IHPBA concordant classification of primary liver cancer: working group report

Abstract

The working group of the International Scientific Committee of the International Hepato‐Pancreato‐Biliary Association (IHPBA) examined conventional staging systems and decided to establish a new staging system that depended on macroscopic findings after liver resection. The TNM/International Union Against Cancer (UICC) classification has been widely used but is too complicated. Vauthey and colleagues, and the Liver Cancer Study Group of Japan (LCSGJ) have proposed new simplified classifications. These are compared and discussed. The IHPBA working group proposed a new classification, as follows. T factor: Solitary No more than 2 cm No vascular invasion to portal vein, hepatic vein, and bile duct T1 meets all of the above three requirements. T2 meets two of the three requirements. T3 meets one of the three requirements. T4 does not meet any requirements. Stage: IT1N0M0IIT2N0M0IIIT3N0M0IV AT4N0M0Any TN1M0IV BAny T/N, M1 The survival curves of each stage were separated clearly (P < 0.0001). The staging system is easy to remember and easy to use. We hope this staging system will be generally used in future.

An artificial neural networking model for the prediction of post‐hepatectomy survival of patients with early hepatocellular carcinoma

“…The currently used staging systems had been adopted for prognostic evaluation of early HCC. [9][10][11][12] However, in our study these staging systems had suboptimal predictive values. There were two possible explanations: (i) very few variables included in these staging systems with an attempt to balance the predictive factors with parsimony to create a streamlined model, thus limiting the accuracy in predicting prognosis of early HCC; (ii) these staging systems were also based on a linear additive form of the risk factors, and the interaction between the risk factors could not be accurately demonstrated.…”

Combined hepatocellular carcinoma and cholangiocarcinoma with components of mucinous carcinoma arising in a cirrhotic liver

“…However, CHC has a somewhat poorer prognosis because metastasis occurs more frequently and the 5 year survival is lower. 4 CHC is intermediate in character between HCC and CC. The present case showed definite liver cirrhosis but no serological evidence of viral hepatitits.…”

“…Combined HCC and CC is usually associated with hepatic cirrhosis, especially micronodular cirrhosis, with an occurrence of 46-50%. 4 But we do not have a good explanation for the relationship of this tumor and hepatic cirrhosis.…”

“…1 CHC is a relatively rare tumor, comprising only 0.54-4.7% of all primary liver can-cers. [2][3][4] We present a case of combined HCC and CC with a very poor outcome.…”

Review of current staging systems for hepatocellular carcinoma

“…23 Makuuchi et al demonstrated that the Japanese TNM stage was superior to the TNM stage by the New American Joint Committee on Cancer, 24 and the working group of the International Hepato-Pancreato-Biliary Association proposed it as a new concordant TNM classification. 25 The JIS score demonstrated better stratification ability and prognostic predictive power than the CLIP score in a multicenter study, using a large cohort of Japanese patients with HCC despite its simplicity of use. 13 Furthermore, Toyoda et al compared the individual usefulness of the JIS score, CLIP score and BCLC staging classification in their own Japanese cohort of patients with HCC diagnosed after 1990 and before 1991, and demonstrated that the JIS score was the most suitable staging system of the three on the prognostic prediction of patients with HCC diagnosed after 1990, when frequency of early detection of HCC had increased.…”