Open AccessUsefulness of staging systems and prognostic scores for hepatocellular carcinoma treatments
Author(s) -
Xavier Adhoute,
Guillaume Pénaranda,
JeanLuc Raoul,
Patrice Le Treut,
Emilie Bollon,
Jean Hardwigsen,
Paul Castellani,
H. Perrier,
Marc Bourlière
Publication year - 2016
Publication title -
world journal of hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.913
H-Index - 55
ISSN - 1948-5182
DOI - 10.4254/wjh.v8.i17.703
Subject(s) - medicine , hepatocellular carcinoma , cirrhosis , stage (stratigraphy) , liver cancer , portal hypertension , liver function , clinical practice , staging system , oncology , radiology , intensive care medicine , cancer , physical therapy , paleontology , biology
Therapeutic management of hepatocellular carcinoma (HCC) is quite complex owing to the underlying cirrhosis and portal vein hypertension. Different scores or classification systems based on liver function and tumoral stages have been published in the recent years. If none of them is currently "universally" recognized, the Barcelona Clinic Liver Cancer (BCLC) staging system has become the reference classification system in Western countries. Based on a robust treatment algorithm associated with stage stratification, it relies on a high level of evidence. However, BCLC stage B and C HCC include a broad spectrum of tumors but are only matched with a single therapeutic option. Some experts have thus suggested to extend the indications for surgery or for transarterial chemoembolization. In clinical practice, many patients are already treated beyond the scope of recommendations. Additional alternative prognostic scores that could be applied to any therapeutic modality have been recently proposed. They could represent complementary tools to the BCLC staging system and improve the stratification of HCC patients enrolled in clinical trials, as illustrated by the NIACE score. Prospective studies are needed to compare these scores and refine their role in the decision making process.