Staging Systems for Hepatocellular Carcinoma

Abstract

Clinical staging systems for cancer provide guidelines for patient assessments and treatments. A proper staging is essential for objective comparison between the outcomes of different treatments. While the prognosis of most solid tumors is generally dependent on tumor stage at presentation, prediction of prognosis in hepatocellular carcinoma (HCC) patients is somewhat more complicated due to various aspects affecting patient survival including cirrhosis and underlying liver function. Up to date, at least eight staging systems have been proposed for HCC, but the optimal staging system for HCC is still under intense debate. Each existing staging system, characterized by the patient population based on which it was constructed, may have different predictive power for HCC patient in different area of the world, roughly the East and the West. The lack of a consensus on HCC staging systems is mostly in part related to the heterogeneity in treatment modalities at diagnosis. Therefore, we hereby propose a novel staging system for HCC, named as the Eastern staging, based on the authors’ previous study with a large cohort of Chinese patients undergoing surgical resection. Compared with the six existing staging systems, including CLIP, TNM, JIS, BCLC, CUPI and Okuda, the Eastern staging appears to have the best predictive ability for mortality at 1, 3, and 5 years. Thus, we believe the Eastern staging to be a simple and practical system for prognostic factor evaluation, risk level determination, and prognosis assessment after surgical resection in patients with HCC.