Role of surgical resection for hepatocellular carcinoma based on Japanese clinical guidelines for hepatocellular carcinoma

Table 1 Staging systems for hepatocellular carcinoma

Classification	Year	Background	Variables
			Tumor status	Liver function	Health status
Okuda staging	1985	850 Japanese patients	50% liver involvement	Ascites, bilirubin, albumin	-
BCLC staging	1999	Selected papers	Size, number, vascular invasion, Okuda stage	Child-Pugh, bilirubin, porta hypertension	Performance status
CLIP score	2000	435 Italian patients	50% liver involvement, vascular invasion, AFP	Child-Pugh	-
CUPI	2002	926 Chinese patients	TNM, AFP	Bilirubin, albumin, alkaline phosphatase	Presence of symptoms
JIS score	2003	3334 Japanese patients	TNM (Japanese)	Child-Pugh	-
m-JIS score	2006	42269 Japanese patients	TNM (Japanese)	Liver damage	-
Tokyo score	2005	403 Japanese patients	Size, number	Bilirubin, albumin	-

BCLC: Barcelona Clinic Liver Cancer; CLIP: Cancer of the liver Italian Program; CUPI: Chinese University Prognostic Index; JIS: Japan Integrated Staging; m-JIS: Modified Japan Integrated Staging; AFP: Alpha-fetoprotein. Revise from ref. [22].

Table 2 Treatment options for hepatocellular carcinoma in barcelona clinic liver cancer system and Japanese guidelines

Tumor number	Tumor size (cm)	Child-Pugh class	Treatment
			BCLC system	Japanese guidelines
Single	2	A, B	Resection	1 Resection
				2 Ablation
	2.1-3	A, B	1 Resection	1 Resection
			2 Transplantation or ablation	2 Ablation
	3.1-5	A, B	1 Resection	Resection
			2 Transplantation
2 or 3 nodules	≤ 3	A, B	Transplantation or ablation	Resection or ablation
		C	Palliative care	Transplantation
	> 3	A, B	Chemoembolization	1 Resection
				2 Chemoembolization
4 or more nodules		A, B	Chemoembolization	1 Chemoembolization
				2 Chemotherapy
		C	Palliative care	Palliative care

Degree of Liver damage replaced Child-Pugh classification as liver function in Japan Revise from ref. [22].