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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 18, 2016; 8(17): 703-715
Published online Jun 18, 2016. doi: 10.4254/wjh.v8.i17.703
Usefulness of staging systems and prognostic scores for hepatocellular carcinoma treatments
Xavier Adhoute, Guillaume Penaranda, Jean Luc Raoul, Patrice Le Treut, Emilie Bollon, Jean Hardwigsen, Paul Castellani, Hervé Perrier, Marc Bourlière
Xavier Adhoute, Paul Castellani, Hervé Perrier, Marc Bourlière, Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, 13008 Marseille, France
Guillaume Penaranda, AlphaBio Laboratory, 13008 Marseille, France
Jean Luc Raoul, Department of Hepato-Gastroenterology and Digestive Oncology, Institut Paoli-Calmette, 13008 Marseille, France
Patrice Le Treut, Emilie Bollon, Jean Hardwigsen, Department of Hepatobiliary Surgery, Centre Hospitalo-Universitaire Timone, 13008 Marseille, France
Author contributions: Adhoute X, Le Treut P, Bollon E, Hardwigsen J, Castellani P, Perrier H and Bourlière M collected the data; Penaranda G proceeded to statistical analysis; Adhoute X, Penaranda G, Raoul JL and Bourlière M wrote the manuscript.
Conflict-of-interest statement: Raoul JL, Board member (Bayer, BMS, Daichi). Bourliere M, Board member (Merck-Schering Plough, Gilead, Janssen, Vertex, Boehringer-Ingelheim, BMS, Roche, Abbvie, GSK); Speaker (Merck-Schering Plough - Gilead, Janssen, Vertex, Boehringer-Ingelheim, BMS, Roche, Abbvie, Novartis, GSK). Adhoute X, Penaranda G, Bollon E, Castellani P, Perrier H, Hardwigsen J and Le Treut P declare that they have no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Xavier Adhoute, Department of Hepato-Gastroenterology, Hôpital Saint-Joseph, 26 Bd de Louvain, 13008 Marseille, France. adhoute.xavier@neuf.fr
Telephone: +33-49-1807065 Fax: +33-49-1806912
Received: February 17, 2016
Peer-review started: February 19, 2016
First decision: April 5, 2016
Revised: April 24, 2016
Accepted: May 17, 2016
Article in press: May 27, 2016
Published online: June 18, 2016
Abstract

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.

Keywords: Scoring system, Hepatocellular carcinoma, Barcelona Clinic Liver Cancer staging system, NIACE, Transarterial chemoembolization

Core tip: Different scores or classification systems have been proposed to refine hepatocellular carcinoma prognosis and better guide medical treatment. The Barcelona Clinic Liver Cancer (BCLC) system has become the reference classification in Western countries. Its treatment algorithm is based on randomized studies, but only offers one recommendation for BCLC stages B and C, whereas they include a broad spectrum of tumors. In clinical practice, many patients are treated out of the scope of these recommendations. In this context, alternative scores or classifications, which have been opposed for a long time, could be complementary tools for the benefit of the treatment.