Chapter category: Surgery

Staging Systems to Predict Survival in Hepatocellular Carcinoma

This chapter appears in the following book:

Recent Advances in Liver Surgery

Edited by: Renzo Dionigi
ISBN: TBA
» Get more information about this book at landesbioscience.com «

Chapter authors:
Sonia Pascual and Miguel Pérez-Mateo

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There has been a considerable controversy regarding which is the best prognostic staging system to predict survival in patients with cirrhosis and hepatocellular carcinoma (HCC). Several prognostic models have been developed in the recent years but none has been widely accepted. The staging systems developed by European groups are the French model (GRETCH, Groupe d´Etude de Traitement du Carcinoma Hepatocellulaire), the Barcelona Clinic Liver Cancer classification (BCLC), the Cancer Liver Italian Program classification (CLIP) and the Vienna Survival Model for HCC (VISUM‑HCC). The Asiatic staging systems are: Okuda score, JIS score (Japan Integrated Staging), CUPI (Chinese University Prognosis Index) and Tokyo score. The lack of consensus is in part related to the heterogeneity of models because have been developed in different parts of the world, with different population characteristics and using different variables. Factors that may affect the prognosis of the patients with HCC include tumour stage at diagnosis, physical status of the patient, residual liver function and the therapeutic modality. In order to best assessing the prognosis of patients with HCC it is recommended that the staging systems take into account all of these variables. Most of the prognostic staging systems for HCC use a combination of factors related to liver function, such as presence of ascites, levels of albumin, bilirubin, Child‑Pugh score and others related to the tumour characteristics including portal vein thrombosis, alfa‑fetoprotein (AFP), size, number of lesions and distribution, morphology and TNM (Tumour, Nodule, Metastasis) stage.rnAll available staging systems have demonstrated to be useful in predicting survival but only a few have been externally validated. CLIP, BCLC and JIS staging systems are the most extended and validated. Moreover, BCLC and CLIP have been supported by relevant scientific societies. The BCLC model includes treatment, which is a relevant aspect to consider in these patients and is not included in the other prognostic systems. Until we have more information and considering all of these aspects, probably BCLC should be the preferred staging system.

Sonia Pascual
Unidad Hepática. Hospital General Universitario de Alicante, C/Pintor Baeza s/n, Alicante

Miguel Pérez-Mateo

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Chapter category: Surgery

Staging Systems to Predict Survival in Hepatocellular Carcinoma

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