간세포암종 환자에서 TNM, Okuda, CLIP, JIS, BCLC 병기설정에 따른 예후 분별 능력의 비교

The Discriminating Ability of a Prognosis According to the TNM, Okuda, CLIP, JIS, and BCLC Staging Systems for Hepatocellular Carcinoma

  • 구혜영 (CHA의과학대학교 외과학교실) ;
  • 권성원 (CHA의과학대학교 외과학교실) ;
  • 이화영 (CHA의과학대학교 소화기내과학교실) ;
  • 황성규 (CHA의과학대학교 소화기내과학교실) ;
  • 임규성 (CHA의과학대학교 소화기내과학교실) ;
  • 김만득 (CHA의과학대학교 영상의학과교실)
  • Koo, Hye-Young (Department of Surgery, CHA University College of Medicine) ;
  • Kwon, Sung-Won (Department of Surgery, CHA University College of Medicine) ;
  • Lee, Hwa-Young (Department of Gastroenterology, CHA University College of Medicine) ;
  • Hwang, Sung-Kyu (Department of Gastroenterology, CHA University College of Medicine) ;
  • Lim, Kyu-Sung (Department of Gastroenterology, CHA University College of Medicine) ;
  • Kim, Man-Deuk (Department of Radiology, CHA University College of Medicine)
  • 발행 : 2010.03.30

초록

Purpose: There is yet no ideal single staging system for hepatocellular carcinoma (HCC). The aim of this study was to analyze HCC survival times according to the TNM, Okuda, CLIP, JIS, and BCLC staging systems and their prognostic discrimination ability. Methods: A retrospective analysis of medical records and statistical data from the Korean statistical information service was done for HCC patients diagnosed at Bundang CHA hospital between June, 1992 and February, 2009. Results: During follow-up, 121 (72%) of 168 people died and 1, 3 and 5 year overall survival rates were, respectively, 58%, 35% and 25%. In the analysis of discriminative ability of each staging system, the CLIP staging system showed the highest LR $X^2$ value, and the lowest AIC value (p<0.05). Therefore, the CLIP staging system appears to be superior to the other systems. Conclusion: Of the 5 staging systems in this study, the CLIP staging system was superior to the other systems, but the results of many other studies from different countries have varied. It is necessary to establish the staging system suitable for each country's actual circumstances.

