title: Modified CLIP with objective liver reserve assessment retains prognosis prediction for patients with advanced hepatocellular carcinoma.
abstract: OBJECTIVE
  The Cancer of the Liver Italian Program (CLIP) score is a commonly used staging system for hepatocellular carcinoma (HCC) helpful with predicting prognosis of advanced HCC. CLIP uses the Child-Turcotte-Pugh (CTP) score to evaluate liver reserve. A new scoring system, the albumin-bilirubin (ALBI) grade, has been proposed as they objectively evaluate liver reserve. We examined whether the modification of CLIP with ALBI retained its prognosis prediction for patients with advanced HCC.
  
  
  METHODS
  We included patients who received first-line antiangiogenic therapy for advanced HCC. Liver reserve was assessed using CTP and ALBI scores, which were then incorporated into CLIP and ALBI-CLIP, respectively. To assess their efficacies of prognostic prediction, the Cox's proportional hazard model and concordance indexes were used.
  
  
  RESULTS
  A total of 142 patients were included; 137 of them were classified CTP A and 5 patients CTP B. Patients could be divided into four or five groups with different prognosis according to CLIP and ALBI-CLIP, respectively. Higher R(2) (0.249 vs 0.216) and lower Akaike information criterion (995.0 vs 1001.1) were observed for ALBI-CLIP than for CLIP in the Cox's model predicting overall survival. ALBI-CLIP remained an independent predictor for overall survival when CLIP and ALBI-CLIP were simultaneously incorporated in Cox's models allowing variable selection with adjustment for hepatitis etiology, treatment, and performance status. The concordance index was also higher for ALBI-CLIP than for CLIP (0.724 vs 0.703).
  
  
  CONCLUSIONS
  Modification of CLIP scoring with ALBI, which objectively assesses liver reserve, retains and might have improved prognosis prediction for advanced HCC.
authors: Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan.|National Taiwan University Cancer Center, College of Medicine, National Taiwan University, Taipei City, Taiwan.|Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan.
authors: Yu-Yun
authors: YY
authors: Shao
authors: Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan.
authors: Tsung-Hao
authors: TH
authors: Liu
authors: Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan.
authors: Ying-Hui
authors: YH
authors: Lee
authors: Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan.|Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan.
authors: Chih-Hung
authors: CH
authors: Hsu
authors: Graduate Institute of Oncology, College of Medicine, National Taiwan University, Taipei City, Taiwan.|National Taiwan University Cancer Center, College of Medicine, National Taiwan University, Taipei City, Taiwan.|Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan.|Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei City, Taiwan.
authors: Ann-Lii
authors: AL
authors: Cheng
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001663:Bilirubin / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000503:physiopathology*; D005260:Female; D005544:Forecasting; D006801:Humans; D008099:Liver / Q000502:physiology*; D008111:Liver Function Tests / Q000379:methods*; D008113:Liver Neoplasms / Q000473:pathology* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D059351:Organ Sparing Treatments; D011379:Prognosis; D012709:Serum Albumin; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D012709:Serum Albumin; D001663:Bilirubin
keywords: ALBI; CLIP; Child-Turcotte-Pugh; hepatocellular carcinoma; prognosis