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©The Author(s) 2017.
World J Gastroenterol. Aug 7, 2017; 23(29): 5282-5294
Published online Aug 7, 2017. doi: 10.3748/wjg.v23.i29.5282
Published online Aug 7, 2017. doi: 10.3748/wjg.v23.i29.5282
Table 1 Barcelona Clinic Liver Cancer staging classification
Tumor status | ||||
Stage | PST | Tumor stage | Okuda Stage | Liver function studies |
Stage A: early HCC | ||||
A1 | 0 | Single | I | No portal hypertension |
A2 | 0 | Single | I | Portal hypertension and normal bilirubin |
A3 | 0 | Single | I | Portal hypertension and abnormal bilirubin |
A4 | 0 | 3 tumors < 3 cm | I-II | Child-Pugh A-B |
Stage B: idermediate HCC | 0 | Large multinodular | I-II | Child-Pugh A-B |
Stage C: advanced HCC | 1-21 | Vascular invasion or extrahepatic spread | I-II | Child-Pugh A-B |
Stage D: end-stage HCC | 3-42 | Any | III | Child-Pugh C |
Table 2 Child-Turcotte-Pugh score
Measurements | Score | ||
1 | 2 | 3 | |
Encephalopathy | None | Mild | Moderate |
Ascites | None | Slight | Moderate |
Serum Bilirubin (mg/dL) | 1-2 | 2-3 | > 3 |
Serum Albumin (mg/dL) | > 3.5 | 2.8-3.5 | < 2.8 |
PT (seconds prolonged) | < 4 | 4-6 | > 6 |
Table 3 Model for end-stage liver disease, United Network for Organ Sharing modification
MELD Score = 9.57 × ln (Serum Creatinine in mg/dL) |
+ 3.78 × ln (Serum Bilirubin in mg/dL) |
+ 11.2 × ln (INR) + 6.43 |
Table 4 American Joint Committee on Cancer TNM Staging for Liver Tumors (7th edition, 2010)
Primary tumor (T) | |||
Tx | Primary tumor cannot be assessed | ||
T0 | No evidence of primary tumor | ||
T1 | Solitary tumor without vascular invasion | ||
T2 | Solitary tumor with vascular invasion or multiple tumors, none more than 5 cm | ||
T3a | Multiple tumors more than 5 cm | ||
T3b | Single tumor or multiple tumors of any size involving a major branch of the portal vein or the hepatic vein | ||
T4 | Tumors with direct invasion of adjacent organs other than the gallbladder or with perforation of visceral peritoneum | ||
Regional lymph nodes (N) | |||
Nx | Regional lymph nodes cannot be assessed | ||
N0 | No regional node metastasis | ||
N1 | Regional lymph node metastasis | ||
Distal Metastases (M) | |||
M0 | No distant metastasis | ||
M1 | Distant metastasis | ||
Anatomic stage/prognostic groups | |||
Stage I | T1 | N0 | M0 |
Stage II | T2 | N0 | M0 |
Stage IIIA | T3a | N0 | M0 |
Stage IIIB | T3b | N0 | M0 |
Stage IIIC | T4 | N0 | M0 |
Stage IςA | Any T | N1 | M0 |
Stage IςB | Any T | Any N | M1 |
Histologic grade (G) | |||
G1 | Well differentiated | ||
G2 | Moderately differentiated | ||
G3 | Poorly differentiated | ||
G4 | Undifferentiated | ||
Fibrosis core (F) | |||
The fibrosis score as defined by Ishak recommended because of its prognostic value in overall survival. This scoring system uses a 0-6 scale | |||
F0 | Fibrosis score 0-4 (none to moderate fibrosis) | ||
F1 | Fibrosis score 5-6 (severe fibrosis or cirrhosis) |
Table 5 Current treatment options for hepatocellular carcinoma
Surgical |
Resection |
Resection + ablation |
Orthotopic liver transplantation |
Ablative |
Thermal ablation (radiofrequency ablation, microwave ablation) |
Percutaneous alcohol (ethanol) injection |
Transarterial |
Embolization |
Chemoembolization |
Radiotherapy |
Transarterial and ablative (combined) |
Systemic chemotherapy + radioembolization |
Table 6 Treatment schedule proposed for hepatocellular carcinoma cirrhotic patients according to the Barcelona Clinic Liver Cancer classification system
Stage | Treatment intention | First/second choice |
Stage A: early HCC | ||
A1 | Radical | Surgical resection |
A2 | Surgical resection ð OLT/percutaneous treatment | |
A3 | OLT/percutaneous treatment (Ablation) | |
A4 | OLT/percutaneous treatment (Ablation) | |
Stage B: intermediate HCC | Palliative1 | Trasanterial embolization (associated or not to percutaneous treatment) |
Chemoembolization (TACE) | ||
Stage C: advanced HCC | Palliative1 | New agents (Sorafenib) |
Stage D: end-stage HCC | Symptomatic | Supporting treatment |
- Citation: Dimitroulis D, Damaskos C, Valsami S, Davakis S, Garmpis N, Spartalis E, Athanasiou A, Moris D, Sakellariou S, Kykalos S, Tsourouflis G, Garmpi A, Delladetsima I, Kontzoglou K, Kouraklis G. From diagnosis to treatment of hepatocellular carcinoma: An epidemic problem for both developed and developing world. World J Gastroenterol 2017; 23(29): 5282-5294
- URL: https://www.wjgnet.com/1007-9327/full/v23/i29/5282.htm
- DOI: https://dx.doi.org/10.3748/wjg.v23.i29.5282