Hepatology. 1998 Sep;28(3):751-5. doi: 10.1002/hep.510280322.
The clinical outcome of cirrhotic patients with hepatocellular carcinoma (HCC) depends both on the residual liver function and tumor characteristics. However, the relative prognostic weight of these variables is not well defined. The aims of this study were to verify the value of known prognostic factors and to devise a prognostic index more sensitive than the commonly used Okuda stage. A retrospective analysis of the cases of HCC diagnosed at 16 Italian institutions from 1990 to 1992 was performed. Overall survival was the only end point used in the analysis. The Cox model, stratified by locoregional treatment, was used for multivariate analyses. The final model was derived from 10 randomly chosen training samples, and the prognostic validity of the Cancer of the Liver Italian Program (CLIP) score was assessed on the corresponding testing samples. Four hundred thirty-five cases of HCC were collected. As of January 1997, 313 patients (72%) were deceased. Overall median survival was 20 months. At multivariate analysis, independent predictive factors of survival were Child-Pugh stage, tumor morphology, alpha-fetoprotein (AFP), and portal vein thrombosis. A simple scoring system (CLIP score) was thus produced, assigning linear scores (0/1/2) to the covariates. Compared with Okuda stage, the CLIP score, structured as a six-category tool, has a greater discriminant ability, revealing a class of patients with an impressively more favorable prognosis and another class with a relatively shorter life expectancy. The CLIP score is a new prognostic system that accounts for both liver function and tumor characteristics. It is easy to calculate and appears to give more precise information than the Okuda stage.
肝硬化合并肝细胞癌（HCC）患者的临床结局取决于残余肝功能和肿瘤特征。然而，这些变量的相对预后权重尚未明确界定。本研究的目的是验证已知预后因素的价值，并设计一种比常用的奥田分期更敏感的预后指数。对1990年至1992年在意大利16家机构诊断的HCC病例进行了回顾性分析。总生存是分析中使用的唯一终点。采用按局部区域治疗分层的Cox模型进行多变量分析。最终模型来自10个随机选择的训练样本，并在相应的测试样本上评估了意大利肝癌计划（CLIP）评分的预后有效性。收集了435例HCC病例。截至1997年1月，313例患者（72%）死亡。总中位生存期为20个月。多变量分析显示，生存的独立预测因素为Child-Pugh分期、肿瘤形态、甲胎蛋白（AFP）和门静脉血栓形成。由此产生了一个简单的评分系统（CLIP评分），为协变量赋予线性评分（0/1/2）。与奥田分期相比，CLIP评分作为一种六分类工具，具有更强的判别能力，揭示出一类预后明显更好的患者和另一类预期寿命相对较短的患者。CLIP评分是一种新的预后系统，兼顾了肝功能和肿瘤特征。它易于计算，且似乎比奥田分期能提供更精确的信息。
