. Kaplan-Meier survival curve and log-rank test were used to compare the advanced HCC's overall survival rate of different scoring systems, and likelihood ratio test (LRT) was used to evaluate different scoring systems'predicting value of advanced HCC's overall survival. Results For 3-month mortality, the prognostic values in predicting 3-month mortality of CLIP, JIS and Tokyo were similar. A of CLIP was significantly higher than that of MELD, TNM in predicting 3-month mortality (P <0.05). For 6-month mortality, the prognostic values in predicting 6-month mortality of CLIP, JIS and Tokyo were similar. A of CLIP was significantly higher than that of JIS, TOKYO, MELD, TNM in predicting 6-month mortality (P <0.05).χ2 of CLIP was the highest and CLIP scoring system's predicting value of overall survival is best. Conclusion CLIP is the best scoring system in predicting 3-month mortality, 6-month mortality and overall survival of advanced HCC.