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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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Chinese University Prognostic Index (CUPI Score)

Chinese University Prognostic Index (CUPI Score)

HBV-related HCC Prognostic System

Optimized for HBV-related Hepatocellular Carcinoma

CUPI Index

-3
Low Risk

Clinical Prognosis

Low-risk group. Potential candidates for radical therapies such as resection or RFA. Requires MDT review.

Guidelines & Evidence

Verified

Last Review: 2026-07-17

Clinical Significance

HBV-Related HCC Staging

In Asia, the majority of HCC is driven by chronic Hepatitis B. These patients have a different clinical profile than Western cohorts. CUPI provides better prognostic discrimination for this demographic.

Granular Risk Groups

By using a weighted point system for seven clinical and laboratory variables, CUPI allows for a very precise survival estimate, helping guide treatment intensity.

The Power of Screening

The CUPI score heavily weights "Asymptomatic Presentation," highlighting the survival benefit of finding HCC via regular ultrasound and AFP screening.

How it Works

The 7 CUPI Variables

TNM Stage: I–IV.
Asymptomatic Presentation: Yes/No.
Ascites: Clinical presence.
AFP: Threshold of 500 ng/mL.
Bilirubin: Serum levels.
Albumin: Synthetic function.
ALP: Alkaline Phosphatase level.

Scoring Logic

Scores range from -7 to 12. Negative scores signify a significantly better prognosis.

Risk Tiers

Low Risk: Score ≤ 1. Intermediate Risk: 2–7. High Risk: ≥ 8.

Clinical Pearls

The ALP Factor

A high Alkaline Phosphatase (ALP) in HCC often signifies microvascular invasion or an infiltrative growth pattern, which is why it carries a +3 weighting in CUPI.

The "Asymptomatic" Bonus

Being asymptomatic subtracts 4 points from the score. This reflects the "lead-time bias" and the generally smaller tumor burden found in screening patients.

HBV Management

Regardless of the CUPI score, all HBV-positive patients with HCC should be on potent antiviral therapy (Tenofovir/Entecavir) to stabilize liver function.

Next Steps

Treatment by CUPI Risk

Low Risk (≤ 1): Evaluate for curative resection or RFA.
Intermediate Risk (2-7): Consider TACE or systemic therapy.
High Risk (≥ 8): Early Palliative Care referral and symptom management.

The Evidence

Development in Hong Kong

Construction of a prognostic index for hepatocellular carcinoma: the CUPI score.

Leung TW et al. • Cancer. 2002;Study of 926 patients. Demonstrated superior accuracy for HBV-HCC compared to OKUDA and TNM systems.

Chemotherapy Prediction

Development of a prediction model for survival in HCC patients receiving systemic chemotherapy.

Yau T et al. • Br J Cancer. 2008;Confirmed the score's utility in predicting the benefit of systemic treatments in Asian populations.

Origins & History

The Chinese University of Hong Kong

Developed at CUHK, a world leader in HBV and liver cancer research. It was designed to fill the gap left by Western staging systems that didn't account for Asian pathology.

The Enduring Value of AFP

CUPI reinforced the value of Alpha-fetoprotein (AFP) as a primary prognostic marker, a concept that was contested in the West for many years but has since been globally accepted.

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.