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Yamaguchi et al. Hepatoma Res 2018;4:50 I http://dx.doi.org/10.20517/2394-5079.2018.68 Page 3 of 10

HCC

Stage 0 Stage A-C Stage D
PST 0, Child-Pugh A PST 0-2, Child-Pugh A-B PST > 2, Child-Pugh C

Stage 0 Early stage (A) Intermediate stage (B) Advanced stage (C) Terminal stage (D)
Single < 2 cm, Single or 3 nodules ≤ 3 cm Multinodular, Portal invasion,
Carcinoma in situ PS0 PS 0 N1, M1, PS1-2

Single 3 nodules ≤ 3 cm

Portal pressure/bilirubin

Increased Associated diseases

Normal No Yes

Liver transplantation Best supportive
Resection RF/PEI TACE Sorafenib
(CLT/LDLT) care
Curative treatment (30%-40%) Target: 20% Target: 40% Target: 10%
Median OS > 60 months; 5-year survival: 40%-70% OS: 20 months (45-14) OS: 11 months (6-14) OS: < 3 months

[2]
Figure 1. Updated BCLC staging system and treatment strategy: EASL-EORTC Clinical Practice Guidelines . HCC: hepatocellular
carcinoma; PST: performance status; CLT: cadaveric liver transplantation; LDLT: living donor liver transplantation; RF: radiofrequency; PEI:
percutaneous ethanol injection; TACE: transcatheter arterial chemoembolization; OS: overall survival
HCC
HCC

Extrahepatic No Yes
Yes
No
spread
Child-Pugh A/B Child-Pugh C Child-Pugh B/C Child-Pugh A
Child-Pugh C
Child-Pugh A/B
Child-Pugh B/C
Child-Pugh A
Liver function
Liver No Yes No Yes
No
Yes
No
Yes
function
Single 1~3 4 or more
4 or more
1～3
Number
Within Milan Exceeding
Hypovascular criteria Milan criteria
early HCC or age ≤ 65 or age > 65
Size ≤ 3 cm ≥ 3 cm
≦ 3 cm
≧ 3 cm
Resection; TACE;
Treatment Intensive TACE; HAIC; HAIC (Vp1-4); Transplantation;
follow-up; Resection; TACE+ Resection; Sorafenib (Vp1-3); TACE/ablation Palliative Sorafenib
Ablation Ablation ablation Ablation TACE (Vp1,2); for Child-Pugh care
Resection (Vp1,2) C pts
Sorafenib
(TACE refractory, Child-Pugh A)
[1]
Figure 2. JSH-LCSGJ consensus-based treatment algorithm for hepatocellular carcinoma (HCC) revised in 2014 . TACE: transcatheter
arterial chemoembolization; HAIC: hepatic arterial infusion chemotherapy; JSH: Japan Society of Hepatology; LCSGJ: Liver Cancer Study
Group of Japan