Review of current staging systems for hepatocellular carcinoma

Abstract

Several staging systems have been developed to classify patients with hepatocellular carcinoma (HCC), however, there is no consensus on which of these is the most useful and reliable. In this review article, currently available integrated staging systems taking into account both liver function and tumor progression are presented, and their characteristics and applicability for current HCC patients, many of whom are diagnosed in the early stage of the disease and treated by curative therapy, are discussed. Based on the original andsubsequent validation studies of these staging systems, we recommend that further validation studies of staging systems for HCC should focus on the revised Barcelona Clinic Liver Cancer (BCLC) staging classification, Japan Integrated Staging (JIS) score and Tokyo score.

Perioperative Risk Assessment for Hepatocellular Carcinoma by Using the MELD Score

“…39 There is no consensus on which staging system is best. 40,41 Minagawa et al 42 compared in a large series the accuracy of the Japanese tumor-node-metastases (TNM) staging system for predicting patient survival (Liver Cancer Study Group of Japan (LCSGJ)) with that of the TNM staging system of the American Joint Committee on Cancer/ International Union Against Cancer (UICC), using the crossvalidation method. They concluded that, while both staging systems allow for the clear stratification of patients into prognostic groups, the LCSGJ staging may be more appropriate for stratifying patients with early-stage HCC.…”

Tumor and liver determinants of prognosis in unresectable hepatocellular carcinoma: a large case cohort study

“…This includes early identification due to screening, or to diagnosis later in the disease progression consequent on complications from tumor growth, or from hepatic failure. Many scoring and classification systems have taken the twin issues of cirrhosis and tumor extent into account, including those of Okuda, CLIP, BCLC, CUPI, SLiDE, JIS, and Tokyo scores, amongst others [3][4][5][6][7][8][9][10][11] and several papers have recently compared multiple staging systems [12][13][14][15][16][17][18][19][20][21][22][23]. They have been mainly intended to aid in patient selection for surgery, loco-regional therapy such as RFA or TACE, or palliative care.…”

Review of 4th Single Topic Conference on HCC

“…In Europe and the USA, the Barcelona Clinic Liver Cancer (BCLC) staging system 23 is generally well accepted; BCLC is a staging system to determine therapeutic strategy, and not to predict prognosis. The Japan Integrated Staging (JIS) score is a prognostic staging system commonly used in Japan 24,25 . The Cancer of the Liver Italian Program (CLIP) score is also a prognostic staging system commonly used in Europe 26 .…”

“…The Cancer of the Liver Italian Program (CLIP) score is also a prognostic staging system commonly used in Europe 26 . Although the JIS and CLIP scores are integrated staging systems incorporating hepatic functional reserve and the degree of cancer spread, the BCLC staging system only determines the therapeutic strategy, 22,25 which appears to be confused even by Western researchers. The BCLC staging system is a treatment algorithm, in which stage 0 and stage A (stage A) represents lesions that should be treated curatively, the intermediate (stage B) or advanced stage without portal invasion (stage C) represents lesions that should be treated by TACE, and stage D (terminal stage) lesions should receive best supportive care only.…”