Comparison of current staging systems for advanced hepatocellular carcinoma not amendable to locoregional therapy as inclusion criteria for clinical trials

Aims The prognosis of patients with advanced hepatocellular carcinoma (HCC) is poor and testing drug efficacy in clinical trials is hazardous. This study was aimed to evaluate different prognostic scoring systems for HCC in estimating prognosis (3-month survival and overall survival (OS)). Methods From November 2008 to April 2010, 208 patients with advanced HCC who were not amendable to locoregional therapy were included in this study. Data were collected to classify patients according to the following: the Japanese integrated staging scoring system, TNM stage by the Liver Cancer Study Group of Japan criteria, TNM 6th edn, the cancer of the liver Italian program scoring system (CLIP), the advanced liver cancer prognostic system (ALCPS), the model of end-stage liver disease, the Groupe d'etude et de Traitement du Carcinome Hepatocellulaire (GETCH) scoring system, the Chinese University prognostic index staging system (CUPI), the Okuda scoring system, the ChildPugh score, the Tokyo scoring system and the Barcelona Clinic liver cancer staging. Survival analysis and relative operating characteristic (ROC) were utilized to access the prognostic value of each scoring system. Results ALCPS performed best, with the largest area under the ROC curve in predicting 3-month OS (sensitivity 76.32%, specificity 78.72%). CLIP and CUPI were similar to ALCPS in prognostic discrimination but with relatively lower power. Conclusions ALCPS, CLIP and CUPI are the preferred scoring systems in the prediction of OS and 3-month survival among the 12 systems analyzed, and should be used as inclusion criteria in clinical trials for advanced HCC patients.