肿瘤负荷评分在肝细胞癌患者预后预测中的价值

目的 探讨肿瘤负荷评分（tumor burden score，TBS）预测肝细胞癌患者预后的价值。方法 回顾性收集487例行肝切除术肝细胞癌患者的临床资料。采用时间依赖的ROC曲线及曲线下面积（area under the ROC curve，AUC）评价TBS预测总生存率和无瘤生存率的准确性。多因素Cox回归筛选影响肝细胞癌患者预后的独立因素。结果 ROC曲线分析显示，TBS预测肝细胞癌患者术后5年生存率的AUC为0.722，高于肿瘤最大直径的AUC （0.711）和肿瘤数目的AUC（0.548）。TBS可将患者分成4个不同预后风险组，即TBS≤3组（n=70，14.4%）、3n=175，35.9%）、5n=150，30.8%）、TBS>8组（n=92，18.9%），各组患者5年总生存率依次为87.5%、75.7%、62.9%和36.3%；5年无瘤生存率依次为62.4%、44.2%、31.1%和12.9%。组间总生存率和无瘤生存率比较差异均有统计学意义（P<0.001）。Cox多因素分析显示，TBS是影响肝细胞癌患者术后总生存率和无瘤生存率的独立因素。结论 TBS可较好地预测肝细胞癌患者肝切除术后的预后情况。

Prognostic value of tumor burden score in patients with hepatocellular carcinoma

Objective To evaluate the prognostic value of tumor burden score（TBS） in patients with hepatocellular carcinoma（HCC）. Methods The clinical data of 487 patients with HCC undergoing liver resection were retrospectively collected. Time-dependent ROC analysis was conducted to evaluate the ability of TBS in predicting overall survival（OS） and disease-free survival （DFS）. Multivariable Cox regression analysis was used to determine independent factors affecting prognosis. Results Time-dependent ROC analysis showed that the AUC of TBS for predicting OS at 5 years was 0.722，higher than that of maximum tumor diameter （0.711） and tumor number（0.548）. TBS stratified patients into 4 prognostic risk strata，namely TBS ≤3 （n=70，14.4%），3n=175，35.9%），5n=150，30.8%），and TBS>8（n=92，18.9%）. The 5-year OS for patients in the 4 risk strata was 87.5%，75.7%，62.9%，and 36.3%，respectively（P<0.001）. The 5-year DFS in the 4 risk strata was 62.4%，44.2%，31.1%，and 12.9%，respectively（P<0.001）. Multivariable analysis also revealed that TBS was an independent factor for both OS and DFS in patients with HCC after liver resection. Conclusion TBS may be a good tool for predicting the prognosis of patients with HCC after liver resection.