Prospective validation of the CLIP score: A new prognostic system for patients with cirrhosis and hepatocellular carcinoma

Prognosis of patients with cirrhosis and hepatocellular carcinoma (HCC) dep ends on both residual liver function and tumor extension. The CLIP score in cludes Child-Pugh stage, tumor morphology and extension, serum alfa-fetopro tein (AFP) levels, and portal vein thrombosis. We externally validated the CLIP score and compared its discriminatory ability and predictive power wit h that of the Okuda staging system in 196 patients with cirrhosis and HCC p rospectively enrolled in a randomized trial. No significant associations we re found between the CLIP score and the age, sex, and pattern of viral infe ction. There was a strong correlation between the CLIP score and the Okuda stage, As of June 1999, 150 patients (76.5%) had died. Median survival time was 11 months, overall, and it was 36, 22, 9, 7, and 3 months for CLIP cat egories 0, 1, 2, 3, and 4 to 6, respectively. In multivariate analysis, the CLIP score had additional explanatory power above that of the Okuda stage. This was true for both patients treated with locoregional therapy or not. A quantitative estimation of 2-year survival predictive power showed that t he CLIP score explained 37% of survival variability, compared with 21% expl ained by Okuda stage. In conclusion, the CLIP score, compared with the Okud a staging system, gives more accurate prognostic information, is statistica lly more efficient, and has a greater survival predictive power. It could b e useful in treatment planning by improving baseline prognostic evaluation of patients with RCC, and could be used in prospective therapeutic trials a s a stratification variable, reducing the variability of results owing to p atient selection.