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

Abstract

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.

Management of Hepatocellular Carcinoma in Japan: Consensus-Based Clinical Practice Guidelines Proposed by the Japan Society of Hepatology (JSH) 2010 Updated Version

“…Various staging systems such as: (1) Okuda stage [56], (2) BCLC stage [1], (3) CLIP score, (4) JIS score [58,59 ](table 14), and (5) Tokyo Score [61], have all seen long-time use. The JIS score utilizing both the LCSGJ TNM and Child-Pugh stages is considered the most useful for overall staging of HCC in Japan [59,60].…”

Management of Hepatocellular Carcinoma in Japan: Consensus-Based Clinical Practice Manual Proposed by the Japan Society of Hepatology

“…Various staging systems such as: (1) Okuda stage [27], (2) BCLC stage [28, 29], (3) CLIP score [30], (4) JIS score [31, 32] (table 8), and (5) Tokyo Score [33], have all been in long-time use. The JIS score utilizing both the LCSGJ TNM and Child-Pugh stages is considered the most useful for overall staging of HCC in Japan [31, 32].…”

I-CLIP: Improved Stratification of Advanced Hepatocellular Carcinoma Patients by Integrating Plasma IGF-1 into CLIP Score

“…Notably, many studies validated the use of CLIP in HCC patients [6,7,8,9,10,11,12,13,14,15]. Furthermore, recent studies, including one of our patient population [5], evaluated the predictive accuracy of different HCC staging systems and showed that the CLIP score was more predictive than BCLC in the studied patient populations, which included a significant number of patients with advanced HCC [5,16,17].…”