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Abdominal Imaging

, Volume 39, Issue 5, pp 1070–1087 | Cite as

TNM/Okuda/Barcelona/UNOS/CLIP International Multidisciplinary Classification of Hepatocellular Carcinoma: concepts, perspectives, and radiologic implications

  • Silvana C. Faria
  • Janio Szklaruk
  • Ahmed O. Kaseb
  • Hesham M. Hassabo
  • Khaled M. ElsayesEmail author
Review Paper

Abstract

Hepatocellular carcinoma (HCC) is a major health problem worldwide. Moreover, the liver cancer field is evolving rapidly, with early diagnosis, new therapies, and a better understanding of HCC’s biology and development. Accurate staging is important for determining prognosis and selecting the most appropriate treatment for each patient. Surgical intervention remains the most effective treatment for HCC and is the only potentially curative modality. However, in HCC patients, overall survival is also independently affected by underlying liver disease and cirrhosis, which in turn affect the applicability and efficacy of treatment. Although several staging classification and prognostic scoring systems have been proposed for determining the stage and prognosis of HCC, no consensus exists on the best classification method. The most common staging classification systems include tumor-node-metastasis stage, Okuda staging, Cancer of the Liver Italian Program score, Barcelona Clinic Liver Cancer staging classification, the French, the Chinese University Prognostic Index, Japanese Integrated Scoring, and the Tokyo score. Radiologists should be aware of the different staging classification systems for HCC and familiar with the system relevant to their respective referring clinicians, as it will provide pertinent radiological evaluation for multidisciplinary management.

