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目的 寻找适合于中国肝细胞癌患者最佳的分期标准.方法 回顾性分析1999年1月至2010年12月中国医学科学院肿瘤医院外科治疗的908例肝细胞癌患者的临床资料,比较TNM分期第七版、BCLC分期、Tokyo分期、JIS分期、CUPI分期、CLIP分期以及Okuda分期对肝细胞癌术后生存情况的判断力.采用Kaplan-Meier法进行生存分析,采用Cox比例风险模型进行多因素分析.应用赤池宏治信息准则(AIC,Akaike Information Criterion)来判断各分期系统对预后总的评估能力.结果 Kaplan-Meier生存曲线及Log-rank检验结果显示,BCLC与JIS分期系统中各期之间差异有统计学意义(P＜0.05);TNM第七版中Ⅰ、Ⅱ、Ⅲ期间差异有统计学意义,但Ⅲ、Ⅳ期间差异无统计学意义(P =0.538);Tokyo评分0分与1分组(P=0.398),3分与4分组(P =0.290)之间差异无统计学意义;本研究CUPI分期只包含低危组和中危组,两分期间差异有统计学意义(P=1.03×10-8);CLIP分期中2分组与3,4组之间差异无统计学意义(P=0.805及P=0.073);Okuda Ⅰ、Ⅱ期间差异无统计学意义(P=0.872).采用SAS软件计算各自的AIC值,结果显示TNM第七版具有最小的AIC值(3 719.39),其次为BCLC分期(3 724.38).结论 TNM第七版分期对于肝细胞癌的生存情况具有较好的预测作用,是一种较适用于国人的肝细胞癌分期方法.

Objective To compare the performance of 7 prognostic staging systems in predicting the survival of surgical patients with hepatocellular carcinoma (HCC).Methods A total of 908 surgical HCC patients were recruited from January,1999 to December,2010 at our hospital.They were assigned retrospectively into different stages according to the classification criteria of 7 different staging systems.That is,Tumor-Node-Metastasis classification system (TNM7th),Barcelona Clinic Liver Cancer staging system (BCLC),Tokyo score,Japan Integrated Staging score (JIS),model for the Chinese University Prognostic Index grade(CUPI),Cancer of the Liver Italian Program score (CLIP) and Okuda staging.Kaplan-Meier survival estimations were performed and P values assessed with Log-rank test.Results Significant survival difference was found across all groups of these staging systems (P ＜ 0.05) except for comparison between TNM7th Stage Ⅳ versus Ⅲ(P=0.538),Tokyo score4 versus 3(P =0.290) and 1 versus0(P =0.398),CLIP score 4 versus 3 (P =0.073) and 3 versus 2 (P =0.805) and Okuda stage Ⅱ versus stage Ⅰ (P =0.872).For neutralizing potential bias in comparing prognostic scores with different numbers of stages,Akaike information criterion (AIC) was calculated by the results of Cox's regression.Therefore TNM7th had the lowest AIC result(AIC =3 719.39).Conclusion TNM7th staging system is a better staging model for HCC of Chinese population among seven currently applied staging systems.