摘要
目的:研究终末期肝病模型(model for end-stage liver disease,MELD)判断原发性肝癌(primary hepatic cancer,PHC)患者病情和预后的可行性。方法:选择原发性肝癌患者的资料进行登记和随访,最后选择具有完整记录资料和随访结果的303例原发性肝癌患者进行分析,根据MELD公式计算每个患者的MELD值,并同时计算Child-Turcotte-Pugh(CTP)评分(CS)和分级(CC)。运用接受者运行曲线(ROC曲线)及其曲线下面积(AUC)比较MELD、CTP评分和分级判断肝硬化患者生存3个月、1年等不同时间的准确性。运用Kaplan-Meier生存分析,比较不同MELD值时患者的生存率变化。结果:MELD判断患者生存3个月和1年时间的ROC曲线AUC分别为0·85和0·78,CS分别是0·88和0·76,CC分别是0·81和0·73。3种模型判断患者生存不同时间的ROC曲线AUC差异无统计学意义,P>0·05。当MELD值>20时,门脉高压并发症的发生率明显高于<20组,患者生存时间和生存率明显下降,P=0·000。结论:MELD同CTP评分和分级一样,在判断PHC患者短期预后方面是一个较好的指标。
OBJECTIVE.. To evaluate the predicting abilities of the model for end-stage liver disease （MELD） to predict prognosis in pationts with primary bepatic cancer. METHODS： A cohort of 303 patients with primary hepatic cancer were retrospectively studied and followed up at least for one year. MELD score was calculated for each patient according to the modified formula by Kamath P. S. , Child-Turcotte-Pugh （CTP） score and classification were calculated at the same time. The area under the receiver operating characteristic （ROC） curve （AUC） was used to compare MELD and CTP score and classification in predicting accuracy for different sur- vival periods. Kaplan-Meier survival analysis was used to compare the mortality in subgroups ranked by the MELD score. RESULTS： The AUC values generated by the ROC curves for the MELD were 0.85 in predicting 3-month, and 0.78 for 1-year survival respectively, whereas the AUC values for CTP score and for CTP classification were 0.88, 0.81 in predicting 3-month, and 0.76, 0.73 for 1- year survival respectively. The differences of AUCs between the MELD and CTP score and classification were all not significant in predicting above period survival （P 〉 0.05）. When the MELD score was greater than 20, the complications of portal hypertensions presented more significantly than that of MELD score less than 20, and the survival time and rate were significantly decreased （P= 0. 000）. CONCLUSION： MELD is a good prognosis indictor in patients with primary hepatic cancer for short-term survival. The ability of prognosis of MELD is similar to Child-Turcotte-Pugh score and classification.
出处
《中华肿瘤防治杂志》
CAS
2007年第4期297-299,共3页
Chinese Journal of Cancer Prevention and Treatment
关键词
肝肿瘤/治疗
预后
模型
统计学
liver neoplasms/therapy
prognosis
models
statistical
