Rival Scoring Systems: Do they Offer more?

Angelo Sangiovanni, Massimo Colombo

Research output: Chapter in Book/Report/Conference proceedingChapter


The aim of a staging system is to provide a prognosis framework and help the clinician in the selection of the most appropriate treatment choices. Under these circumstances, a single staging system that serves these purposes is not applicable worldwide. Most experts think that ideally an effective staging system should include information on tumour burden, liver disease severity, comorbidities and variables that predict the biological aggressiveness of the tumour, thus definitely guiding treatment choice. None of the currently available scoring systems including Okuda, GRoupe d'Etude et de Traitement du Carcinoma Hépatocellulaire (GRETCH), Cancer of the Liver Italian Program (CLIP), Chinese University Prognostic Index (CUPI), Japanese Integrated Staging (JIS), Tumour-Node-Metastasis (TNM) and Tokyo is superior to Barcelona Clinic Liver Cancer (BCLC) in the prognostication and stratification of patients with hepatocellular carcinoma (HCC), whereas, as consequence of differences in the epidemiology of HCC, most of them are not reproducible worldwide. While the comparison of these staging systems does not provide a definitive conclusion as to which is best, it confirms that those staging systems that do not allow guiding of treatment choice are unlikely to positively impact on the clinical practice of liver oncology.

Original languageEnglish
Title of host publicationClinical Dilemmas in Primary Liver Cancer
Number of pages10
ISBN (Print)9780470657973
Publication statusPublished - Nov 29 2011


  • Cirrhosis
  • Hepatocellular carcinoma
  • Liver function
  • Metastases
  • Staging
  • Tumour burden

ASJC Scopus subject areas

  • Medicine(all)


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