Advances in non-surgical management of primary liver cancer

Table 4 Barcelona Clinic Liver Cancer staging system

Stage	PST1	Tumor stage2/cancer symptoms	Hepatic function	Recommended treatment
0 (very early)	0	Single nodule < 2 cm	Child-Pugh A; normal portal pressure; normal bilirubin	Resection
A (early)	0	Single nodule < 5 cmUp to 3 nodules, < 3 cm each	Child-Pugh A; elevated portal pressure and/or elevated bilirubin	Liver transplantations or PEI/RFA34
B (intermediate)	0	Large, multinodular; no cancer symptoms	Child-Pugh A-B	TACE
C (advanced)	1-2	Portal invasion, extrahepatic disease, or cancer symptoms	Child-Pugh A-B	New anti-tumoral agents
D (terminal)	> 2	Any of the above	Child-Pugh C	Symptomatic treatment

¹PST evaluated using the World Health Organization’s performance status scoring system (also known as the Eastern Cooperative Oncology Group System or the Zubrod system);

²N1 or M1 under American Joint Committee on Cancer's Tumor Node Metastasis staging system;

³Recommended in the absence of associated diseases;

⁴PEI/RF is recommended in the presence of associated diseases. PEI: Percutaneous ethanol injection; PST: Performance status; REA: Radiofrequency ablation; TACE: Transarterial chemoembolization.