Prognostic prediction in patients with hepatocellular carcinoma.

With most solid tumors, the estimation of life expectancy is related to tumor stage at diagnosis and staging is directly linked to treatment indication. By contrast, in patients with hepatocellular carcinoma (HCC) the prediction of prognosis is more complex. There is no worldwide consensus on the use of any HCC staging system. Classifications that take into account only one of the relevant prognostic parameters, such as tumor, nodes, and metastasis (TNM) or Child-Pugh staging, are useless. Several scoring systems have been developed, but unfortunately their major capacity is to identify end-stage patients and they do not link staging with therapy. The Barcelona Clinic Liver Cancer (BCLC) staging system was developed according to the results of cohort studies and randomized clinical trials. It considers tumor stage, liver functional status, physical status, and cancer-related symptoms and, by dividing patients into early, intermediate, advanced, and end-stage categories, provides a link to treatment indication.