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Page 2 of 18 Karademir. Hepatoma Res 2018;4:58 I http://dx.doi.org/10.20517/2394-5079.2018.40

Table 1. Components of HCC scores and staging systems published in the recent years
Tumor status
Liver functional Performance
Staging systems AFP Vascular Other
reserve status, symptoms Number Size Metastasis
invasion
Okuda (1985) [6] Ascites, albumin, Yes
bilirubin
CLIP (1998) [7] Child-Pugh score Yes Yes Yes Yes
French (1999) [8] Bilirubin Karnofsky scale Yes Yes Alk-P, PVT
BCLC (1999) [3] Child-Pugh score EGOS PST Yes Yes Yes Yes
AJCC TNM-7 (2010) [5] Yes Yes Yes Yes
CUPI (2002) [9] Ascites, bilirubin Symptoms Yes Yes Yes Yes Yes Alk-P
JIS (2003) [10] Child-Pugh score Yes Yes Yes Yes
m-JIS (2006) [57] +ICG-R15 (- Yes Yes Yes Yes
encepalopathy)
bm-JIS (2008) [58] Child-Pugh score Yes Yes Yes Yes Yes AFP-L3, DCP
Tokyo (2005) [11] Albumin, bilirubin Yes Yes
BALAD (2006) [60] Albumin, bilirubin Yes AFP-L3, DCP
ALPCS (2008) [48] Child-Pugh score Symptoms Yes Yes Yes Alk-P, Urea, PVT
TIS (2010) [63] Child-Pugh score Yes Total tumor volume
MESIAH (2012) [12] MELD, albumin Age Yes Yes Yes Yes Yes
HKLC (2014) [4] Child-Pugh score EGOS PST No Yes Yes Yes Yes
ITA.LI.CA (2016) [68] Child-Pugh score EGOS PST Yes Yes Yes Yes Yes
HCC: hepatocellular carcinoma; CLIP: Cancer of the Liver Italian Program; BCLC: Barcelona Clinic Liver Cancer; AJCC: American Joint
Committee of Cancer; TNM: tumor-node-metastasis; CUPI: Chinese University Prognostic Index; JIS: Japan Integrated Staging; m-JIS:
modified JIS; bm-JIS: biomarker combined JIS; BALAD: bilirubin-albumin-AFPL3-AFP-DCP; ALPCS: advanced liver cancer prognostic
system; TIS: Taipei Integrated Scoring System; MESIAH: model to estimate survival in ambulatory HCC; HKLC: Hong Kong Liver Cancer;
AFP: alpha-fetoprotein; AFP-L3: AFP-Lens culinaris agglutinin-reactive; DCP: des-gamma-carboxy prothrombin; EGOS PST: Eastern
Cooperative Oncology Group performance status; ICG-R15: indocyanine green clearance; PVT: portal vein thrombosis

search for a simple, reliable, reproducible and comprehensive staging system continues.

Most HCCs develop upon chronic diseases of the liver, mainly B or C viral hepatitis. Due to the underlying
liver disease, prognosis of HCC depends not only on extend of the tumor but also on functional reserve of
liver, overall health status of the patient and the treatment given for HCC . For an accurate prognostication
[2]
of HCC, parameters which look at all these aspects of prognosis must be included in staging process. In
addressing interrelationship of prognostic factors in HCC, several staging systems have been developed but
only a few have been widely used and validated.

To date, various parameters have been studied to be of prognostic usefulness in patients with HCC.
Parameters based on systematic reviews of the literature and/or expert opinions as well as variables
[3-5]
that were significant in multivariable Cox survival analyses [6-12] were incorporated in these staging/
scoring systems. Besides the simple patient related demographic data such as age and gender, many other
specific biochemical and clinical variables of liver function, tumor burden and biology as well as age-
related clinical consequences and comorbidities have been included in regression analysis of the different
[1]
studied populations worldwide [Table 1]. Several biomarkers have also been studied for their prognostic
[13]
significance in patients with HCC .
The treatment options for patients with HCC are expanding. Depending on the stage of the disease, surgical
resection, percutaneous ablation, transarterial chemoembolization and transplantation are being performed
either singly or as combination of various modalities. For patients with advanced disease, sorafenib, a
multikinase inhibitor is also available. The choice of therapy is influenced by several factors including stage
of tumor and severity of underlying liver dysfunction as well as availability of resources and of expertise.
Thus, to reach a single staging system and treatment algorithm applicable to all patients with HCC seems to
continue to be challenging.