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背景与目的:索拉非尼(Sorafenib)联合氩氦刀局部冷冻消融(argon-helium cryoablation)治疗进展期肝细胞癌(advanced hepatocellular carcinoma,AHCC)患者疗效确定,但患者之间的预后相差很大。目前所采用的进展期肝癌预测系统(advanced liver cancer prognostic systems,ALCPS)、终末期肝病模型(model for end-stage liver disease,MELD)、Child-Pugh分级等评分系统对疗效的评价都有一定的意义,但对其优劣性缺乏相关的对比研究。本研究采用上述系统对接受联合治疗的AHCC患者进行分层分析,以评价各个评分系统在联合治疗预后预测中的意义,为临床医生选择合适的治疗对象提供依据。方法:50例进展期乙型肝炎相关性肝癌患者,给予索拉非尼联合氩氦刀局部冷冻消融治疗后,分别比较按照ALCPS、MELD、Child-Pugh评分系统划分的不同分值区间患者的疗效、生存期及疾病进展时间,分析各评分系统在预后评价中的意义。结果:50例患者经治疗后中位总生存期(OS)为11.0个月、中位疾病进展时间(TTP)为6.0个月,其中2例(4%)患者获得完全缓解(CR),8例(16%)部分缓解(PR),23例(46%)病情稳定(SD),治疗有效率达66%。ALCPS评分≤8分、9～15分及≥16分的患者中位OS分别为16.5、8.6和6.8个月(P<0.05),中位TTP分别为12.0、6.0和2.0个月(P<0.01),治疗有效率分别为94.1%、70.6%和31.3%(P<0.01)。MELD评分≤7分和>7分的患者中位OS分别为16.5和7.8个月(P<0.05),中位TTP分别为10.0和2.5个月(P<0.05);治疗有效率分别为78.8%和41.2%(P<0.01);Child-Pugh A/B的患者OS及TTP差异无统计学意义(P>0.05),治疗有效率分别为69.2%和54.6%(P>0.05)。结论:ALCPS、Child-Pugh、MELD系统对AHCC患者治疗预后均有不同程度的预测意义,而ALCPS系统更能有效地预测AHCC的临床获益程度。
BACKGROUND & AIM: Sorafenib combined with argon-helium cryoablation is effective in the treatment of advanced hepatocellular carcinoma (AHCC), but the prognosis varies greatly between patients . At present, advanced liver cancer prognostic systems (ALCPS), model for end-stage liver disease (MELD), Child-Pugh grading and other scoring systems all have certain curative effect evaluation Significance, but the lack of relative merits of its comparative study. In this study, the above system was used to stratify AHCC patients receiving combination therapy to evaluate the significance of each scoring system in prognosis prediction of combination therapy, which provided the basis for clinicians to choose the appropriate treatment target. Methods: Fifty patients with advanced hepatocellular carcinoma associated with hepatitis B were treated with sorafenib combined with argon-helium cryoablation. The curative effect of patients with different scores according to ALCPS, MELD, Child-Pugh score system was compared , Survival time and disease progression time, analyze the significance of each scoring system in prognosis evaluation. Results: The median overall survival (OS) was 11.0 months and the median time to progression (TTP) was 6.0 months after treatment in 50 patients, of whom 2 (4%) achieved complete remission (CR), 8 Cases (16%) partially relieved (PR), 23 cases (46%) stable condition (SD), the effective rate of 66%. The median OS was 16.5, 8.6 and 6.8 months (P <0.05), and the median TTP was 12.0, 6.0 and 2.0 months in patients with ALCPS ≤8, 9-15, and ≥16 (P <0.01 ), The effective rate was 94.1%, 70.6% and 31.3% (P <0.01). The median OS was 16.5 and 7.8 months (P <0.05), and the median TTP was 10.0 and 2.5 months respectively (P <0.05). The effective rates of treatment were 78.8% And 41.2%, respectively (P <0.01). There was no significant difference in OS and TTP among Child-Pugh A / B patients (P> 0.05). The effective rates were 69.2% and 54.6% (P> 0.05) respectively. Conclusion: ALCPS, Child-Pugh and MELD systems have different predictive value in the prognosis of patients with AHCC, while ALCPS system can predict the clinical benefit of AHCC more effectively.