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A new prognostic system for hepatocellular carcinoma: A retrospective study of 435 patients
Author(s) -
Giuseppe Manghisi,
Silvana Elba,
Ascanio Mossa,
Antonio Giorgio,
Vincenza Aloisio,
A. Perrotta,
B Tardio,
Carlo Del Naja,
Eugenio Caturelli,
Maria Calandra,
Luigi Castellano,
Ilario de Sio,
Gaetano Capuano,
Domenico Pomponi,
Fabio Castiglione,
Pasqualina Cocchia,
Fabio Farinati,
M. Rinaldi,
Luigi Elio Adinolfi,
Enrico Ragone,
Martina Felder,
L. Zancanella,
Giuseppe Pasquale,
Maria Stanzione,
G. Marone,
Valentina D’Angelo,
Giovanni Battista Gaeta,
Giancarlo Giolitto,
Bruno Lamborgese,
Luigi Manzione,
M. G. Russo,
Raffaele Colurcio,
Enzo Veltri,
Francesco Izzo,
G Budillon,
N. Caporaso,
C. Del Vecchio Blanco,
B Galanti,
G. Giusti,
G Mazzacca,
S. Monfardini,
F Piccinino,
Giuseppe Ruggiero,
Ciro Gallo,
Francesco Perrone,
Sabino De Placido,
Giuliana Canzanella,
Bruno Daniele,
Sandro Pignata
Publication year - 1998
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.510280322
Subject(s) - medicine , hepatocellular carcinoma , multivariate analysis , stage (stratigraphy) , survival analysis , discriminant function analysis , retrospective cohort study , proportional hazards model , liver cancer , liver function , oncology , surgery , gastroenterology , paleontology , machine learning , computer science , biology
The clinical outcome of cirrhotic patients with hepatocellular carcinoma (HCC) depends both on the residual liver function and tumor characteristics. However, the relative prognostic weight of these variables is not well defined. The aims of this study were to verify the value of known prognostic factors and to devise a prognostic index more sensitive than the commonly used Okuda stage. A retrospective analysis of the cases of HCC diagnosed at 16 Italian institutions from 1990 to 1992 was performed. Overall survival was the only end point used in the analysis. The Cox model, stratified by locoregional treatment, was used for multivariate analyses. The final model was derived from 10 randomly chosen training samples, and the prognostic validity of the Cancer of the Liver Italian Program (CLIP) score was assessed on the corresponding testing samples. Four hundred thirty‐five cases of HCC were collected. As of January 1997, 313 patients (72%) were deceased. Overall median survival was 20 months. At multivariate analysis, independent predictive factors of survival were Child‐Pugh stage, tumor morphology, α‐fetoprotein (AFP), and portal vein thrombosis. A simple scoring system (CLIP score) was thus produced, assigning linear scores (0/1/2) to the covariates. Compared with Okuda stage, the CLIP score, structured as a six‐category tool, has a greater discriminant ability, revealing a class of patients with an impressively more favorable prognosis and another class with a relatively shorter life expectancy. The CLIP score is a new prognostic system that accounts for both liver function and tumor characteristics. It is easy to calculate and appears to give more precise information than the Okuda stage.