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Prospective validation of the CLIP score: A new prognostic system for patients with cirrhosis and hepatocellular carcinoma
Author(s) -
Francesco Izzo,
O. Cuomo,
Gaetano Capuano,
Giuseppe Ruggiero,
Roberto Mazzanti,
F. Farinati,
Silvana E. l. b. a. Participating Investigators Bruno Daniele,
Sandro Pignata,
Francesco Cremona,
Francesco Izzo,
Valerio Parisi,
Francesco Fiore,
Paolo Vallone,
Francesco Perrone,
Cuomo Oreste,
Massimo Di Palma,
Emilio Manno,
Giuseppe Militerno,
G Budillon,
L. Cimino,
Domenico Pomponi,
Luigi Elio Adinolfi,
Enrico Ragone,
Riccardo Utili,
Umberto Arena,
G. Fiore,
Paolo Geñtilini,
F. Farinati,
M. Rinaldi,
Silvana Elba,
Angelo Coviello,
O. G. Manghisi,
Crispino Bernardino,
Raffaele Laviscio,
G. Piai,
N. Caporaso,
Ilario de Sio,
Giulio Belli,
Antonio Iannelli,
M. L. Santangelo,
Giovanni Battista Gaeta,
Tiziana Ascione,
G. Giusti,
Valentina D’Angelo,
Giampiero Francica,
G. Marone,
Giuseppe Pasquale,
F Piccinino,
Maria Stanzione,
Angelo Raffaele Bianco,
Sabino De Placido,
Giovannella Palmieri,
D’Agostino Luciano,
D. Mattera,
Alessandro Puzziello,
Antonino Aiello,
O Ferraù,
M. Freni,
Vincenza Aloisio,
Antonio Giorgio,
A. Perrotta,
Maria Calandra,
Luigi Castellano,
C. Del Vecchio Blanco,
Fabio Castiglione,
G Mazzacca,
Antonio Rispo,
Raffaele Colurcio,
B Galanti,
M. G. Russo,
Bruno Palmentieri,
Marcello Persico,
Martina Felder,
L. Zancanella,
M Belli,
Giuseppe Colantuoni,
Guido De Sena,
Guardascione Francesco,
Gino Petrelli,
Lamorgese Bruno,
Luigi Manzione,
T. Pedicini,
Modesto D’Aprile,
Ciro G. a. l. l. o.,
Napoli,
Ospedale A. Cardarelli,
Gastroenterologia,
Irccs De Bellis,
Grotte Castellana,
Ospedale di Marcianise,
Dipartimento di Internistica Clinica F. Magrassi,
Dong Sun,
Chirurgia Generale e. dei Trapianti,
Fed,
I Istituto di Malattie Infettive,
Asst Grande Ospedale,
Malattie Tropicali e. Subtropicali Sun,
Oncologia Medica Fed,
Dipartimento Patologia Digestiva e. Chirurgia Generale Fed,
Ospedale Cotugno,
Sun Gastroenterologia,
I Gastroenterologia,
Aids Servizio,
Vii Medicina Generale ed Epatologia,
Ospedale Civile,
Bolzano,
Avellino,
Ospedale di Giugliano,
Ospedale S. Carlo,
Potenza,
Ospedale Fatebenefratelli,
Benevento,
Ospedale S. Maria Goretti,
Metodologia Epidemiologica Clinica,
Centro Elaborazione Dati Clinici del Mezzogiorno,
Cnr Pf Acro
Publication year - 2000
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1053/he.2000.5628
Subject(s) - hepatocellular carcinoma , cirrhosis , medicine , stage (stratigraphy) , prospective cohort study , gastroenterology , liver function , oncology , paleontology , biology
Prognosis of patients with cirrhosis and hepatocellular carcinoma (HCC) depends on both residual liver function and tumor extension. The CLIP score includes Child‐Pugh stage, tumor morphology and extension, serum alfa‐fetoprotein (AFP) levels, and portal vein thrombosis. We externally validated the CLIP score and compared its discriminatory ability and predictive power with that of the Okuda staging system in 196 patients with cirrhosis and HCC prospectively enrolled in a randomized trial. No significant associations were found between the CLIP score and the age, sex, and pattern of viral infection. 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 categories 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 the CLIP score explained 37% of survival variability, compared with 21% explained by Okuda stage. In conclusion, the CLIP score, compared with the Okuda staging system, gives more accurate prognostic information, is statistically more efficient, and has a greater survival predictive power. It could be useful in treatment planning by improving baseline prognostic evaluation of patients with HCC, and could be used in prospective therapeutic trials as a stratification variable, reducing the variability of results owing to patient selection.