AJCC TNM Classification 8th ed
The TNM classification, developed jointly by the American Joint Committee on Cancer (AJCC) and the International Union for Cancer Control (UICC), has been regularly updated since its initial release in 1977. TNM staging system is not employed for hepatocellular carcinoma (HCC) as this system primarily assesses the size and spread of the tumor, lymph node involvement, and distant metastasis, without considering liver function reserve in the patient. Consequently, it is often supplemented with additional criteria such as the Child-Pugh classification or integrated into alternative grading systems like the CLIP score.
| Stage | T | N | M | Definition |
|---|---|---|---|---|
| IA | T1a | N0 | M0 | Solitary tumor ≤ 2 cm with/without vascular invasion |
| IB | T1b | N0 | M0 | Solitary tumor >2 cm without vascular invasion |
| II | T2 | N0 | M0 | Solitary tumor >2 cm with vascular invasion or multifocal tumors, none >5 cm |
| IIIA | T3 | N0 | M0 | Multifocal tumors at least one of which is >5 cm |
| IIIB | T4 | N0 | M0 | Single tumor or multifocal tumors of any size involving a major branch of the portalvein or hepatic vein or tumor(s) with direct invasion of adjacent organs other than the gallbladder or with perforation of visceral peritoneum |
| IVA | T any | N1 | M0 | Regional lymph node metastasis |
| IVB | T any | N any | M1 | Distant metastasis |
- Amin MB, Greene FL, Edge SB, Compton CC, Gershenwald JE, Brookland RK, Meyer L, Gress DM, Byrd DR, Winchester DP. The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population‐based to a more “personalized” approach to cancer staging. CA: a cancer journal for clinicians. 2017 Mar;67(2):93-9.
- Karademir S. Staging of hepatocellular carcinoma. Hepatoma Res. 2018;4:58.
- Kinoshita, Akiyoshi et al. “Staging systems for hepatocellular carcinoma: Current status and future perspectives.” World journal of hepatology vol. 7,3 (2015): 406-24. doi:10.4254/wjh.v7.i3.406