Published online Jun 18, 2016. doi: 10.4254/wjh.v8.i17.703
Peer-review started: February 19, 2016
First decision: April 5, 2016
Revised: April 24, 2016
Accepted: May 17, 2016
Article in press: May 27, 2016
Published online: June 18, 2016
Therapeutic management of hepatocellular carcinoma (HCC) is quite complex owing to the underlying cirrhosis and portal vein hypertension. Different scores or classification systems based on liver function and tumoral stages have been published in the recent years. If none of them is currently “universally” recognized, the Barcelona Clinic Liver Cancer (BCLC) staging system has become the reference classification system in Western countries. Based on a robust treatment algorithm associated with stage stratification, it relies on a high level of evidence. However, BCLC stage B and C HCC include a broad spectrum of tumors but are only matched with a single therapeutic option. Some experts have thus suggested to extend the indications for surgery or for transarterial chemoembolization. In clinical practice, many patients are already treated beyond the scope of recommendations. Additional alternative prognostic scores that could be applied to any therapeutic modality have been recently proposed. They could represent complementary tools to the BCLC staging system and improve the stratification of HCC patients enrolled in clinical trials, as illustrated by the NIACE score. Prospective studies are needed to compare these scores and refine their role in the decision making process.
Core tip: Different scores or classification systems have been proposed to refine hepatocellular carcinoma prognosis and better guide medical treatment. The Barcelona Clinic Liver Cancer (BCLC) system has become the reference classification in Western countries. Its treatment algorithm is based on randomized studies, but only offers one recommendation for BCLC stages B and C, whereas they include a broad spectrum of tumors. In clinical practice, many patients are treated out of the scope of these recommendations. In this context, alternative scores or classifications, which have been opposed for a long time, could be complementary tools for the benefit of the treatment.