What is the best staging system for hepatocellular carcinoma in the setting of liver transplantation?

Abstract

SUMMARY To assess the prognosis of all HCC patients, the beststaging system should take into account tumor stage,liver function, and physical status. In addition, theprognosis should be modified according to the treat-ment. There is no worldwide consensus about the useof any HCC staging system for all HCC patients, andthe systems vary significantly by country. The TNMand Okuda staging systems are most commonly usedinternationally. The BCLC and CLIP staging systemsare used most frequently in Europe, whereas the JISsystem has been accepted as a standard in Japan.The BCLC staging system is the only system thatlinks the prognosis with treatment recommendations,and it has been used in several major trials of HCCtherapy to define the patient population to berecruited and to stratify the patients into separateprognostic categories. It has been validated in severallarge patient populations around the world and hasbeen endorsed by several societies as a guide for clini-cal decision making. The sixth edition of the TNM sys-tem is most widely used for determining a patient’sprognosis after surgery or transplantation, and it hashigh predictive value after transplantation and resec-tion. It has been validated in numerous patient popu-lations and forms the basis for many other stagingsystems and allocation policies. Unfortunately, thepathological TNM stage is not known before trans-plantation, and it plays an important role in determin-ing posttransplant survival.