Prospective validation of the CLIP score: a new prognostic system for patient with cirrhosis and hepatocellular carcinoma

Prognosis of patients with cirrhosis and hepatocellular carcinoma (HCC) depends on both residual liver function and tumor extension. The CLIP score includes Child-Pugh stage, tumor morphology and extension, serum alfa-fetoprotein (AFP) levels, and portal vein thrombosis. We externally validated the CLIP score and compared its discriminatory ability and predictive power with that of the Okuda staging system in 196 patients with cirrhosis and HCC prospectively enrolled in a randomized trial. No significant associations were found between the CLIP score and the age, sex, and pattern of viral infection. There was a strong correlation between the CLIP score and the Okuda stage, As of June 1999, 150 patients (76.5%) had died. Median survival time was 11 months, overall, and it was 36, 22, 9, 7, and 3 months for CLIP categories 0, 1, 2, 3, and 4 to 6, respectively. In multivariate analysis, the CLIP score had additional explanatory power above that of the Okuda stage. This was true for both patients treated with locoregional therapy or not. A quantitative estimation of 2-year survival predictive power showed that the CLIP score explained 37% of survival variability, compared with 21% explained by Okuda stage. In conclusion, the CLIP score, compared with the Okuda staging system, gives more accurate prognostic information, is statistically more efficient, and has a greater survival predictive power. It could be useful in treatment planning by improving baseline prognostic evaluation of patients with RCC, and could be used in prospective therapeutic trials as a stratification variable, reducing the variability of results owing to patient selection

The Janus-Faced New European Neighbourhood Policy: Normative (Hard) Power vs. the Pragmatic (Soft) Approach

The implementation of the European Neighbourhood Policy has drawn strong criticism. Commentators have highlighted its inefficiency and the weak institutional and legal frameworks that have so far characterized this domain. An especially vexed issue is the legal nature of the ENP instruments so far developed by EU actors. This article explores the impact the Lisbon Treaty has had on the definition of ENP tools. I observe that, although some clear features of the new primary-law framework suggest the need for "formalized" ENP tools, the ENP, and in particular its southern dimension, continues to be implemented for the most part by means of soft-law instruments. Despite an undeniable evolution of nonbinding ENP tools, a similar trend could jeopardize the development of the ENP as a whole. I argue that a broader recourse to multilateral or bilateral agreements could make the ENP more effective while strengthening its democratic accountability: a new ENP model based on treaty cooperation would exclude neither flexibility nor a complementary or parallel recourse to soft-law instruments, and would at the same time make the actors involved more accountable, all the while enabling stronger cooperation, at the EU level, between the EU's institutions and its Member States