目的：探讨美国癌症联合委员会（AJCC）第6版TNM分期标准对原发性肝癌（PLC）患者预后判断的指导意义。方法：将美国SEER数据库2004—2010年间收录的接受肝切除的2 456例PLC患者纳入研究，其中肝细胞癌（HCC）2 270例（92.4%），肝内胆管癌（ICC）145例（5.9%），混合型（cHCC-ICC）41例（1.7%）。分析并比较不同类型PLC患者术后总体生存（OS）情况，以及分析患者TNM分期与预后的关系。结果：HCC患者术后1、3、5年OS为83.0%、58.1%、46.6%，ICC患者为80.0%、45.5%、26.2%，cHCC-ICC患者为63.4%、29.3%、29.3%，前者的OS明显优于后两者（P=0.049、0.004），后两者间OS差异无统计学意义（P>0.05）。HCC与ICC中I期患者的OS明显优于其他各期（均P<0.05），但III期分层（IIIA，IIIB，IIIC）的患者间OS无统计学差异（均P>0.05）；cHCC-ICC各分期间OS无统计学差异（P>0.05）。PLC伴淋巴结转移（N1期）少见（3.9%），N1期的HCC、ICC和cHCC-ICC之间OS比较无统计学差异（P>0.05）。结论：TNM分期预测PLC预后存在局限性，需纳入新的病理指标进一步研究完善，以满足临床应用实际需求。
Association of TNM stage with postoperative survival in patients with primary liver cancer: an analysis of SEER database
Objective: To investigate the guiding significance of the criteria of TNM classification (6th edition) developed by American Joint Committee on Cancer (AJCC) in estimating prognosis of primary liver cancer (PLC). Methods: A total of 2 456 PLC patients undergoing liver resection recorded in the seer database between 2004 and 2010 were included in this study. Of the patients, 2 270 cases (92.4%) had hepatocellular carcinoma (HCC), 145 cases (5.9%) had intrahepatic cholangiocarcinoma (ICC), and 41 cases (1.7%) had combined HCC and ICC (cHCC-ICC). The overall survivals (OS) of the patients with different types of PLC were analyzed and compared, and the relations of TNM classification with the prognosis of the patients were also analyzed. Results: The 1-, 3-, and 5-year OS was 83.0%, 58.1% and 46.6% in HCC patients, 80.0%, 45.5% and 26.2% in ICC patients and 63.4%, 29.3% and 29.3% in cHCC-ICC patients respectively, and the OS in the former was significantly better than those in the latter two groups (P=0.049, 0.004), but showed no statistical difference between the latter two groups (P>0.05). For HCC or ICC, the OS in patients with TNM stage I was significantly better than those in patients with other TNM stages (all P<0.05), but no statistical difference was noted among patients in different stage III stratifications (IIIA, IIIB, IIIC) (both P>0.05); for cHCC-CC patients, the OS had no statistical difference among patients of all TNM stages (P>0.05). The presence of lymph node metastasis (N1) in PLC was rare (3.9%), and OS showed no statistical difference among HCC, ICC and cHCC-CC patients with N0 disease (P>0.05). Conclusion: There are some limitations in TNM staging system for estimation of prognosis of PLC, so some new pathological indicators should be incorporated into the system so as to satisfy clinical needs.