How should patients with hepatocellular carcinoma be staged? Validation ofa new prognostic system

BACKGROUND. The life expectancy of a patient with hepatocellular carcinoma (HCC) in cirrhosis is hard to predict, making it difficult to decide whethe r a certain treatment is indicated and what to say to the patient regarding prognosis. A new score recently has been proposed, which includes the para meters involved in the Child-Pugh stage, plus macroscopic turner morphology , alpha -fetoprotein levels, and the presence or absence of portal thrombos is. The score has been validated in internal control series, but its genera l applicability has yet to be confirmed. The authors compared the discrimin atory ability of the Cancer of the Liver Italian Program (CLIP) score with those of the Okuda and TNM staging systems and the Child-Pugh classificatio n in a group of cirrhotic patients with HCC, diagnosed and followed up by t heir unit. METHODS. One hundred fifty-four patients with histologically ascertained HC C in cirrhosis were recruited (median age, 62.5 years; male/female ratio, 1 22/32) and prospectively followed up. Staging was performed at the baseline using the Child-Pugh, Okuda, TNM, and CLIP systems. RESULTS. The CLIP score was able to predict survival better than the Okuda or TNM staging system, as confirmed by the Kaplan-Meier comparison of survi val curves and by the Cox regression analysis, with a median survival rate of 31, 27, 13, 8, 2, and 2 months in patients with CLIP Stages 0, I, II, II I, IV, and V-VI, respectively. The Child-Pugh classification performed as w ell as the Okuda. The predictive capacity of CLIP score was confirmed ill t he subgroup of patients undergoing chemoembolization. Overall, the survival rate in the authors' series was higher than predicted on the basis of prev ious reports. CONCLUSIONS. The CLIP score, which is based on simple features of the patie nt and of the tumor, can accurately identify patients with different progno ses, particularly in the early phases of HCC, thus representing a useful to ol in the management of the disease and of the affected patient. Cancer 200 0;89:2266-73. (C) 2000 American Cancer Society.