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Multiple staging systems have been proposed for hepatocellular carcinoma (HCC). However there is no consensus regarding which system provides the best prognostic accuracy. We aimed to investigate the performance of 11 currently used HCC staging systems.

Between 2002 and 2013, a large prospective dataset of 3182 HCC patients were enrolled. The baseline characteristics and staging information were collected. Independent predictors of survival were identified. Homogeneity and corrected Akaike information criterion (AICc) were compared between each system.

The median follow-up duration was 17 months. Independent predictors of adverse outcome were serum albumin <3.5 g/dl, bilirubin ⩾1 mg/dl, creatinine ⩾1 mg/dl, alpha-fetoprotein ⩾20 ng/ml, alkaline phosphatase ⩾200 IU/L, presence of ascites, multiple tumor nodules, maximal tumor size >5 cm, presence of …