title: Prognosis of unresectable hepatocellular carcinoma: comparison of seven staging systems (TNM, Okuda, BCLC, CLIP, CUPI, JIS, CIS) in a Chinese cohort.
abstract: BACKGROUND
  Many liver staging systems that include the tumor stage and the extent of liver function have been developed. However, prognosis assessment for hepatocellular carcinoma (HCC) remains controversial. In this study, the performances of 7 staging systems were compared in a cohort of patients with HCC who underwent non-surgical treatment.
  
  
  METHODS
  A total of 196 consecutive patients with HCC who underwent non-surgical treatment seen between January 1, 2004, and December 31, 2007, were included. Performances of TNM sixth edition, Okuda, Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), Chinese University Prognostic Index (CUPI), Japan Integrated Staging (JIS), and China integrated score (CIS) have been compared and ranked using concordance index (c-index). Predictors of survival were identified using univariate and multivariate Cox model analyses.
  
  
  RESULTS
  The median survival time for the cohort was 7.6 months (95% CI 5.6-9.7). The independent predictors of survival were performance status (P<.001), serum sodium (P<.001), alkaline phosphatase (P<.001), tumor diameter greater than 5 cm (P = .001), portal vein invasion (P<.001), lymph node metastasis (P = .025), and distant metastasis (P = .004). CUPI staging system had the best independent predictive power for survival when compared with the other six prognostic systems. Performance status and serum sodium improved the discriminatory ability of CUPI.
  
  
  CONCLUSIONS
  In our selected patient population whose main etiology is hepatitis B, CUPI was the most suitable staging system in predicting survival in patients with unresectable HCC. BCLC was the second top-ranking staging system. CLIP, JIS, CIS, and TNM sixth edition were not helpful in predicting survival outcome, and their use is not supported by our data.
authors.affiliation: Department of Traditional Chinese Medicine, Shanghai Hospital of Chinese Integrative Medicine, Shanghai, China.
authors.forename: Jin-feng
authors.initials: JF
authors.lastname: Zhang
authors.affiliation: Department of Surgery, Shanghai Hospital of Chinese Integrative Medicine, Shanghai, China.
authors.forename: Zhi-jun
authors.initials: ZJ
authors.lastname: Shu
authors.affiliation: Department of Cardiology, Shanghai Hospital of Chinese Integrative Medicine, Shanghai, China.
authors.forename: Chun-yi
authors.initials: CY
authors.lastname: Xie
authors.affiliation: Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Massage, Yueyang Hospital of Integrated Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Xi-hong
authors.initials: XH
authors.lastname: Jin
authors.affiliation: Department of Traditional Chinese Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Gu
authors.affiliation: Department of Traditional Chinese Medicine, Shanghai Hospital of Chinese Integrative Medicine, Shanghai, China.
authors.forename: Fang-jian
authors.initials: FJ
authors.lastname: Jiang
authors.affiliation: Department of Traditional Chinese Medicine, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Chang-quan
authors.initials: CQ
authors.lastname: Ling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000473:pathology*; D002681:China; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D008113:Liver Neoplasms / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D055815:Young Adult