Prognostic Accuracy of 12 Liver Staging Sys in Patients with Unresectable Hepatocellula Carcinoma Treated with Transarterial Chemoembolization Christos S. Georgiades, MD,PhD,Eleni Liapi, MD,Constantine Frangakis, PhD,Ju-un Park, BS, Hyung Woo Kim, BS,Kelvin Hong, MD,and Jean-Francois H. Geschwind, MD PURPOSE: The objective of the present study was to rank the most common liver staging systems according to prognostic accuracy in patients with unresectable hepatocellular carcinoma (HCC) treated with transar embolization (TACE). MATERIALS AND METHODS: Survival of 172 consecutive patients with unresectable HCC treated with correlated with the pretreatment Child-Pugh (categoric and nominal), Okuda,Cancer of the Liver Italian Program, Barcelona Clinic Liver Cancer, Modelfor End-stage Liver Disease, Chinese University Prognostic Index (CUPI), Japanese Integrated Staging, Tumor/Node/Metastasis, Group d’Etude de Traitement du Carcinoma Hep Liver Cancer Study Group of Japan, and Tokyo staging systems. The systems were ranked according to in predicting median survival (Kaplan-Meier survival curve and Cox regression analysis). The error reduction was normalized to the error in predicting survival in the absence of a staging system. RESULTS: Median survival was 80 weeks. The error in predicting survival of an unstaged population wa Child-Pugh nominal, CUPI, and Tokyo scores yielded the largest reduction in survival prediction error, 19.6%, respectively. Their actual error measurements in predicting survival were 40.4, 40.0, and 41.0 w CONCLUSIONS: Child-Pugh nominal, CUPI,and Tokyo scores provide the best prognostic accuracy among the systems studied. However, those of the Tokyo and CUPI methods are artificially enhanced because of their g number of staging levels. The Child-Pugh nominal liver staging system is the most accurate in predicti patients with unresectable HCC treated with TACE, and it is recommended that it be adopted as the sta staging in such patients. J Vasc Interv Radiol 2006; 17:1619 –1624 Abbreviations: BCLC ⫽ Barcelona Clinic Liver Cancer, CLIP ⫽ Cancer of the Liver Italian Program, CUPI ⫽ Chinese University Prognostic Index, HCC ⫽ hepatocellular carcinoma, MELD ⫽ Model for End-stage Liver Disease, TACE ⫽ transarterial chemoembolization RECENT studies (1–3) have shown a survival benefit in selected patients with unresectable hepatocellular carci- noma (HCC) treated with transarterial chemoembolization(TACE). How- ever, despite the widespread use of TACE, lack of standardization affects all aspectsof patienttreatment,in- cluding patient selection, disease stag- ing, embolization technique, follow- up, and repeat treatment. One of the nonstandardized issues facing inter- ventionalradiologists today in plan- ning TACE treatment for their patients is which liver staging system to use. Standardizing the staging system would optimize patientselection by eliminating unnecessary procedures, allow for more valid comparisons among studies, and provide more ac- curate survival prediction for patients and their families. Results of limited comparisons be- tween two or three liver staging sys- tems have been published; however, these comparisons do not answer the question which system provides the bestsurvivalpredictive accuracy (4 – 7). Grieco et al (4) have reported better prognostic accuracy with use of the Barcelona Clinic Liver Cancer (BCLC) system as opposed to the Okuda sys- From the Departments ofVascularand Interven- tional Radiology (C.S.G., E.L.,J.U.P.,H.W.K.,K.H.) and Biostatistics (C.F.), Johns Hopkins University; 600 North Wolfe Street,Blalock 545,Baltimore, Maryland 21287. Received April4, 2006;and ac- cepted July 3. Address correspondence to J.F.H.G.; E-mail:jfg@jhmi.edu J.F.H.G. is a consultant for MDS Nordion, Biosphere Medical, and Biocompatibles. None of the other au- thors have identified a conflict of interest. © SIR, 2006 DOI:10.1097/01.RVI.0000236608.91960.34 1619