What is the best staging system for hepatocellular carcinoma in the setting of liver transplantation?

✍ Scribed by Kim M. Olthoff; Alejandro Forner; Stefan Hübscher; John Fung

• Publisher: John Wiley and Sons
• Year: 2011
• Tongue: English
• Weight: 106 KB
• Volume: 17
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.22352

✦ Synopsis

The purposes of cancer staging are (1) to accurately predict a patient's prognosis and (2) to determine the appropriate interventions. Hepatocellular carcinoma (HCC) is somewhat unique: it usually affects patients with underlying liver disease, and both tumor burden and liver function need to be carefully evaluated at the time of the prognostic prediction and the treatment recommendation. The liver disease stage has a significant impact on the chosen treatment, and symptoms such as encephalopathy, coagulopathy, fluid overload, and poor synthetic function affect a patient's ability to endure the treatment. The extent of the tumor, symptoms such as limiting asthenia, anorexia, and pain, and impaired performance status also have a high prognostic value. Conversely, the type of treatment can have a significant impact on the prognosis. Therefore, when the optimal staging system for HCC is being considered, it is important for the tumor burden, the presence of symptomatic diseases, and the functional status to be considered in the assessment of each system.

In the setting of liver transplantation, however, we have to determine which patients will benefit most from liver transplantation. Hence, the staging systems in this scenario should not be focused on the selection of the best treatment for patients. Instead, the staging systems should be designed to identify the best candidates for liver transplantation, and the results should be compared to those for patients without HCC.