Tso-Tsai Liu a, Chi-Shun Yi a, b, Andy Shau-Bin Chou b, c, Ming-Che Lee d, Ming-Cheh Chen a, b, Li-Yu Wang e, Hans Hsienhong Lin b, f, Chi-Tan Hu a, b
aDivision of Gastroenterology, Department of Internal Medicine, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
bResearch Center of Hepatology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
cDepartment of Medical Radiology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
dDepartment of General Surgery, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
eGraduate Institute of Aboriginal Health, Buddhist Tzu Chi University, Hualien, Taiwan
fDivision of Gastroenterology, Buddhist Tzu Chi General Hospital Taipei Branch, Taipei, Taiwan
Abstract
Objective
Prediction of the survival time for patients with hepatocellular carcinoma (HCC) by a clinical staging system could influence treatment planning. The aim of this study was to evaluate the predictive power of the Cancer of the Liver Italian Program (CLIP) and the Okuda staging system in the prognosis of patients with HCC in eastern Taiwan.
Materials and Methods
We performed a retrospective chart review of patients admitted from 1986 to 2000 with a diagnosis of HCC. Parameters for staging with the Okuda and CLIP systems were collected. The median survival time and 5-year survival curves were obtained using the Kaplan-Meier method. The discriminatory ability of the systems was also compared.
Results
A total of 342 cases were included in the study. The median survival time of patients at Okuda stage I (24.3% of patients), II (56.1%) and III (19.6%) was 16.8, 5.0 and 1.9 months, respectively. The respective 5-year survival rates were 19.0%, 5% and 0%. The median survival times of patients with CLIP scores of 0 (10.2% of patients), 1 (16.1%), 2 (23.1%), 3 (24.9%), 4 (15.2%), 5 (7.9%) and 6 (2.6%) were 32.7, 10.3, 6.7, 4.7, 2.5, 1.9 and 0.8 months, respectively. The respective 5-year survival rates were 23%, 14%, 10%, 1.1%, 0%, 0% and 0%. The CLIP classification showed more prominent discriminatory ability than the Okuda classification, as confirmed by statistical methods.
Conclusion
The CLIP system is more accurate in identifying patients at both extremes of better and worse prognoses than the Okuda classification, and can be used to stratify patients for prospective therapeutic trials for HCC in eastern Taiwan.
Keywords
CLIP staging system; Eastern Taiwan; Hepatocellular carcinoma; Okuda staging system; Staging
