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AST-to-Platelet Ratio Index (APRI Score)Acute Liver Failure Study Group Index (ALFSG Index)Age, Bilirubin, INR and Creatinine Score (ABIC Score)Albumin-Bilirubin Grade (ALBI Score)BMI, AST/ALT Ratio, and Diabetes Score (BARD Score)CLIF-C ACLF Score for Acute-on-Chronic Liver Failure (CLIF-C ACLF)CLIF-C AD Score for Acute Decompensation of Cirrhosis (CLIF-C AD)CLIF-SOFA Score for Organ Failure Assessment (CLIF-SOFA)Cancer of the Liver Italian Program Score (CLIP Score)Child-Pugh Classification for Cirrhosis (Child-Pugh)Chinese University Prognostic Index (CUPI Score)Fibrosis-4 Index (FIB-4 Index)Lille Model for Alcoholic Hepatitis (Lille Model)Maddrey Discriminant Function (Maddrey DF)Model for End-Stage Liver Disease (MELD Score)NAFLD Fibrosis Score (NFS)Simplified Autoimmune Hepatitis Score (Simplified AIH)
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Cancer of the Liver Italian Program Score (CLIP Score)

Cancer of the Liver Italian Program Score (CLIP Score)

HCC Prognosis & Staging System

Integrated Clinical & Morphologic Staging

CLIP Staging Engine

Select tumor and hepatic parameters to determine the CLIP prognosis.

Guidelines & Evidence

Verified

Last Review: 2026-07-17

Clinical Significance

Integrating Liver and Tumor

In HCC, the prognosis is determined by two factors: the burden of the cancer and the underlying severity of the cirrhosis. CLIP was one of the first scores to successfully integrate both.

Survival in Advanced Disease

While systems like BCLC are used for treatment selection, the CLIP score is particularly granular for predicting survival in patients with advanced HCC who are not surgical candidates.

Objective Staging

Using objective markers like AFP levels and portal vein thrombosis (PVT) makes CLIP highly reproducible across different clinical centers.

How it Works

The 4 CLIP Components

Child-Pugh Stage: A=0, B=1, C=2.
Tumor Morphology: Number of nodules and liver occupancy.
AFP Level: Threshold of 400 ng/mL.
Portal Vein Thrombosis: Yes/No.

Total Score Interpretation

The score ranges from 0 to 6. Median survival decreases rapidly as the score increases.

Median Survival Data

Score 0: ~42 months. Score 3: ~7 months. Score 6: ~1 month.

Clinical Pearls

The "Massive" Tumor

A massive uninodular tumor (>50% liver occupancy) carries a poor prognosis (CLIP morphology = 2) despite being a "single" lesion.

PVT Confirmation

Portal vein thrombosis should be tumor-thrombus (enhancing on multiphase imaging) to be scored as positive in the CLIP system.

AFP Negative HCC

Approx. 30% of HCC patients have normal AFP. In these cases, tumor morphology and liver function (Child-Pugh) drive the CLIP score.

Next Steps

HCC Management Strategy

Evaluate for curative surgery if CLIP = 0.
Consider TACE or SIRT if CLIP ≤ 3.
Assess for systemic therapy (Sorafenib/Lenvatinib) if liver function allows.
Transition to palliative care if CLIP ≥ 4.

The Evidence

Original Development

A new prognostic system for hepatocellular carcinoma.

The Cancer of the Liver Italian Program Investigators. • Hepatology. 1998;Derived from 435 patients. Proved superior to OKUDA and TNM staging for survival prediction.

Global Validation

A prognostic staging system for HCC: the CLIP score.

Ueno S et al. • Hepatology. 2001;Validated in a large Japanese cohort, confirming its utility across different ethnic groups.

Origins & History

The Italian Multi-Center Effort

Developed by a consortium of Italian liver experts (the CLIP group) to improve on the older Okuda staging system. It reflects the European experience with HCV-related HCC.

Bridging the Gap

CLIP bridged the gap between pure oncology staging (TNM) and pure hepatology staging (Child-Pugh), leading to the more complex systems used today like BCLC.

Last Comprehensive Review: 2026-07-17

In Recent Clinical News

Scanning Medical Journals

No new significant updates or guidelines matching this topic were found today. We will check again soon.