Keywords

Hepatocellular carcinoma Hepatocellular carcinoma staging BCLC CLIP TNM Okuda 

References

  1. 1.
    Parkin DM, Bray F, Ferlay J, Pisani P (2001) Estimating the world cancer burden: Globocan 2000. Int J Cancer 94(2):153–156PubMedCrossRefGoogle Scholar
  2. 2.
    El-Serag HB, Davila JA, Petersen NJ, McGlynn KA (2003) The continuing increase in the incidence of hepatocellular carcinoma in the United States: an update. Ann Intern Med 139(10):817–823PubMedCrossRefGoogle Scholar
  3. 3.
    Cauchy F, Fuks D, Belghiti J (2012) HCC: current surgical treatment concepts. Langenbecks Arch Surg 397(5):681–695PubMedCrossRefGoogle Scholar
  4. 4.
    Kaseb AO, Abaza YM, Roses RE (2013) Multidisciplinary management of hepatocellular carcinoma. Recent Results Cancer Res. 190:247–259PubMedCrossRefGoogle Scholar
  5. 5.
    Edge SB, Byrd DR, Compton CC, et al. (eds) (2010) American Joint Committee on Cancer. American Joint Committee on Cancer Staging Manual, 7th edn. New York: Springer, pp 191–199Google Scholar
  6. 6.
    Ishak K, Baptista A, Bianchi L, et al. (1995) Histological grading and staging of chronic hepatitis. J Hepatol 22(6):696–699PubMedCrossRefGoogle Scholar
  7. 7.
    Vauthey JN, Ribero D, Abdalla EK, et al. (2007) Outcomes of liver transplantation in 490 patients with hepatocellular carcinoma: validation of a uniform staging after surgical treatment. J Am Coll Surg 204(5):1016–1027PubMedCrossRefGoogle Scholar
  8. 8.
    Vauthey JN, Lauwers GY, Esnaola NF, et al. (2002) Simplified staging for hepatocellular carcinoma. J Clin Oncol 20(6):1527–1536PubMedCrossRefGoogle Scholar
  9. 9.
    Okuda K, Ohtsuki T, Obata H, et al. (1985) Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer 56(4):918–928PubMedCrossRefGoogle Scholar
  10. 10.
    Tateishi R, Yoshida H, Shiina S, et al. (2005) Proposal of a new prognostic model for hepatocellular carcinoma: an analysis of 403 patients. Gut 54(3):419–425PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators. Hepatology 1998, 28(3):751–755Google Scholar
  12. 12.
    Durand F, Valla D (2005) Assessment of the prognosis of cirrhosis: Child-Pugh versus MELD. J Hepatol 42(Suppl(1)):S100–S107PubMedCrossRefGoogle Scholar
  13. 13.
    Farinati F, Rinaldi M, Gianni S, Naccarato R (2000) How should patients with hepatocellular carcinoma be staged? Validation of a new prognostic system. Cancer 89(11):2266–2273PubMedCrossRefGoogle Scholar
  14. 14.
    Llovet JM, Brú C, Bruix J (1999) Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis. 19(3):329–338PubMedCrossRefGoogle Scholar
  15. 15.
    de Borja MT, Chow E, Bovett G, Davis L, Gillies C (2004) The correlation among patients and health care professionals in assessing functional status using the Karnofsky and Eastern Cooperative Oncology Group performance status scales. Support Cancer Ther. 2(1):59–63PubMedCrossRefGoogle Scholar
  16. 16.
    Forner A, Llovet JM, Bruix J (2012) Hepatocellular carcinoma. Lancet 379(9822):1245–1255PubMedCrossRefGoogle Scholar
  17. 17.
    Whang-Peng J, Cheng A, Hsu C, Chen C (2010) Clinical development and future direction for the treatment of hepatocellular carcinoma. J Exp Clin Med 293:93–103CrossRefGoogle Scholar
  18. 18.
    Cillo U, Vitale A, Grigoletto F, et al. (2006) Prospective validation of the Barcelona Clinic Liver Cancer staging system. J Hepatol 44(4):723–731PubMedCrossRefGoogle Scholar
  19. 19.
    Marrero JA, Kudo M, Bronowicki JP (2010) The challenge of prognosis and staging for hepatocellular carcinoma. Oncologist 15(Suppl 4):23–33PubMedCrossRefGoogle Scholar
  20. 20.
    Huitzil-Melendez FD, Capanu M, O’Reilly EM, et al. (2010) Advanced hepatocellular carcinoma: which staging systems best predict prognosis? J Clin Oncol 28(17):2889–2895PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Kaseb AO, Morris JS, Hassan MM, et al. (2011) Clinical and prognostic implications of plasma insulin-like growth factor-1 and vascular endothelial growth factor in patients with hepatocellular carcinoma. J Clin Oncol. 29(29):3892–3899PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Kaseb AO, Hassan MM, Lin E, et al. (2010) V-CLIP: integrating plasma vascular endothelial growth factor into a new scoring system to stratify patients with advanced hepatocellular carcinoma for clinical trials. Cancer 1–21Google Scholar
  23. 23.
    Kaseb AO, Abbruzzese JL, Vauthey JN, et al. (2011) I-CLIP: improved stratification of advanced hepatocellular carcinoma patients by integrating plasma IGF-1 into CLIP score. Oncology 80(5–6):373–381PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Chevret S, Trinchet JC, Mathieu D, et al. (1999) A new prognostic classification for predicting survival in patients with hepatocellular carcinoma, Groupe d’Etude et de Traitement du Carcinome Hépatocellulaire. J Hepatol 31(1):133–141PubMedCrossRefGoogle Scholar
  25. 25.
    Leung TW, Tang AM, Zee B, et al. (2002) Construction of the Chinese University Prognostic Index for hepatocellular carcinoma and comparison with the TNM staging system, the Okuda staging system, and the Cancer of the Liver Italian Program staging system: a study based on 926 patients. Cancer. 94(6):1760–1769PubMedCrossRefGoogle Scholar
  26. 26.
    Yang T, Zhang J, Lu JH, et al. (2011) A new staging system for resectable hepatocellular carcinoma: comparison with six existing staging systems in a large Chinese cohort. J Cancer Res Clin Oncol. 137(5):739–750PubMedCrossRefGoogle Scholar
  27. 27.
    Kudo M, Chung H, Osaki Y (2003) Prognostic staging system for hepatocellular carcinoma (CLIP score): its value and limitations, and a proposal for a new staging system, the Japan Integrated Staging Score (JIS score). J Gastroenterol. 38(3):207–215PubMedCrossRefGoogle Scholar
  28. 28.
    Kudo M, Chung H, Haji S, et al. (2004) Validation of a new prognostic staging system for hepatocellular carcinoma: the JIS score compared with the CLIP score. Hepatology. 40(6):1396–1405PubMedCrossRefGoogle Scholar
  29. 29.
    Kitai S, Kudo M, Minami Y, et al. (2008) A new prognostic staging system for hepatocellular carcinoma: value of the biomarker combined Japan integrated staging score. Intervirology 51(Suppl 1):86–94PubMedCrossRefGoogle Scholar
  30. 30.
    Forner A, Bruix J (2013) The size of the problem: clinical algorithms. Dig Dis 31(1):95–103PubMedCrossRefGoogle Scholar
  31. 31.
    Pons F, Varela M, Llovet JM (2005) Staging systems in hepatocellular carcinoma. HPB 7(1):35–41PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Olthoff KM, Forner A, Hübscher S, Fung J (2011) What is the best staging system for hepatocellular carcinoma in the setting of liver transplantation? Liver Transpl. 17(Suppl 2):S26–S33PubMedCrossRefGoogle Scholar
  33. 33.
    Purysko AS, Remer EM, Coppa CP, et al. (2012) LI-RADS: a case-based review of the new categorization of liver findings in patients with end-stage liver disease. Radiographics 32(7):1977PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Silvana C. Faria
    • 1
  • Janio Szklaruk
    • 1
  • Ahmed O. Kaseb
    • 2
  • Hesham M. Hassabo
    • 2
  • Khaled M. Elsayes
    • 1
    Email author
  1. 1.Department of Diagnostic Radiology, Unit 1473The University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Medical Oncology, Unit 1473The University of Texas MD Anderson Cancer CenterHoustonUSA

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