Abstract: Objective To compare the values of Barcelona clinic liver cancer (BCLC), China liver cancer staging (CNLC), TNM staging system, Japanese integrated staging score (JIS), cancer of the liver Italian program (CLIP) and Okuda kunio staging system (Okuda) in the postoperative prognosis prediction of patients with serum alpha-fetoprotein (AFP)-negative hepatocellular carcinoma (HCC). Methods The clinicopathological data of AFP-negative HCC patients were retrospectively analyzed, who underwent hepatectomy at the Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, from January 2012 to December 2017 and met the inclusion criteria.The patients were staged according to the BCLC, CNLC, TNM, JIS, CLIP, and Okuda staging systems and followed up.The discrimination, stratification ability, and predictive value of the six staging systems were compared based on time-dependent receiver operating characteristic(ROC) curves, log-rank test, and likelihood ratio test. Results The area under ROC curves(AUC) of CNLC to predict the overall survival of HCC patients after surgery was 0.682, corresponding to a sensitivity of 0.655 and a specificity of 0.691 using stage Ⅱb as the cut point; the AUCs of CNLC staging to predict the survival at 1-, 3-, and 5-year were 0.670 (95%CI: 0.603-0.738), 0.575 (95%CI: 0.441-0.708), and 0.689 (95%CI: 0.407-0.971), respectively, which was better than those of other staging systems (all P<0.05).The log-rank test showed that all the six staging systems had a good risk stratification ability. The likelihood ratio test showed that CNLC had the highest value in predicting the overall survival (χ2=39.575, P=0.011). Conclusions Among the six staging systems, CNLC staging is the best staging system in predicting the prognosis of AFP-negative HCC patients after surgery.

Key words: Hepatocellular carcinoma, Barcelona clinic liver cancer (BCLC), China liver cancer staging (CNLC), TNM staging system, Japanese integrated staging score (JIS), Cancer of the liver Italian program (CLIP), Okuda kunio staging system (Okuda)