title: Evaluation of predictive value of CLIP, Okuda, TNM and JIS staging systems for hepatocellular carcinoma patients undergoing surgery.
abstract: BACKGROUND
  An accurate staging system is required to assess hepatocellular carcinoma (HCC) patients in order to benefit from hepatic resection before surgery. Cancer of the Liver Italian Program (CLIP) score was considered to be better than the Okuda staging system to predict survival. Japan Integrated Staging Score (JIS score) includes tumor, nodes, metastases (TNM) stage and Child-Pugh grade as a new staging system for HCC. The purpose of the present paper was to compare the CLIP, Okuda, TNM and JIS staging systems for HCC patients undergoing surgery.
  
  
  METHODS
  From 1991 to 1995, 599 patients undergoing hepatic resection for HCC from four medical centers in Taiwan were evaluated. All patients were classified by Okuda, CLIP, TNM and JIS systems. Factors associated survivals were analyzed.
  
  
  RESULTS
  There was no statistical difference in survival between CLIP 0 and 1 patients, or among CLIP 2-4 patients. The prognostic validation of the Okuda and CLIP scoring systems in discriminating survival in HCC patients undergoing surgery was not satisfied. The TNM system was successful in predicting survival for HCC patients undergoing surgery. The JIS score could also differentiate survivals for those patients except for JIS 3. By multivariate analysis, age > or =60 years old, serum albumin <3.5 g/dL, tumor size >5 cm and TNM stage were associated with survival.
  
  
  CONCLUSIONS
  Both the Okuda and CLIP systems are not superior to TNM staging for HCC patients who undergo surgical resection. Whether JIS score is feasible for those patients with advanced HCC needs further evaluation.
authors.affiliation: Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Chen
authors.forename: Ting-Tsung
authors.initials: TT
authors.lastname: Chang
authors.forename: Shinn-Cherng
authors.initials: SC
authors.lastname: Chen
authors.forename: Shen-Yung
authors.initials: SY
authors.lastname: Wang
authors.forename: Hsuan-Shu
authors.initials: HS
authors.lastname: Lee
authors.forename: Pin-Wen
authors.initials: PW
authors.lastname: Lin
authors.forename: Guan-Tarn
authors.initials: GT
authors.lastname: Huang
authors.forename: Jin-Chuan
authors.initials: JC
authors.lastname: Sheu
authors.forename: Hong-Ming
authors.initials: HM
authors.lastname: Tsai
authors.forename: Pui-Ching
authors.initials: PC
authors.lastname: Lee
authors.forename: Gar-Yang
authors.initials: GY
authors.lastname: Chau
authors.forename: Wing-Yiu
authors.initials: WY
authors.lastname: Lui
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
authors.forename: Jaw-Ching
authors.initials: JC
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D015996:Survival Rate