American Journal of Gastroenterology ISSN 0002-9270 C  2008 by Am. Coll. of Gastroenterology doi: 10.1111/j.1572-0241.2007.01604.x Published by Blackwell Publishing ORIGINAL CONTRIBUTIONS Liver and Biliary Tract Comparison of Seven Staging Systems in Cirrhotic Patients With Hepatocellular Carcinoma in a Cohort of Patients Who Underwent Radiofrequency Ablation With Complete Response Alfredo Guglielmi, M.D., 1 Andrea Ruzzenente, M.D., 1 Silvia Pachera, M.D., 1 Alessandro Valdegamberi, M.D., 1 Marco Sandri, B.S., 2 Mirko D’Onofrio, M.D., 3 and Calogero Iacono, M.D. 1 1 Department of Surgery and Gastroenterology, University of Verona Medical School, Verona, Italy; 2 Department of Economic Sciences, University of Verona, Verona, Italy; and 3 Department of Radiology, University of Verona Medical School, Verona, Italy BACKGROUND Many staging systems for hepatocellular carcinoma (HCC) have been proposed but the best tool for AND AIMS: staging of HCC remains controversial. The aim of the present study was to identify the best staging system evaluating the predictive ability for outcome for each of the seven different staging systems applied in a homogeneous group of patients who underwent percutaneous radiofrequency ablation (RFA). METHODS: We analyzed retrospectively 112 patients with HCC and cirrhosis treated with percutaneous RFA from January, 1998 to April, 2005. Response to treatment after 30 days and for long-term follow-up was evaluated with computed tomography (CT) or magnetic resonance imaging (MRI) and serum alpha-fetoprotein level (AFP). All of the 112 patients were grouped according to each one of the seven different staging systems: Okuda, TNM, BCLC, CLIP, GRETCH, CUPI, JIS. RESULTS: The mean follow-up time of the 112 patients submitted to RFA was 24 months (range 3–92 months) with survival rates at 1, 3, and 5 yr of 82%, 40%, and 18%, respectively. Univariate and multivariate analyses showed that factors related to survival were Child-Pugh score (P ≤ 0.01), serum AFP (P ≤ 0.01), and the response to treatment (P ≤ 0.01) with hazard ratios of 2.09 (95% CI 1.21–3.61), 2.79 (95% CI 1.59–4.90), and 2.76 (95% CI 1.25–6.09), respectively. The comparison of the results of the different staging systems in all of the 112 patients and in a subgroup of 96 patients with complete response to treatment showed that BCLC had the best discrimination ability, monotonicity of gradient (linear trend χ 2 6.07, P = 0.01), and homogeneity ability (LR χ 2 test 10.00, P = 0.008). CONCLUSIONS: The BCLC staging system shows a superior discriminatory power in our cohort of HCC patients who underwent RFA; moreover, it can give important prognostic information after complete response to treatment. Our study confirms the validity of the BCLC staging system in patients with HCC in cirrhosis. (Am J Gastroenterol 2008;103:597–604) INTRODUCTION Hepatocellular carcinoma (HCC) is the fifth leading cause of cancer-related death worldwide, and its incidence is increas- ing in western countries (1). The association between HCC and cirrhosis influences prognosis and therapeutic planning among surgical and nonsurgical treatments (2). While liver transplantation offers the best results in selected patients, it can be applied in only a small number of patients due to shortage of organs; in contrast, liver resection offers excel- lent comparable results in highly selected patients with good liver function (3). Unfortunately, >80% of the patients are not candidates for transplantation or surgical resection; in these patients, local ablative therapy, in particular radiofrequency ablation (RFA), can achieve good results in local necrosis of the tumor and prolonged survival. For several decades, many groups have devised staging sys- tems for HCC that allow accurate therapeutic planning with good prognostic value (2, 4). Although many staging sys- tems have been proposed as the best tool for staging of HCC, 597