- Staging Systems of HCC
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SoonHo Um
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Journal of the Korean Liver Cancer Study Group. 2013;13(1):22-43. Published online February 28, 2013
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DOI: https://doi.org/10.17998/jlc.13.1.22
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Abstract
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- A well-designed staging system of cancer is an essential tool for assessing the prognosis of patients and establishing
therapeutic plan, and for comparing the effect of various anti-cancer therapeutic modalities. To date, many (at least 15) staging
schemes have been developed for hepatocellular carcinoma (HCC). It remains, however, which system fits best to stratify the
patients with HCC according to the survival and therapeutic plan. In this review article, the staging systems for HCC were
explained in detail and the results of many studies that had compared the predictive powers of staging systems of HCC were
described, including the studies performed in our institution. In summary, TNM staging systems remains to be a mainstay of
tumor staging for classifying the tumor extent and anatomic progression of HCC, although they are inferior to clinical staging
systems in terms of predictive power. In the current clinical situations, in which TNM staging of HCC is generally determined by
imaging studies because a majority of HCC patients are treated by nonsurgical treatment, the modified 5th UICC TNM system
for HCC devised by liver cancer study group of Japan appears to be more competent than the AJCC TNM systems for HCC.
Child-Pugh classification is still useful for evaluating the severity of liver dysfunction of patients with HCC. BCLC staging have
the highest prognostic power among various clinical staging systems for HCC, especially in patients with early and intermediate
stage of HCC that can be subject to curative or palliative treatment. In addition, BCLC staging can offer the general guideline for
therapeutic plan. However, a more sophisticated staging system will be required for accurate prediction of survival and for proper
planning of treatment.
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