基于巴塞罗那分期与香港分期肝细胞肝癌患者不同治疗方案生存率的比较

目的比较接受巴塞罗那临床肝癌分期系统(BCLC)或香港的分期系统(HKLC)推荐治疗方案对肝细胞肝癌(HCC)患者生存率的影响。方法回顾性分析436例初治肝癌患者的临床资料,根据HKLC和BCLC进行肿瘤分期,按是否最终接受两个分期系统推荐的治疗方案分组。比较患者是否接受BCLC或HKLC分期推荐方案治疗对生存率的影响,并评估拒绝BCLC或HKLC推荐方案对预后可能产生的影响。结果接受BCLC推荐治疗方案的患者5年生存率显著高于拒绝推荐治疗方案的患者(48% vs. 30%, P<0.001)。与拒绝推荐治疗方案的患者相比,接受HKLC推荐治疗方案的患者亦有较高的5年生存率(41% vs. 29%, P<0.001)。对BCLC和HKLC交叉亚组分析,BCLC-B/HKLC-Ⅰ+Ⅱa+Ⅱb、BCLC-B/HKLC-Ⅲa+Ⅲb和BCLC-C/HKLC-Ⅲa+Ⅲb亚组中,接受手术切除的HCC患者显著高于接受TACE、索拉非尼或最佳支持治疗的患者5年生存率均较高(均P<0.05)。结论接受BCLC和HKLC分期系统推荐治疗方案可以提高HCC患者的存活率,但对于中晚期肝癌患者指导作用减弱。部分BCLC-B/HKLC-Ⅰ+Ⅱa+Ⅱb、BCLC-B/HKLC-Ⅲa+Ⅲb和BCLC-C/HKLC-Ⅲa+Ⅲb的患者通过积极的根治性治疗可以获得更好的生存。

Comparison of Survival Rates Based on Recommended Treatment Algorithms of BCLC or HKLC Staging Systems for Hepatocellar Carcinoma Patients

Objective To evaluate the effect of the recommended treatment algorithms of the Barcelona Clinic Liver Cancer (BCLC) or Hong Kong Liver Cancer (HKLC) staging systems on the survival rate of patients with HCC. Methods A total of 436 patients newly diagnosed as HCC were analyzed. The prognostic performance and efficacy of treatment recommendations were compared between the two systems. All patients were first classified into a tumour stage according to the HKLC and BCLC staging systems respectively, and then they were divided into groups depending on whether they ultimately received the treatment recommended by the two staging systems. The efficacy of treatment algorithms of BCLC and HKLC systems was evaluated by comparing the patients who received treatment recommendations of either BCLC or HKLC stage to those who did not. Results HCC patients who received the recommended treatment algorithms of the BCLC and HKLC systems had a significantly favourable 5-year survival probability compared with the patients who did not (BCLC: 48% vs. 30%, P<0.001; HKLC: 41% vs. 29%, P<0.001). Patients receiving resection had a significantly favourable 5-year survival rate in BCLC-B/HKLC-Ⅰ+Ⅱa+Ⅱb, BCLC-B/HKLC-Ⅲa+Ⅲb and BCLC-C/HKLC-Ⅲa+Ⅲb groups than those receiving TACE, Sorafenib or best supportive care(all P<0.05). Conclusion The recommended treatment algorithms of the BCLC and HKLC systems could improve survival rates of HCC patients. Curative therapies are superior to standard of care for BCLC-B/HKLC-Ⅰ+Ⅱa+Ⅱb, BCLC-B/HKLC-Ⅲa+Ⅲb and BCLC-C/HKLC-Ⅲa+Ⅲb patients. Some patients can achieve better survival through active radical treatment.