키워드

참고문헌

  1. Korean Liver Cancer Study Group and National Cancer Center, Korea. Practice guidelines for management of hepatocellular carcinoma 2009. Korean J Hepatol 2009;15: 391-423. https://doi.org/10.3350/kjhep.2009.15.3.391
  2. Chen CH, Hu FC, Huang GT, et al. Applicability of staging systems for patients with hepatocellular carcinoma is dependent on treatment method--analysis of 2010 Taiwanese patients. Eur J Cancer 2009;45:1630-1639. https://doi.org/10.1016/j.ejca.2008.12.025
  3. Varotti G, Ramacciato G, Ercolani G, et al. Comparison between the fifth and sixth editions of the AJCC/UICC TNM staging systems for hepatocellular carcinoma: multicentric study on 393 cirrhotic resected patients. Eur J Surg Oncol 2005;31:760-767. https://doi.org/10.1016/j.ejso.2005.04.008
  4. Minagawa M, Ikai I, Matsuyama Y, Yamaoka Y, Makuuchi M. Staging of hepatocellular carcinoma: assessment of the Japanese TNM and AJCC/UICC TNM systems in a cohort of 13,772 patients in Japan. Ann Surg 2007;245:909-922. https://doi.org/10.1097/01.sla.0000254368.65878.da
  5. Okuda K, Ohtsuki T, Obata H, et al. Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer 1985;56:918-928. https://doi.org/10.1002/1097-0142(19850815)56:4<918::AID-CNCR2820560437>3.0.CO;2-E
  6. A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators. Hepatology 1998;28: 751-755.
  7. Chevret S, Trinchet JC, Mathieu D, Rached AA, Beaugrand M, Chastang C. A new prognostic classification for predicting survival in patients with hepatocellular carcinoma. Groupe d'Etude et de Traitement du Carcinome Hepatocellulaire. J Hepatol 1999;31:133-141. https://doi.org/10.1016/S0168-8278(99)80173-1
  8. Leung TW, Tang AM, Zee B, et al. Construction of the Chinese University Prognostic Index for hepatocellular carcinoma and comparison with the TNM staging system, the Okuda staging system, and the Cancer of the Liver Italian Program staging system: a study based on 926 patients. Cancer 2002;94:1760-1769. https://doi.org/10.1002/cncr.10384
  9. Kudo M, Chung H, Osaki Y. Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). J Gastroenterol 2003;38:207-215. https://doi.org/10.1007/s005350300038
  10. Llovet JM, Bru C, Bruix J. Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 1999;19:329-338. https://doi.org/10.1055/s-2007-1007122
  11. Lee CH, Shin DH, Park YJ, et al. Survival rate of hepatectomy according to liver cirrhosis in hepatoculluar carcinoma. Korean J Hepatobiliary Pancreat Surg 1999;3:17-24.
  12. Park JW. Practice guideline for diagnosis and treatment of hepatocellular carcinoma. Korean J Hepatol 2004;10:88-98.
  13. Toyoda H, Kumada T, Kiriyama S, et al. Changes in the characteristics and survival rate of hepatocellular carcinoma from 1976 to 2000: analysis of 1365 patients in a single institution in Japan. Cancer 2004;100:2415-2421. https://doi.org/10.1002/cncr.20289
  14. Park KW, Park JW, Kim TH, et al. Five-year survival analysis of a cohort of hepatocellular carcinoma patients who treated at the National Cancer Center, Korea. Korean J Hepatol 2007;13:530-542. https://doi.org/10.3350/kjhep.2007.13.4.530
  15. Ueno S, Tanabe G, Sako K, et al. Discrimination value of the new western prognostic system (CLIP score) for hepatocellular carcinoma in 662 Japanese patients. Cancer of the Liver Italian Program. Hepatology 2001;34:529-534.
  16. Yan P, Yan LN. Staging of hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2003;2:491-495.
  17. Collette S, Bonnetain F, Paoletti X, et al. Prognosis of advanced hepatocellular carcinoma: comparison of three staging systems in two French clinical trials. Ann Oncol 2008;19: 1117-1126. https://doi.org/10.1093/annonc/mdn030
  18. Takanishi DM Jr, Severino R, Wong LL. The Cancer of the Liver Italian Program (CLIP) score: validation of a new prognostic system for hepatocellular carcinoma. Hawaii Med J 2007;66:209-212.
  19. Kudo M, Chung H, Haji S, et al. Validation of a new prognostic staging system for hepatocellular carcinoma: the JIS score compared with the CLIP score. Hepatology 2004;40: 1396-1405. https://doi.org/10.1002/hep.20486
  20. Vitale A, Saracino E, Boccagni P, et al. Validation of the BCLC prognostic system in surgical hepatocellular cancer patients. Transplant Proc 2009;41:1260-1263. https://doi.org/10.1016/j.transproceed.2009.03.054
  21. Henderson J, Sherman M, Tavill A, Abecassis M, Chejfec G, Gramlich T. AHPBA/AJCC consensus conference on staging of hepatocellular carcinoma: consensus statement. HPB (Oxford) 2003;5:243-250.
  22. Cillo U, Bassanello M, Vitale A, et al. The critical issue of hepatocellular carcinoma prognostic classification: which is the best tool available? J Hepatol 2004;40:124-131.
  23. Chen TW, Chu CM, Yu JC, et al. Comparison of clinical staging systems in predicting survival of hepatocellular carcinoma patients receiving major or minor hepatectomy. Eur J Surg Oncol 2007;33:480-487. https://doi.org/10.1016/j.ejso.2006.10.012
  24. Lee SW, Han SY, Kim KT, et al. Evaluation of predictive value of Okuda, TNM, CLIP and JIS staging systems for hepatocellular carcinoma patients. Korean J Hepatol 2007; 13:196-207.
  25. Farinati F, Sergio A, Baldan A, et al. Early and very early hepatocellular carcinoma: when and how much do staging and choice of treatment really matter? A multi-center study. BMC Cancer 2009;9:33. https://doi.org/10.1186/1471-2407-9-33