Clinical staging of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common cancers in the world. The resistance of HCC to existing treatments and the lack of biomarkers for early detection make it one of most hard-to-treat cancers. Surgical tumor resection, including liver transplantation, remains the only curative modality for HCC. Several clinical prognostic models have been developed for the staging of patients with HCC, but there is no general consensus which is the most reliable. There are restrictions in the use of these prognostic scores, because most scores were not validated in different countries and the HCCs differ in their biological behavior. A further problem is the heterogeneity of patients with HCC (with or without cirrhosis, compensated or decompensated cirrhosis and treated or nontreated patients); many studies combine patients with and without cirrhosis and patients with compensated and decompensated cirrhosis. The clinical efficiency of these scores is therefore limited to patients with HCC. Nowadays, DNA microarray technology has revolutionized the understanding of the molecular basis of HCC; therefore, many studies aimed to discover biomarkers for cancer staging, for prediction of recurrence, for prognosis, and for treatment selection. Most of the studies are too small for the development of predictors and at the moment microarray technology is too expensive for daily clinical use. Therefore, DNA microarray technology is at the moment not an established method in the prediction of the prognosis of patients with HCC. Future prognostic studies should include different predictors and should be performed in selected patient populations to determine whether specific prognostic indicators are more relevant at different stages of liver disease.