Advances in non-surgical management of primary liver cancer

Table 1 American Joint Committee on Cancer Tumor Node Metastasis staging system

Stage	Tumor	Node	Metastasis
Stage I	T1: Solitary tumor without vascular invasion	N0: No regional lymph	M0: No distant metastasis
Stage II	T2: Solitary tumor with vascular invasion or multiple tumors, size < 5 cm	Node metastasis
StageIIIA	T3: Multiple tumors with size > 5 cm or tumor involving a major branch of the portal or hepatic vein(s)
Stage IIIB	T4: Tumor that invades adjacent organs other than the gallbladder or perforates visceral peritoneum
Stage IIIC	Any T	N1: Regional lymph node metastasis
Stage IV	Any T	Any N	M1: Distant metastasis

Table 2 Okuda staging system¹

Criteria	Positive	Negative
Tumor size2	> 50%	< 50%
Ascites	Clinically detectable	Clinically absent
Albumin	< 3 mg/dL	> 3 mg/dL
Bilirubin	> 3 mg/dL	< 3 mg/dL

¹Stage 1: No positive criteria; Stage 2: 1-2 positive criteria; Stage 3: 3-4 positive criteria;

²Measured from the largest cross-sectional area of tumor to the largest cross-sectional area of the liver.

Table 3 Cancer of the Liver Italian Program staging system

Criteria	Points
Child-Pugh stage
A	0
B	1
C	2
Tumor morphology
Uni-nodular and extension ≤ 50%	0
Multinodular and extension ≤ 50%	1
Massive or extension > 50%	2
Alpha-fetoprotein level
< 400 ng/mL	0
≥ 400 ng/mL	1
Portal vein thrombosis
No	0
Yes	1

Table 4 Barcelona Clinic Liver Cancer staging system

Stage	PST1	Tumor stage2/cancer symptoms	Hepatic function	Recommended treatment
0 (very early)	0	Single nodule < 2 cm	Child-Pugh A; normal portal pressure; normal bilirubin	Resection
A (early)	0	Single nodule < 5 cmUp to 3 nodules, < 3 cm each	Child-Pugh A; elevated portal pressure and/or elevated bilirubin	Liver transplantations or PEI/RFA34
B (intermediate)	0	Large, multinodular; no cancer symptoms	Child-Pugh A-B	TACE
C (advanced)	1-2	Portal invasion, extrahepatic disease, or cancer symptoms	Child-Pugh A-B	New anti-tumoral agents
D (terminal)	> 2	Any of the above	Child-Pugh C	Symptomatic treatment

¹PST evaluated using the World Health Organization’s performance status scoring system (also known as the Eastern Cooperative Oncology Group System or the Zubrod system);

²N1 or M1 under American Joint Committee on Cancer's Tumor Node Metastasis staging system;

³Recommended in the absence of associated diseases;

⁴PEI/RF is recommended in the presence of associated diseases. PEI: Percutaneous ethanol injection; PST: Performance status; REA: Radiofrequency ablation; TACE: Transarterial chemoembolization.

Table 5 Chinese University Prognostic Index risk groups in hepatocellular carcinoma

Parameter	Weight (CUPI score)
Bilirubin (mg/mL)	< 1.9	0	1.9-2.8	3	> 2.9	4
Ascites	Present	3
Alkaline phosphatase	≥ l ka IU/L	3
TNM stage	I and II	-3	IIIa and IIIb	-1	IVa and IVb	0
AFP (ng/mL)	≥ FP	2
Disease symptoms on presentation	None	-4

Adapted from Leung et al[9]. CUPI: Chinese University Prognostic Index; TNM: Tumor Node Metastasis; AFP: Alpha fetoprotein.