Comparison Between the CLIP and Okuda Staging Systems for Prediction of Survival Time of Patients with Hepatocellular Carcinoma in Eastern Taiwan

Objective: Prediction of the survival time for patients with hepatocellular carcinoma (HCC) by a clinical staging system could influence treatment planning. The aim of this study was to evaluate the predictive power of the Cancer of the Liver Italian Program (CLIP) and the Okuda staging system in the prognosis of patients with HCC in eastern Taiwan. Materials and Methods: We performed a retrospective chart review of patients admitted from 1986 to 2000 with a diagnosis of HCC. Parameters for staging with the Okuda and CLIP systems were collected. The median survival time and 5-year survival curves were obtained using the Kaplan-Meier method. The discriminatory ability of the systems was also compared. Results: A total of 342 cases were included in the study. The median survival time of patients at Okuda stage I (24.3% of patients), II (56.1%) and III (19.6%) was 16.8, 5.0 and 1.9 months, respectively. The respective 5-year survival rates were 19.0%, 5% and 0%. The median survival times of patients with CLIP scores of 0 (10.2% of patients), 1 (16.1%), 2 (23.1%), 3 (24.9%), 4 (15.2%), 5 (7.9%) and 6 (2.6%) were 32.7, 10.3, 6.7, 4.7, 2.5, 1.9 and 0.8 months, respectively. The respective 5-year survival rates were 23%, 14%, 10%, 1.1%, 0%, 0% and 0%. The CLIP classification showed more prominent discriminatory ability than the Okuda classification, as confirmed by statistical methods. Conclusion: The CLIP system is more accurate in identifying patients at both extremes of better and worse prognoses than the Okuda classification, and can be used to stratify patients for prospective therapeutic trials for HCC in eastern Taiwan.