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Karademir. Hepatoma Res 2018;4:58 I http://dx.doi.org/10.20517/2394-5079.2018.40 Page 11 of 18

Table 10. Advanced liver cancer prognostic system [48]
Parameters 0 1 2 3 4 5
Ascites No Yes
Abdominal pain No Yes
Weight loss No Yes
Child-Pugh A B C
ALP (IU/L) ≤ 200 > 200
Total bilirubin (mg/dL) ≤ 2 2-3 > 3
Urea (mmol/L) ≤ 8.9 > 8.9
Portal vein thrombosis No Yes
Tumor size ≤ 5 cm > 5 cm Diffuse
Lung metastasis No Yes
Alpha-fetoprotein (ng/mL) ≤ 400 > 400

ALPCS: advanced liver cancer prognostic system; ALP: alkaline phosphates; IU: international unit

Table 11. Survival for each prognostic group of corresponding ALPCS score
Prognosis Score 3 month survival
Good (0-8) 0-2 > 0.81
3-6 0.72-0.8
7-8 0.66-0.69
Intermediate (9-15) 9 0.63
10-12 0.51-0.59
13-14 0.42-0.47
15 0.38
Poor (16-39) 16 0.33
17-19 0.21-0.29
20-22 0.1-0.17
≥ 23 < 0.1

Table 12. Taipei Integrated System [63]
Scores
0 1 2 3
3
Total tumor volume (cm ) < 50 50-250 250-500 > 500
Child-Pugh A B C
Alpha-fetoprotein (ng/mL) ≤ 400 > 400

addition, considering 11 factors included into the system, calculation of the score is somewhat complicated
in daily clinical practice.

Taipei Integrated Score System score
[63]
The Taipei Integrated Score System (TIS) was proposed by Hsu et al. in 2010. This system is derived from
the study of a cohort of 2030 HCC patients undergoing different treatment modalities at a single institution in
Taiwan. The authors included the total tumor volume (TTV) as an indicator of tumor burden and combined
it with Child-Pugh grade (A, B and C: 0, 1 and 2 points, respectively) and AFP (<400 vs. > 400 ng/mL: 0 vs. 1
3
3
3
point) [Table 12]. Calculated TTV was categorized into four groups (< 50 cm , 50-250 cm , 250-500 cm and >
3
500 cm : 0, 1, 2 and 3 points, respectively). The score identified six distinct prognostic groups. TIS shows
superior prognostic value compared with the four current staging systems (CLIP, BCLC, JIS and Tokyo) for
the whole cohort, independently of the treatment modality (curative or palliative). However, in a subgroup
of 936 patients treated with curative intent, TIS failed to CLIP probably related to vascular invasion (a factor
in the CLIP but not in the TIS) that was observed in 36.7% of the patients. Although the TTV based staging
system is a useful and reliable system, it has some limitations. First, all tumors are not spherical. Therefore,
TTV value may not be accurate in cases involving tumors that are infiltrative or numberless. Second, TIS