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Cancer Health Center

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Adult Primary Liver Cancer Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Stage Information for Adult Primary Liver Cancer

Table 4. Anatomic Stage/Prognostic Groupsa

a Reprinted with permission from AJCC: Liver. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual, 7th ed. New York, NY: Springer, 2010, pp 191-9.

Okuda Staging System

The Okuda staging system includes variables related to tumor burden and liver function, such as bilirubin, albumin, and ascites and has been extensively used in the past. However, many significant prognostic tumor factors confirmed in both surgical and nonsurgical series (e.g., unifocal or multifocal, vascular invasion, portal venous thrombosis, or locoregional lymph node involvement) are not included.[2,3] As a result, Okuda staging is unable to stratify prognosis for early-stage cancers and mostly serves to recognize end-stage cancer patients.

Barcelona Clinic Liver Cancer (BCLC) Staging System

New classifications have been proposed in an effort to overcome the difficulties of having several staging systems. The BCLC staging classification retains its usefulness in early tumors and is currently the most accepted staging system for HCC. Recent evidence from an American cohort has shown that BCLC staging offers better prognostic stratification power than other staging systems.[4]

The BCLC staging system attempts to overcome the limitations of previous staging systems by including variables related to the following:[5]

  • Tumor stage.
  • Functional status of the liver.
  • Physical status.
  • Cancer-related symptoms.

Five stages (0 and A through D) are identified based on the variables mentioned above. Of note, the BCLC staging system links each HCC stage to appropriate treatment modalities. According to the BCLC, patients with early-stage HCC may benefit from curative therapies (i.e., liver transplantation, surgical resection, and radiofrequency ablation techniques); those at intermediate- or advanced-disease stage may benefit from palliative treatments (i.e., transcatheter arterial chemoembolization and sorafenib); however, those at end-stage disease who have a very poor life expectancy are offered supportive care and palliation.


  1. Liver. In: Edge SB, Byrd DR, Compton CC, et al., eds.: AJCC Cancer Staging Manual. 7th ed. New York, NY: Springer, 2010, pp 191-5.
  2. Poon RT, Ng IO, Fan ST, et al.: Clinicopathologic features of long-term survivors and disease-free survivors after resection of hepatocellular carcinoma: a study of a prospective cohort. J Clin Oncol 19 (12): 3037-44, 2001.
  3. Pompili M, Rapaccini GL, Covino M, et al.: Prognostic factors for survival in patients with compensated cirrhosis and small hepatocellular carcinoma after percutaneous ethanol injection therapy. Cancer 92 (1): 126-35, 2001.
  4. Marrero JA, Fontana RJ, Barrat A, et al.: Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort. Hepatology 41 (4): 707-16, 2005.
  5. Llovet JM, Brú C, Bruix J: Prognosis of hepatocellular carcinoma: the BCLC staging classification. Semin Liver Dis 19 (3): 329-38, 1999.

This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http:// cancer .gov or call 1-800-4-CANCER.

WebMD Public Information from the National Cancer Institute

Last Updated: May 28, 2015
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.
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