Published online Mar 27, 2015. doi: 10.4254/wjh.v7.i3.521
Peer-review started: August 28, 2014
First decision: September 19, 2014
Revised: October 2, 2014
Accepted: November 27, 2014
Article in press: November 27, 2014
Published online: March 27, 2015
Several hepatocellular carcinoma (HCC) staging systems have been established, and a variety of country-specific treatment strategies are also proposed. The barcelona - clinic liver cancer (BCLC) system is the most widely used in Europe. The Hong Kong liver Cancer is a new prognostic staging system; it might become the reference system in Asia. Transarterial chemoembolization (TACE) is the most widely used treatment for HCC worldwide; but it showed a benefit only for intermediate stage HCC (BCLC B), and there is still no consensus concerning treatment methods and treatment strategies. In view of the highly diverse nature of HCC and practices, a scoring system designed to assist with decision making before the first TACE is performed or prior to repeating the procedure would be highly useful.
Core tip: Despite its widespread use in hepatocellular carcinoma, the indications for Transarterial chemoembolization are still debated. There are no rules about the treatment modalities or strategy to follow. To overcome these difficulties, a simple scoring system, including prognostic variables, designed as a decision support, would be useful. Deciding when we have to move from a loco-regional treatment to a systemic option is matter of significant interest, particularly since sorafenib now provides us with a solution.