Both authors contributed equally to this study.
Survival of patients with hepatocellular carcinoma in cirrhosis: a comparison of BCLC, CLIP and GRETCH staging systems
Article first published online: 27 MAR 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Publishing Ltd
Alimentary Pharmacology & Therapeutics
Volume 28, Issue 1, pages 62–75, July 2008
How to Cite
CAMMÀ, C., MARCO, V. D., CABIBBO, G., LATTERI, F., SANDONATO, L., PARISI, P., ENEA, M., ATTANASIO, M., GALIA, M., ALESSI, N., LICATA, A., LATTERI, M. A. and CRAXÌ, A. (2008), Survival of patients with hepatocellular carcinoma in cirrhosis: a comparison of BCLC, CLIP and GRETCH staging systems. Alimentary Pharmacology & Therapeutics, 28: 62–75. doi: 10.1111/j.1365-2036.2008.03692.x
- Issue published online: 2 JUN 2008
- Article first published online: 27 MAR 2008
- Publication data Submitted 14 February 2008 First decision 9 March 2008 Resubmitted 17 March 2008 Accepted 23 March 2008 Epub OnlineAccepted 27 March 2008
Background A major problem in assessing the likelihood of survival of patients with hepatocellular carcinoma (HCC) arises from a lack of models capable of predicting outcome accurately.
Aim To compare the ability of the Italian score (CLIP), the French classification (GRETCH) and the Barcelona (BCLC) staging system in predicting survival in patients with HCC.
Methods We included 406 consecutive patients with cirrhosis and HCC. Seventy-eight per cent of patients had hepatitis C. Independent predictors of survival were identified using the Cox model.
Results One-hundred and seventy-eight patients were treated, while 228 were untreated. The observed mortality was 60.1% in treated patients and 84.9% in untreated patients. Among treated patients, albumin, bilirubin and performance status were the only independent variables significantly associated with survival. Mortality was independently predicted by bilirubin, alpha-fetoprotein and portal vein thrombosis in untreated patients. CLIP achieved the best discriminative capacity in the entire HCC cohort and in the advanced untreatable cases, while BCLC was the ablest in predicting survival in treated patients.
Conclusions Overall predictive ability of BCLC, CLIP and GRETCH staging systems was not satisfactory, and was not uniform for treated patients and untreated patients. None of the scoring systems provided confident prediction of survival in individual patients.