Controversies in the Staging of Hepatocellular Carcinoma

Abstract

Prognosis of patients with hepatocellular carcinoma (HCC) depends on both residual liver function and tumor extension. An accurate staging system for cancer patients with HCC provides guidance in terms of both patient assessment and therapeutic decisions. Staging is also essential for comparison of groups in clinical trials and for comparison between different studies. Because numerous studies have reported divergent outcomes and predictors of survival after resection in patients with HCC, a number of different classification schemes for HCC have been proposed. Several of these staging systems rely heavily on clinical parameters and integrated scoring schemes (Okuda, Barcelona Clinic Liver Cancer Staging, Cancer of the Liver Italian Program). Others, such as the Liver Cancer Study Group of Japan and the Japanese Integrated Staging Score incorporate pathologic data after resection, yet still rely on the computation of a score to determine prognosis. Recently, a new staging system validated in Japan, the United States, and Europe has been adopted by the American Joint Committee on Cancer (AJCC) and the International Union Against Cancer (UICC). This HCC staging system is based on a multivariate analysis and has been independently validated. Because the new AJCC/UICC staging system is easily obtained, is objective, and has been independently validated, we strongly propose it as the prognostic staging system of choice for HCC after resection of HCC.