Page 98 - Read Online

Page 8 of 18 Karademir. Hepatoma Res 2018;4:58 I http://dx.doi.org/10.20517/2394-5079.2018.40

Table 6. Japanese Staging System (LCSGJ-TNM) [55] and Japan Integrated Staging (JIS) score [10]
LCSGJ-TNM
T criteria
Single tumor
Size < 2 cm
No vascular involvement
T1 All 3 features
T2 2 of 3 features
T3 1 of 3 features
T4 None of 3 features
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T3 N0 M0
Stage IVA T4 N0 M0 or any T N1 M0
Stage IVB Any T N0-1 M1
Japan Integrated Staging (JIS)
Stage I 0
Stage II 1
Stage III 2
Stage IV 3
Child-Pugh A 0
Child-Pugh B 1
Child-Pugh C 2
LCSGJ: Liver Cancer Study Group of Japan; TNM: tumor-node-metastasis, TNM: tumor-node-metastasis

developed based solely on Japanese HCC patients, prospective validation studies are required in Western
population. The other limitations inherent in the LCSGJ staging system such as inaccurate weighting of size
and vascular involvement as well as the lack of incorporation of microscopic pathology information remain.

This score was further improved a few years later with the modified-JIS in which the encephalopathy item
is replaced by the indocyanine green clearance (ICG-R15), due to an early HCC screening in Japan and a
[57]
preferred surgical orientation . The substitution of ICG-R15 for encephalopathy in Child-Pugh grade might
have reflected individual differences more accurately among patients who underwent hepatic resection,
[57]
because none of the patients in the present study had any encephalopathy before operation .
JIS has been recently refined as biomarker combined JIS (bm-JIS) by including AFP, AFP-Lens culinaris
agglutinin-reactive (AFP-L3) and des-gamma-carboxy prothrombin (DCP) which allowed better survival
[58]
predictions . However, two of those markers are not frequently used in Western countries where HCC is
also often being diagnosed at more advanced stages. Thus, this score has not been evaluated on patients from
Western countries.

CUPI score
The CUPI for HCC was identified on the basis of a cohort of 926 Chinese patients, most of them with
[9]
hepatitis B virus (HBV) related cirrhosis . CUPI combines the conventional TNM system and a
number of other factors of liver function and tumor load (serum bilirubin, ascites, ALP, serum AFP and
asymptomatic disease on presentation) [Table 7]. Patients are subsequently divided into three groups (low-
risk, intermediate-risk and high-risk) according to the sum of the weights of the six prognostic factors. The
median survival for the low-risk, intermediate-risk, and high-risk groups were 10.1 months, 3.7 months and
1.4 months, respectively. The authors estimate that this classification has better estimation of survival than
CLIP score and Okuda stage, although its discriminatory power in early stages is questionable, as the best
1-year survival was around 50%. In 2011, the group validated the CUPI system in another cohort of 595 HCC
[59]
patients with predominant HBV infection .