| Background:Out of the all incidents of cancer, primary liver cancer is the fifth most common type of cancer one can develop, and, including every variation, is the second most common cause of death in the world. High-risk areas within the world are mainly concentrated in East Asia and Africa. In these regions, the main cause of liver cancer is exposure to the hepatitis B virus (HBV) infection and/or to aflatoxin B1environment. The etiology of this type of cancer in North America, Japan and Europe, however, is mostly due to the HCV (Hepatitis C) virus and alcoholism. China in particular has a high incidence of HBV infection, making up approximately75%of all Hepatitis B carriers in the world. Eventually, about30%of chronic HBV infected patients will develop cirrhosis. Cirrhosis increases the risk of liver cancer; about one-third of the patients with this disease will eventually develop Hepatocellular Carcinoma.Modern medicine utilizes a variety of methods in the treatment of primary liver cancer and has achieved some success; these treatments involve prescribing remedies depending on the type, size or stage and also the patient’s health status to make a decision. The stage of the patient’s liver cancer is essential as well. To improve treatment, there should be a streamlined/standardized liver cancer staging method not only to choose the most appropriate treatment, but also a preliminary assessment of the patient’s prognosis. Nowadays, the primary liver cancer had a variety of staging or scoring system. Installments from1971Kampala to the current NCCN/AJCC TNM stage, there are total of more than ten kinds of staging system and a variety of biological prognostic molecular markers. Due to the different causes of primary liver cancer epidemiological data around the world, different merger lesions of the liver, the diagnosis and treatment of liver cancer is not the same. There are many different liver cancer staging systems but there has not yet been a standardization that is identified as the best.In China, more than90%of liver cancer patients who have received Chinese medicine treatment in the recent years (The role of Chinese medicine in advanced hepatocellular carcinoma had greater emphasis recently) have displayed improvement in symptoms, prolonged survival and an improved quality of life. But there is absence of prognostic and evaluation system of Chinese medical treatments malignant tumors today. According to prominent scholars on the issue, the various installments or biomarkers can reflect the efficacy of Chinese medicine in the treatment of advanced liver cancer. The Jianpiliqi method is the mainstay of treatment of liver cancer. In the Guangdong Provincial Hospital, the mentioned method is widely used and achieved certain results. This study of comparing the different staging methods to the prognostic value of the New JianpiLiqi fomula (XJPLQF) treatment of hepatocellular carcinoma is required in order to explore the installment method suitable for the evaluation of Chinese medicine treatment of liver cancer.Objective:An assessment of primary liver cancer staging/socring systems (including China liver cancer stage, Okuda stage, CLIP score, French stage and BCLC stage) of the prognostic value of the XJPLQF treat liver cancer. It is to explore each staging/scoring system for evaluating Chinese medical treatment of liver cancer.Methods:This study is divided into two parts. First, by looking through prior research, the advantages and disadvantages of different staging/scoring systems can be used in the assessment of viable prognosis staging/scoring system. In the last retrospective study,151patients with primary liver cancer patients to accept the XJPLQF treatment from May2007to December2009in the Guangdong Provincial Hospital for treatment as the research object. All patients were in accordance with the screened out of the installment method or scoring system restaging. The survival rate calculated using the Kaplan-Meier method, rank test (log-rank test). The survival rate of the single factors compared with the proportional hazards model for multivariate analysis of the AIC value evaluation model prognostic value contribution. Linear trend chi-square test, the likelihood ratio chi-square test, Harrell.’s c-index (concordant index, c-index) to assess staging systems for homogeneity, monotonous, discriminant force, with the AIC (Akaike Information Criterion, AIC) finding the best prognostic model.Results:Found by searching the literature, various staging or scoring system has its advantages and disadvantages. The TNM staging including vascular invasion, vascular invasion by surgical resection, confirmed by imaging to confirm whether vascular invasion is not accurate. For non-surgical treatment of patients, the Izumi improved staging, TNM staging simplified, the sixth edition of the UICC/TNM classification of the AJCC TNM staging of Japan, Japanese JIS integration method, and the Chinese University of Hong Kong prognosis coefficient scoring system including TNM stage’s reliability is also questionable. With the China liver cancer staging, Okuda staging, CLIP scoring, French staging and the BCLC staging (cancer that does not include vascular invasion), through imaging and clinical factors to determine the stage of cancer-suitable for non-surgical patients-can be used in the assessment of prognosis of Chinese medical treatment efficacy.Using the retrospective research method by comparing different staging/scoring system (China liver cancer stage, Okuda stage, CLIP score, French stage and BCLC stage), one can accept the XJPLQF treatment in patients with primary liver cancer prognosis value. This study included151patients with primary liver cancer patients of whom127(84.1%) are males while24(15.9%) are females, aged ranging from27to81years old, with a median age of56years old. In univariate analysis, treatment symptoms, ascites, total bilirubin level, albumin level, AFP level, portal vein tumor thrombus, lesion proportion, TCM syndrome, Pugh, Okuda stage, CLIP score, French stage, BCLC stage and China liver cancer staging having prognosis statistically significant. Multivariate analysis shows the classification of albumin, ascites graded cirrhosis, lesions proportion of abdominal lymph node metastasis and prognosis, classification AFP made are significant differences.After using the linear trend chi-square test, likelihood ratio chi-square test, Harrell’s c-index to assess the homogeneity of the staging system and discriminant forces, the CLIP score is better than the other installments in homogeneity and monotonicity. The size of the contribution to the pre-value of the AIC value evaluation model found by Okuda stage and the CLIP score model constituted the lowest AIC value, which is the most effective model. The CLIP score, homogeneity and monotonicity are better than the other installments (including Okuda stage. etc.). The CLIP score also has a better prognostic value. Integrating the different stages of the prognostic value of homogeneity, monotonicity and model results, the CLIP score on the prognostic value of the contribution is greater than the other installments.Conelusions:1. A single factor analysis shows that the treatment symptoms and ascites had statistically significant differences in the impact of factors such as the level of total bilirubin, albumin level, AFP level, portal vein tumor thrombus and the lesions proportion XJPLQF in the treatment of liver cancer prognosis influential.2. The multifactorial analysis suggests that cirrhosis, lesions proportional abdominal lymph node metastases, ascites, and hierarchical classification of albumin and AFP levels have a significant impact on the XJPLQF treatment of liver cancer prognosis statistics.3. Prognostic risk model assessment showed, through experimental results, that the Okuda stage and CLIP score are reliable prognostic models. The CLIP score homogeneity, monotonicity are better than the other installments (including Okuda stage etc.) CLIP score has a higher prognostic value, superior to Okuda stage, French stage, BCLC score and China stage stratification stage. CLIP score also has more prognostic discriminant force to Chinese medicine in the treatment of advanced liver cancer. In fact, CLIP score is rather simple and easy to use and is worthy for further reference and research. |
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