The Study Of Prognostic Factors Of Hepatocellular Carcinoma And 7th/8th AJCC-UICC Staging System

BackgroundPrimary liver cancer is currently one of the most common malignant tumor in the world.Each year more than 700000 patients newly are diagnosed in the world,more than half of patients died are from China,there are about 50-100 new deaths.Hepatectomy is widely used as the major treatment for patients with hepatocellular carcinoma.However,the recurrence of tumor after hepatectomy is still a common and extremely important determinative factor,which seriously affects the survival prognosis of patients.Therefore,it is of great significance to analyze the risk factors of liver cancer.And staging system systematacially takes all kinds of tumor associated risk factors into account,and quantificats them.Thus,we can evaluate liver tumor load and systemic spread,and divide the prognosis of patients with tumor.According them,we can generate the best treatment.The primary liver cancer staging system,however,varies from country to country.There is no consensus reached on this issue.Regional population exists significant differences of epidemiological features,etiology characteristic,histological basis,treatment and prognosis.Especially he different types of hepatitis existed in the difference regions.Thus,the clinical trial results among countries,regions and International research center for liver cancer are various.There is a considerable discrepancy among these established staging system based on clinical trial results.No staging system is available to meet the demands of all nations and races in the worldObjectiveThis study aims to evaluate the prediction value of the 7^th edition and the 8^thh edition of AJCC/UICC staging system for liver cancer patients'prognosis,discusses its practicability in the clinical work,and comprehensively analyses the prognostic factors about patients.MethodIn this trial,the research objects are patients after the curative hepatectomy during January 2010 to December 2015 in the first affiliated hospital of Zhengzhou University.264 cases were included in the trial The significant factors are filtered by the single factor analysis?P<0.2?,evaluated by multi-factor analysis COX proportional hazards model,calculated HR and 95%CI.These patients were staged by the 7th and 8th edition AJCC staging/UICC cancer staging system,respectively.The survival analysis uses Kaplan-Meier method.The differences between groups use the Log-Rank test.The ROC curve was used to evaluate the prognostic value of different stages.Homogeneity,discriminatory,and monotonicity of gradients of the two systems were compared by using the linear trend?²,likelihood ratio?² test.Then,we calculate the Akaike information criterion?AIC?of two stages separately to assess the prognosis value.Results1 In the 623 patients undergoing curative hepatectomy,264 patients met the inclusion criteria,including 208 males and 56 females.There are 252 cases of the radical surgery and 12 cases of palliative surgery.3 and 5-year survival rates were53%and 32%respectively.2 Univariate analysis indicated that AFP?P<0.0001?,liver function rating?P=0.124?and tumor size?P<0.0001?,tumor number?P=0.091?,the degree of differentiation?P<0.0001?,vascular invasion?P<0.0001?,lymph node metastasis?P=0.295?,and distant metastases?P=0.002?,the operation type?P=0.002?are associated with overall survival rate after surgery.3 Multivariate analysis uses COX proportional hazard models respectively for seventh,eighth edition of AJCC/UICC staging system for hepatocellular carcinoma model,including the significant factors filtered by the Univariate analysis?P<0.2?.The results indicated that the independent prognostic factor were AFP,vascular invasion,lymph node metastasis,the degree of differentiation based on the seventh edition of hepatocellular carcinoma TNM staging system,but only AFP,vascular invasion,lymph node metastasis based on the eighth edition of hepatocellular carcinoma TNM staging system.4 Comparison of survival analysis between subgroups of 7th/8th liver cancer TNM staging system.In this paper,the overall stage survival curve was calculated and plotted by Kaplan-Meire method,and the survival difference between adjacent subgroups was compared by Log-rank test.The paired comparison of adjacent the group stages is found that:in the 7th version staging system,?group with?group survival difference?P=0.021?,the comparison of??A survival difference?P=0.001?,?A and B?survival difference was statistically significant?P=0.002?.In 8th version staging system,?and?A?P<0.0001?,?A and B?survival difference?P=0.027?survival difference was statistically significant.5 Assess the prognostic value of the 7th/8th stage system.By using MedCale to calculate the area under the ROC curve,compared with the overall system of TNM staging system in the AJCC/UICC,the AUC was compared with Z=1.255?P=0.2096?,and the difference was not statistically significant?P>0.05?.We used R language to have linear trend chi-square test,likelihood ratios chi-square test to evaluate the consistency of the prognosis of patients with liver cancer based on the AJCC-UICC7th/8th edition of TNM staging system,using red pool Information standards?Akaike's Information Criterion,AIC?to evaluate the fit of the staging system.The results indicated that the AIC value?AIC=1172.654?was slightly less than the AIC system AIC value?AIC=1173.834?.For the prognostic value of patients with hepatocellular carcinoma,the 8th edition of hepatocellular carcinoma staging system is closer to reality,but its advantages are not obvious.Conclusion1.In this study,the prognostic factors of hepatocellular carcinoma patients include AFP level,tumor size,tumor number,differentiation degree,vascular invasion and distant metastasis.In the 7th edition hepatocellular carcinoma staging system,vascular invasion,AFP,degree of differentiation,lymph node metastasis are closely related to the prognosis of patients with hepatocellular carcinoma,while in the8th edition of hepatocellular carcinoma staging system,AFP,vascular invasion and lymph node metastasis and prognosis are closely related.2.Based on the data analysis of this center,the patients in this center are applicable to the TNM staging system of the 7th/8th edition.All of them have clear stratification of prognosis,but there is no significant difference between them...