A review of hepatocellular carcinoma (HCC) staging systems

Accurately staging patients is essential to oncology practice. Cancer staging contributes to prognostication, guides management decisions, and informs clinical, epidemiologic, and health services research. In hepatocellular carcinoma (HCC), staging poses unique challenges due to the geographic and biological heterogeneity of the disease and lack of consensus on how to best classify patients. The features included in various HCC classifications systems have evolved over the last 50 years, but in general, need to account for both tumor characteristics as well as the burden of underlying liver disease.In this review, we discuss the Child-Turcotte-Pugh and Model for End-Stage Liver Disease, two practical systems that reflect the degree of hepatic dysfunction. We then describe several HCC staging systems, reviewing their development, and applicability to clinical practice, with a critical look at their validation. Finally, we look ahead to novel systems utilizing molecular markers. It is hoped this review will provide context regarding the use of current staging and scoring methods and a glimpse of what we can expect with future systems.