Staging Systems For HCC

Cancer staging systems play a vital role in determining appropriate treatments and predicting prognosis for individual patients. In hepatocellular carcinoma (HCC), multiple staging systems have been proposed over the past two decades, but none have gained universal acceptance. Each system is based on the characteristics of the specific patient population studied, taking into account geographic and institutional variations, risk factors, treatment approaches, and healthcare accessibility. The heterogeneity of HCC tumors further adds to the complexity. While a staging system may be effective in one region, it may not be applicable to another. External validation of proposed systems across diverse patient groups is essential to establish a common guideline for HCC management. Various Staging systems present for HCC are as follows:

Staging systemYearLiver Function AssessmentPerformance StatusAFPTumor NumberTumor SizeVascular InvasionExtrahepatic SpreadOthers
Okuda1985Ascites, albumin, bilirubinYes
CLIP1998Child-Pugh scoreYesYesYesYes
BCLC1999 (update 2022)Child-Pugh scoreECOGYesYesYesYes
GRETCH Score1999BilirubinKarnofsky scaleYesYesAlk-P, PVT
CUPI2002Ascites, bilirubinSymptomsYesYesYesYesYesAlk-P
JIS2003Child-Pugh scoreYesYesYesYes
Tokyo2005Albumin, bilirubinYesYes
m-JIS2006Indocyanine green clearance (- encepalopathy)YesYesYesYes
BALAD2006Albumin, bilirubinYesAFP-L3, DCP
bm-JIS2008Child-Pugh scoreYesYesYesYesYesAFP-L3, DCP
ALPCS2008Child-Pugh scoreSymptomsYesYesYesYesAlk-P, Urea, PVT
TIS2010Child-Pugh scoreYesTotal Tumor VolumeTotal Tumor Volume
TNM2010YesYesYesYes
MESIAH2012MELD, albuminAgeYesYesYesYesYes
HKLC2014Child-Pugh scoreECOGYesYesYesYes
ITA.LI.CA2016Child-Pugh scoreECOGYesYesYesYesYes
Supervised Machine Learning

HCC: hepatocellular carcinoma; CLIP: Cancer of the Liver Italian Program; BCLC: Barcelona Clinic Liver Cancer; AJCC: American Joint Committee of Cancer; TNM: tumor-node-metastasis; CUPI: Chinese University Prognostic Index; JIS: Japan Integrated Staging; m-JIS: modified JIS; bm-JIS: biomarker combined JIS; BALAD: bilirubin-albumin-AFPL3-AFP-DCP; ALPCS: advanced liver cancer prognostic system; TIS: Taipei Integrated Scoring System; MESIAH: model to estimate survival in ambulatory HCC; HKLC: Hong Kong Liver Cancer; AFP: alpha-fetoprotein; AFP-L3: AFP-Lens culinaris agglutinin-reactive; DCP: des-gamma-carboxy prothrombin; EGOS PST: Eastern Cooperative Oncology Group performance status;  PVT: portal vein thrombosis

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