原发性肝癌临床分期的对比探讨

原发性肝癌严重威胁着人类的健康，全球每年新增的病例数约为50万，其中54％发生在我国，且患者在3年内复发率高于60％，可见诊治形势十分严峻。肝癌的临床分期系统对于患者的预后评估以及选择何种治疗方案有着极其重要的意义。国内外虽有此类研究的相关内容，但将各种分期的评价及适用范围、发展趋势相结合进行分析的较少。本文对国际上多种常用的分期方案（TNM分期、Child-Pu曲分期、Okuda分期、CLIP评分、JIS分期、CUPI指标、CIS记分）进行探讨，论述各种方案间的差异及相互关系，并对未来可能发展方向进行展望。经本文分析多项研究发现：TNM分期更适用于外科病人，Child—Pugh对肝功能受损的患者具有较好的预后价值，而Okuda、CLIP、JIs分期适用于不适合手术治疗的进展期病人，CUPI指数则对慢性乙肝患者有疗效，CIS适用于非手术治疗的患者。随着肿瘤分子生物学技术的进步，肝癌分期有可能上升到分子病理学的水平，肝癌切除的根治程度将划分得更为细致，以反映患者肝癌切除后所处状态的多种可能性，分子指标也将更加客观、敏感，有利于患者早期的诊断与治疗。

The Comparison and Discussion on the Clinical Staging Systems of Primary Liver Cancer

Primary liver cancer threatens people＇s health severely. Over five hundred thousand new cases are diagnosed each year on worldwide. A total of 54 % of these patients were diagnosed in china, and recurrence rates of those patients are higher than 60%. Thus, the treatment situation of primary liver cancer is very serious. Clinical staging systems are very significant to evaluate prognosis, and make clinical treatment plan on primary liver cancer patients. Some related studies have been discussed in the world, but it is few of integration on evaluation, application and prospect for development. Several common clinical staging systems are compared and dis- cussed, including TNM system, Child-Pugh, Okuda staging system and CLIP, JIS, CUPI, CIS system. Multiple studies have shown that： TNM is suitable for surgical patients; Child-Pugh system has better prognosis value on patients with liver function damage. Staging sys- tems of Okuda, CLIP and JIS are not good for patients on hospitalized and underwent operation. Hepatitis B patients are suitable for us- ing CUPI index, CIS score are better on no-surgical patients. With the developmental technology of tumor molecular biological, primary liver cancer staging systems could evolvement upon molecular pathology. The level of primary liver cancer radical resection will be more in detail, in order to reflect multiple possibilities of patients status on radical resection. With the development of objective and sensitive molecular index, diagnosis and treatment will be more prompt.