Staging systems of hepatocellular carcinoma: A review of literature

Table 1 Comparison of classifications

Okuda staging system[13]
	Score
	0			1
Tumor size	≤ 50% of the liver			> 50% of the liver
Albumin (g/dL)	≥ 3			< 3
Bilirubin (mg/dL)	< 3			≥ 3
Ascites	Absent			Present
CLIP score[14]
	Score
	0		1		2
Tumour morphology	Uninodular and extension ≤ 50%		Multinodular and extension ≤ 50%		Massive or extension > 50%
Child–Pugh score	A		B		C
Alpha-fetoprotein (ng ⁄ mL)	< 400		≥ 400		-
Portal vein thrombosis	Absent		Present		-
GRETCH score[21]
	Score
	0	1	2	3
Karnofsky index	≥ 80%			< 80%
Bilirubin (μmol ⁄ L)	< 50			≥ 50
Alkaline phosphatase	< 2 X ULN		≥ 2 X ULN
Alpha-fetoprotein (μg⁄L)	< 35		≥ 35
Portal vein thrombosis	Absent	Present
BCLC[16]
	Stage
	0 (very early)	A (early)		B (intermediate)	C (advanced)		D (end stage)
ECOG Performance Status	0	0		0	1-2		3-4
Liver function	Child-Pugh A-B	Child-Pugh A-B		Child-Pugh A-B	Child-Pugh A-B		Child-Pugh C
Tumor stage	Single	Single or 3 nodules < 3 cm		Multinodular	Vascular invasion or extrahepatic spread		Any
CUPI[23]
VARIABLE		Weight
TNM stage	I and II	-3
	III	-1
	IV	0
Total Bilirubin (μmol ⁄ L)	< 34	0
	34-51	3
	≥ 52	4
Ascites		3
Alpha-fetoprotein > 500 ng/mL		2
Alkaline phosphatase > 200 IU/L		3
Asymptomatic disease on presentation		-4
JIS[24]
	Score
	0	1	2	3
Child-Pugh score	A	B	C
TNM stage by LCSGJ	I	II	III	IV
Tokyo[22]
	Score
	0	1	2
Albumin (g/dL)	> 3.5	2.8-3.5	< 2.8
Bilirubin (mg/dL)	< 1	1-2	> 2
Tumor size (cm)	< 2	2-5	> 5
Numbers of nodules	≤ 3	-	> 3
AJCC/UICC TNM staging system 7th ed[12]
Group	Description			Stage grouping
T1	Single tumor without vascular invasion			STAGE I	T1	N0	M0
T2	Single tumor with vascular invasion or multiple tumors, none > 5 cm			STAGE II	T2	N0	M0
T3a	Multiple tumors, any > 5 cm			STAGE IIIA	T3a	N0	M0
T3b	Single tumor or multiple tumors of any size involving a major branch of portal or hepatic vein(s)			STAGE IIIB	T3b	N0	M0
T4	Tumors with direct invasion of adjacent organs other than the gallbladder, or perforation of visceral peritoneum			STAGE IIIC	T4	N0	M0
N1	Regional lymph node metastasis			STAGE IVA	Any T	N1	M0
M1	Distant metastasis			STAGE IVB	Any T	Any N	M1

AJCC: American Joint Committee on Cancer; UICC: International Union Against Cancer; CLIP: Cancer of the Liver Italian Program; GRETCH: Groupe d’Etude et de Traitement du Carcinome Hépatocellulaire; BCLC: Barcelona clinic liver cancer; CUPI: Chinese University Prognostic Index for hepatocellular carcinoma; JIS: Japan Integrated Staging Score; TNM: Tumor Node Metastasis; ECOG: Eastern Cooperative Oncology Group; LCSGJ: Liver Cancer Study Group of Japan.