Staging systems of hepatocellular carcinoma: a review of literature

Abstract

Hepatocellular carcinoma (HCC) is a major health problem with a high incidence and mortality all over the world. Natural history of HCC is severe and extremely variable, and prognostic factors influencing outcomes are incompletely defined. Over time, many staging and scoring systems have been proposed for the classification and prognosis of patients with HCC. Currently, the non-ideal predictive performance of existing prognostic systems is secondary to their inherent limitations, as well as to a non-universal reproducibility and transportability of the results in different populations. New serological and histological markers are still under evaluation with promising results, but they require further evaluation and external validation. The aim of this review is to highlight the main tools for assessing the prognosis of HCC and the main concerns, pitfalls and warnings regarding its staging systems currently in use.

Keywords: Barcelona clinic liver cancer; Hepatocellular carcinoma; Natural history; Prognosis; Staging.

Figure 1

Timeline of hepatocellular carcinoma staging system. AJCC: American Joint Committee on Cancer; UICC: International Union Against Cancer; CLIP: Cancer of the Liver Italian Program; GRETCH: Groupe d'Etude et de Traitement du Carcinome Hépatocellulaire; BCLC: Barcelona Clinic Liver Cancer; CUPI: Chinese University Prognostic Index; JIS: Japan Integrated Staging Score; TNM: Tumor Node Metastasis.