Background: Some patients with large hepatocellular carcinoma (HCC > 10 cm in diameter) have favorable surgical outcome, but the selection criteria are controversial. The relationship among various staging systems [(AJCC/UICC TNM classification, Liver Cancer Study Group of Japan TNM classification, the Cancer of the Liver Italian Program (CLIP) scoring system and the Japan Integrated Staging scoring system] and postsurgical prognosis of patients with large HCC is unknown. The aim of this study was to identify the staging system with the best prognostic value for such patients. Methods: The subjects of this retrospective study were 42 patients with large HCC. Various prognostic factors were assessed by multivariate analysis. The disease state was staged by the above four staging systems. The accuracy of prediction of 1-year, 3-year and 5-year mortality for each system was evaluated by the area under the receiver operating characteristic curve. Results: Serum α-fetoprotein and curability were identified by multivariate analysis as the only significant prognostic factors. The discriminatory ability of the CLIP scoring system was superior to other systems. Patients with CLIP scores <2 had better prognosis (score = 0, 100% of 1-year survival rate; score = 1, 75%) than those with scores >2 (score = 2, 3 and 4; 50%, 46% and 33%, respectively). Conclusions: The CLIP scoring system is the best for classifying patients with large HCC and prediction of their prognosis after surgery.
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