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HOME > J Liver Cancer > Volume 13(1); 2013 > Article
Review Article Staging Systems of HCC
SoonHo Um
Journal of Liver Cancer 2013;13(1):22-43
DOI: https://doi.org/10.17998/jlc.13.1.22
Published online: February 28, 2013
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
Corresponding author:  SoonHo Um,
Email: umsh@korea.ac.kr
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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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