摘要目的 比较美国癌症联合委员会肝细胞癌TNM-8分期系统和TNM-7分期系统对可切除肝癌术后的预后评估能力.方法 回顾性分析311例行根治性切除术的肝细胞癌患者资料,所有患者根据美国癌症联合委员会第7、8版TNM分期系统分期,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,应用受试者工作特征曲线(receiver operator characteristic curve,ROC曲线)和曲线下面积(area under curve,AUC)判断各分期系统对预后的评估能力.结果 TNM-7分期中T1期的总体生存率(overall survival,OS)高于T2期,T2期高于T3a,但T4期的5年OS(16.7％)优于T3a(14.3％)和T3b(10.9％),T1期与T3a、T3b、T4期以及T2期与T3b、T4期的OS比较差异均有统计学意义(均P＜ 0.05).TNM-8分期系统的OS和无瘤生存率(disease free survival,DFS)均随着T分期的增加而下降,其中T1a期的OS显著高于T3和T4期(分别P=0.004,0.001),T1b期显著高于T3和T4期(均P＜0.001),T2期显著高于T4期(P =0.009),T1a、T1b、T2期的DFS显著高于T3和T4期(均P＜0.01).TNM-8分期系统的ROC曲线下面积也大于TNM-7分期系统. 结论 TNM-8分期可能较TNM-7分期有更好地评估可切除肝癌患者预后的效果.

abstractsObjective To compare the prognosis prediction value of the 8th edition with the 7th edition of the American Joint Committee on Cancer Staging System in patients with resectable hepatocellular carcinoma (HCC).Methods A total of 311 HCC patients after hepatectomy were retrospectively analysed.Patients were staged according to both the 7th edition (TNM-7) and 8th edition (TNM-8) AJCC TNM staging criteria.The survival rates were estimated using Kaplan-Meier methods.Multivariate analysis was assessed by Cox proportional hazards regression analysis.The predictive ability of staging systems was evaluated by receiver operating characteristic curve (ROC) and area under curve (AUC).Results When stratified according to the TNM-7 system,the overall survival(OS) of stage T1 was higher than that of stage T2,stage T2 higher than stage T3a,however,the 5-year OS rates of stage T4 (16.7％) was higher than those of stage T3a (14.3％) and T3b(10.9％).The difference in survival was significant between stages T1 and stage T3a,T3b,T4 (all P ＜0.05),and that between stages T2 and stage T3b,T4 (all P ＜0.05).When stratified according to the TNM-8 system,the survival rates decreased as the T stage going high.OS rates vary significantly between stagesT1a and stageT3,T4 (P =0.004,0.001),between stage T1b and stage T3,T4 (both P ＜ 0.001),and between stage T2 and stage T4 (P =0.009).The difference in disease free survival (DFS) rates was significant between stages T1a,T1b,T2 and stage T3,T4 (all P ＜0.01).Finally,the area under ROC of TNM-8 is bigger than that of TNM-7.Conclusions Compared with TNM-7 staging,new TNM-8 staging can predict more accurately the prognosis of patients with resectable hepatocellular carcinoma.