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(Department of Oncology of Interventional Radiology, Beijing DitanHospital of Capital Medical University, Beijing 100015, China)



Child-Turcotte-Pugh score and model for end-stage liver disease in judging prognosis of advanced hepatocellular carcinoma in peri-inventional period

WEIJian,LIHonglu,GUOJiang,LIChangqing*

(DepartmentofOncologyofInterventionalRadiology,BeijingDitanHospitalofCapitalMedicalUniversity,Beijing100015,China)

Objective To compare the value of Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD) in judging prognosis of advanced hepatocellular carcinoma in peri-inventional period. Methods Totally 100 patients with hepatocellular carcinoma were collected and underwent TACE. Before TACE, the MELD value for each patient were calculated according to MELD formula, and at the same time CTP score were calculated. The value of MELD and CTP score in judging the prognosis of patients with advanced hepatocellular carcinoma were analyzed and compared by the ROC curves and the area under the curve (AUC). Results The AUC of CTP score in judging survival time before and 3, 6 months after TACE were 0.540, 0.754, 0.889, while the AUC of MELD was 0.682, 0.701, 0.801, and the differences were statistically significant (allP<0.05). Conclusion MELD score is a method as good as CTP in judging the prognosis of advanced liver cancer.

Liver neoplasmas; Transcatheter arterial chemoembolization； Model for end-stage liver disease; Overall survival

TACE对无法接受外科手术的肝癌患者可明显延长生存期、提高生活质量[1-2]，但TACE可导致正常肝组织缺血缺氧，从而引起肝功能损害[3-5]。因此，围介入手术期准确判断肝功能具有重要意义。研究[6]报道，意大利肝癌分期(cancer of the liver Italian program， CLIP)评分系统是评价TACE术后发生急性肝损伤及肝功能衰竭的有效手段，尤其对于急性肝损伤的判断具有独特优势。张珂等[7]以吲哚氰绿实验及血栓弹力图(thrombelastography， TEG)建立的肝储备功能定量评估系统，并结合Child-Turcotte-Pugh(CTP)评分系统，形成了新的肝脏储备评分系统(Ditan分级)，发现其能够更全面地评价肝硬化围手术期肝功能。而实践中探索发现，CTP评分亦具有一定的局限性[8]。另一种评价体系，即终未期肝病模型(model for end-stage liver disease， MELD)，可用于较准确地预测肝硬化患者生存期，尤其在判断终末期肝病病情方面，效果优于CTP评分。CTP评分及MELD均可用于评估肝硬化患者肝功能及预测生存期，但二者的价值存在争议，且MELD应用于晚期肝癌介入围手术期评估方面的研究较少。本研究采用MELD评分评价介入术前肝功能及病情程度，并比较CTP评分与MELD对于晚期肝癌患者失代偿期肝硬化预后的评估价值。

1 资料与方法

1.1一般资料 收集2008年10月—2010年10月于我院住院接受治疗的肝癌患者100例，其中男76例，女24例，年龄36～86岁，平均(65.14±12.4)岁。TACE术前均经CT增强扫描、肿瘤标记物甲胎蛋白(alpha fetoprotein， AFP)检查，符合1990年全国肝癌学术会议修订的诊断标准。巴塞罗那临床分期(Barcelona-Clinic Liver Cancer， BCLC)为C、D期。术前根据MELD公式计算患者的MELD值，并同时计算CTP评分。

1.2仪器与方法 采用GE Corpration Innova DSA机作为引导设备，对所有患者均行TACE治疗。……