Staging systems of hepatocellular carcinoma: A review

Sreeshma Tellapuri, Patrick D. Sutphin, Muhammad S Beg, Amit Singal, Sanjeeva P Kalva

Research output: Contribution to journalReview articlepeer-review

76 Scopus citations


Staging of hepatocellular carcinoma (HCC) is necessary for guiding prognostication, management, and research purposes that further aid in the improvement of existing clinical and epidemiological health services. Though there are some new staging systems for HCC developed in different parts of the world, there is no globally accepted staging system that allows for comparison of current management protocols among heterogeneous populations. In this review, we discuss the evolution and applicability in clinical practice of different clinical staging systems of HCC—Okuda, CLIP (Cancer of the Liver Italian Program) score, MESIAH (Model to Estimate Survival In Ambulatory HCC patients) score, ITA.LI.CA (Italian Liver Cancer) score, BCLC (Barcelona Clinic Liver Cancer) staging, HKLC (Hong Kong Liver Cancer) staging, and the Alberta algorithm. This review aims to highlight the main criteria for assessing the prognosis of HCC that these different staging systems take into account, their strengths and limitations for use in modern clinical practice. Despite the limitations of the BCLC staging system, it remains the most validated and reliable system for prognostication. However, there is a need to update the BCLC staging system to include recent data on locoregional and systemic therapies for HCC, expanded criteria for transplantation, and systemic therapy for hepatitis C infection.

Original languageEnglish (US)
Pages (from-to)481-491
Number of pages11
JournalIndian Journal of Gastroenterology
Issue number6
StatePublished - Nov 13 2018


  • Alberta algorithm
  • BCLC staging
  • CLIP score
  • HKLC staging
  • MESIAH score

ASJC Scopus subject areas

  • Gastroenterology


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