Staging systems for hepatocellular carcinoma

Accurate staging of hepatocellular carcinoma (HCC) is important because it provides prognostic data as well as aids in selecting patients for appropriate clinical treatment regimens (1). Many previous studies, however, have noted differing predictors of survival following treatment of HCC (2–5). A number of staging systems have therefore been proposed, including some that rely mostly on clinical parameters [Okuda, Cancer of the Liver Italian Program (CLIP)] and others that utilize pathologic data [American Joint Committee on Cancer/International Union Against Cancer (AJCC/UICC)]. This chapter provides an overview of the major HCC staging systems and highlights the relative merits of each staging scheme. Child-Turcotte-Pugh Nominal Score: Although not a true prognostic staging scheme for HCC, the Child-Turcotte-Pugh (CTP) score is the most basic scoring system for the assessment of liver disease. The Child-Pugh score assigns points for degree of liver dysfunction based on three biochemical markers (serum albumin, bilirubin and prothrombin time) and two clinical markers (ascites and encephalopathy) (Table 10.1). The CTP score is not an assessment of HCC stage, but it is a well-established predictor of surgical risk and prognosis in patients with liver disease. The CTP score is included here because it is used as a component of several formal HCC staging systems. Okuda Staging System: In 1985, Okuda proposed a HCC staging system based on both serum liver function tests and tumor extension (6).