Prognostic Factors and Staging Systems in Hepatocellular Carcinoma

There are a number of factors that should be taken into consideration when predicting the outcomes and prognosis of hepatocellular carcinoma. Four of the most important factors in determining survival are the severity of the accompanying liver disease, tumor size and number, extension of the tumor into other structures, and presence of metastases. The most common and widely accepted tumor staging systems include these 4 prognostic factors. The staging systems are (1) the tumor-node-metastasis system of the American Joint Committee on cancer, (2) the Okuda system, (3) the Barcelona Clinic Liver Cancer system, (4) the Cancer of the Liver Italian Program score; (5) the recent albumin-bilirubin grading system, and finally (6) the Hong Kong Liver Cancer staging system. The successful staging of patients with hepatocellular carcinoma is difficult because of the many contributing factors to disease. Therefore, in clinical practice, there is no ideal system that can be applicable to every patient in predicting survival. As a general rule, patient and treatment modality selection criteria should be individualized for every patient and should not use an algorithmic approach because aggressive treatments in properly selected patients with hepatocellular carcinoma offer good results. A better approach for increased treatment success is one that is multidisciplinary, that is, one that considers the different variables.