The Cancer of the Liver Italian Program (CLIP) score: validation of a new prognostic system for hepatocellular carcinoma

To determine the prognostic validity of a new staging system for hepatocellular carcinoma (HCC) proposed by the Cancer of the Liver Italian Program (CLIP) in the context of existing staging systems of known significance. Retrospective analysis from an established prospective database of patients with HCC treated at a single, University-affiliated, community-based, tertiary center All consecutively referred patients between 1991 and 2002 were eligible. Duration of follow up was 4 months to 11 years. CLIP score, Okuda, and American Joint Commission on Cancer Stage were determined for each case. Overall survival was the main endpoint measure. Of 208 eligible patients, 8 were excluded due to lack of complete data necessary to determine CLIP Okuda, and AJCC stage parameters. All three prognostication systems individually were predictive of overall survival. Logistic regression analysis demonstrated that AJCC staging was the best prognostic discriminator; however, when CLIP scores 3 through 6 were combined due to small sample size, the CLIP score was found to be the best index of prognosis. The CLIP score may provide a more precise, quantitative method for improved prognostication of patients with HCC.