Chinese University Prognostic Index (CUPI)
The CUPI (Chinese University Prognostic Index) for HCC was established based on a group of 926 Chinese patients, mainly with HBV-related cirrhosis. CUPI integrates the traditional TNM system with additional liver function and tumor load factors (serum bilirubin, ascites, ALP, serum AFP, and asymptomatic presentation). Patients are categorized into low-risk, intermediate-risk, and high-risk groups based on the cumulative weights of these six prognostic factors. Median survival for low-risk, intermediate-risk, and high-risk groups was 10.1 months, 3.7 months, and 1.4 months, respectively. The CUPI system demonstrates improved survival estimation compared to CLIP score and Okuda stage, although its efficacy in early stages is questionable with around 50% 1-year survival. A subsequent validation study in 2011 included 595 HCC patients predominantly with HBV infection.
| Variable | Weight |
|---|---|
| TNM stage (I and II) | - 3 |
| TNM stage (IIIa and IIIb) | - 1 |
| TNM stage (IVa and IVb) | 0 |
| Asymptomatic disease on presentation | - 4 |
| Presence of ascites | 3 |
| AFP ≥ 500 ng/mL | 2 |
| Total bilirubin (< 34 μmol/L) | 0 |
| Total bilirubin ( 34 -51 μmol/L) | 3 |
| Total bilirubin ( >51 μmol/L) | 4 |
| ALP ≥ 200 (IU/L) | 3 |
CUPI Stages: score ≤1 (Low risk); 2-7 (Intermediate risk); ≥8 (High risk), AFP: Alpha-fetoprotein; ALP: Alkaline phosphatase
- Leung TW, Tang AM, Zee B, Lau WY, Lai PB, Leung KL, Lau JT, Yu SC, Johnson PJ. Construction of the Chinese University Prognostic Index for hepatocellular carcinoma and comparison with the TNM staging system, the Okuda staging system, and the Cancer of the Liver Italian Program staging system: a study based on 926 patients. Cancer 2002;94:1760-9.
- Chan SL, Mo FK, Johnson PJ, Liem GS, Chan TC, Poon MC, Ma BB, Leung TW, Lai PB, Chan AT, Mok TS, Yeo W. Prospective validation of the Chinese University Prognostic Index and comparison with other staging systems for hepatocellular carcinoma in an Asian population. J Gastroenterol Hepatol 2011;26:340-7.
- Karademir S. Staging of hepatocellular carcinoma. Hepatoma Res. 2018;4:58.
- Kinoshita, Akiyoshi et al. “Staging systems for hepatocellular carcinoma: Current status and future perspectives.” World journal of hepatology vol. 7,3 (2015): 406-24. doi:10.4254/wjh.v7.i3.406