The Chinese University Prognostic Index (CUPI) can be used to predict survival in a patient with hepatocellular carcinoma. This can help identify patients who may benefit from more aggressive or novel therapies. The authors are from Prince of Wales Hospital and Chinese University of Hong Kong.
Parameters:
(1) TNM stage
(2) status at presentation
(3) ascites
(4) serum AFP
(5) serum total bilirubin
(6) serum alkaline phosphatase (ALP)
|
Parameter |
Finding |
Points |
|
TNM stage |
I or II |
-3 |
|
|
IIIa or IIIb |
-1 |
|
|
IVa or IVb |
0 |
|
status at presentation |
asymptomatic |
-4 |
|
|
symptomatic |
0 |
|
ascites |
present |
3 |
|
|
absent |
0 |
|
AFP |
>= 500 ng/mL |
2 |
|
|
< 500 ng/mL |
0 |
|
serum total bilirubin |
< 34 µmol/L |
0 |
|
|
34 – 51 µmol/L |
3 |
|
|
>= 52 µmol/L |
4 |
|
alkaline phosphatase |
>= 200 IU/L |
3 |
|
|
< 200 IU/L |
0 |
from Table 3, page 1764
where:
• A total bilirubin < 34 µmol/L (1.99 mg/dL) is apparently the upper limit of the normal reference range. If this is taken as ULN, then >= 52 µmol/L would be 1.53 times the ULN.
CUPI =
= SUM(points for all 6 parameters)
Interpretation:
• minimum score: -7
• maximum score: 12
• The higher the score, the worse the prognosis.
|
CUPI |
Prognosis |
12 Month Survival |
Median Survival |
|
<= 1 |
low risk |
47.5% |
10.1 months |
|
2 – 7 |
intermediate risk |
17.5% |
3.7 months |
|
>= 8 |
high risk |
4.8% |
1.4 months |
Performance:
• The index is more discriminant in predicting survival as compared to TNM staging alone.
Limitations:
• The index is currently being validated prospectively at the Chinese University.
• Almost 80% of the patients had viral hepatitis B as the underlying cause. The index needs to be evaluated in patients with other etiologic factors.
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
ICD-10: ,
