Prognostic Factors For Hepatocellular Carcinoma And Comparisons Of Prognostic And Therapeutic Guiding Values Of Five Staging Systems

Objective:From a variety of clinical features of HCC start to get an independent prognostic factor of HCC, the comparison of five commonly used in clinical staging system (BCLC, Okuda, JIS, domestic2001staging system, TNM) the ability of prognostic value and guiding therapy, find the staging system suitable for China.Methods:A retrospective analysis of patients with primary liver cancer first diagnosed with complete follow-up data, Affiliated Tumor Hospital of Guangxi Medical University in September2010to August2011admitted a total of376cases, all patients were followed up until March1,2014. According to the patients diagnosed with a variety of clinical data before treatment, the use of Kaplan-Meier method and log-rank test for univariate analysis of each indicator to obtain statistically significant factors. Then import these factors Cox analysis, regression model to obtain statistically significant prognostic factors. Using ROC curves for each single staging system trend analysis, comparison of its ability to determine prognosis. Each installment of the internal system, depending on the receiving treatment, in order to Kaplan-Meier method and log-rank test to compare the ability of each installment treatment guidelines.Results:To March1,2014,251patients died,125patients survive, censored proportion of33.2%. The median survival time was (16±1.723) months,1year,2years,3years survival rates were (54.8±2.6)%,(39.9±2.5)%,(32.6±2.5)%. According to Kaplan-Meier analysis and log-rank test tumor factors on various clinical factors, the number of the tumor, the tumor is located in the leaf, tumor extent, tumor size, presence of vascular invasion, vascular or biliary bolt, with or without lymph nodes, distant metastasis, tumor grade, AFP levels associated with survival of patients. Liver background, HBeAg, HBV-DNA, ascites extent, TB, ALT, AST, ALP, GGT, ALB, PT, Child-Pugh classification, associated with survival of patients. Therapeutic factors, the main choice of treatment will lead to differences in survival. Cox analysis showed that the presence or absence of vascular or biliary bolt, maximum tumor diameter, ALT, treatment as an independent prognostic factor. According to Kaplan-Meier analysis and log-rank test, five staging systems and patient survival were related to the later stages, the worse the prognosis (P values<0.0001). Make a single trend analysis of prognostic ability of each system and found that2001staging system has the largest area under the ROC curve (AUC=0.882, P<0.0001), followed by BCLC and JIS staging system, the area under the ROC curve Okuda minimum. In guiding treatment, staging Ⅲa of2001, JIS score3points, BCLC staging stage C, Okuda staging of patients with stage Ⅱ, such as the physical condition allows, you can choose surgical treatment, staging more than these patients should still early surgical treatment of the treatment of choice.Conclusion:The current five kinds staging system,2001prognostic staging system optimal capacity, followed by BCLC and JIS staging system. Treatment recommendations BCLC staging in guiding the treatment of liver cancer too harsh, still need more clinical validation on a large sample of clinical treatment, and JIS2001staging system scoring system can guide treatment.