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 system | Year | Liver Function Assessment | Performance Status | AFP | Tumor Number | Tumor Size | Vascular Invasion | Extrahepatic Spread | Others |
---|---|---|---|---|---|---|---|---|---|
Okuda | 1985 | Ascites, albumin, bilirubin | Yes | ||||||
CLIP | 1998 | Child-Pugh score | Yes | Yes | Yes | Yes | |||
BCLC | 1999 (update 2022) | Child-Pugh score | ECOG | Yes | Yes | Yes | Yes | ||
GRETCH Score | 1999 | Bilirubin | Karnofsky scale | Yes | Yes | Alk-P, PVT | |||
CUPI | 2002 | Ascites, bilirubin | Symptoms | Yes | Yes | Yes | Yes | Yes | Alk-P |
JIS | 2003 | Child-Pugh score | Yes | Yes | Yes | Yes | |||
Tokyo | 2005 | Albumin, bilirubin | Yes | Yes | |||||
m-JIS | 2006 | Indocyanine green clearance (- encepalopathy) | Yes | Yes | Yes | Yes | |||
BALAD | 2006 | Albumin, bilirubin | Yes | AFP-L3, DCP | |||||
bm-JIS | 2008 | Child-Pugh score | Yes | Yes | Yes | Yes | Yes | AFP-L3, DCP | |
ALPCS | 2008 | Child-Pugh score | Symptoms | Yes | Yes | Yes | Yes | Alk-P, Urea, PVT | |
TIS | 2010 | Child-Pugh score | Yes | Total Tumor Volume | Total Tumor Volume | ||||
TNM | 2010 | Yes | Yes | Yes | Yes | ||||
MESIAH | 2012 | MELD, albumin | Age | Yes | Yes | Yes | Yes | Yes | |
HKLC | 2014 | Child-Pugh score | ECOG | Yes | Yes | Yes | Yes | ||
ITA.LI.CA | 2016 | Child-Pugh score | ECOG | Yes | Yes | Yes | Yes | Yes | |
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