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    Patent Pending

    TNM Staging for Hepatocellular Carcinoma (HCC)

    Stages hepatocellular carcinoma based on tumor, lymph node and metastasis characteristics.
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    When to Use
    Pearls/Pitfalls
    Why Use

    Patients diagnosed with hepatocellular carcinoma (HCC) who have undergone surgical resection.

    • Stages HCC by tumor, nodes, and metastasis characteristics.
    • Requires pathologic specimen for evaluation, thus limiting its use since most HCC patients do not undergo surgical resection.
    • Does not account for liver function, which is a known prognostic factor in HCC and cirrhosis.
    • Gives prognosis of HCC when pathologic data is available.
    • Barcelona Clinic Liver Cancer (BCLC) staging may be more clinically useful, as it incorporates liver function and patient functional status, and does not require a pathologic specimen.

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • National Comprehensive Cancer Network (NCCN) guidelines use TNM staging for treatment recommendations, but note that many staging systems exist, all have limitations, and some are region-dependent.
    • Cannot be used in patients who have not had surgical resection.

    Formula

    Staging based on multiple factors including:

    • Primary tumor (T) characteristics
    • Regional lymph nodes (N)
      • Clinical
      • Pathological
    • Distant metastasis (M)

    Facts & Figures

    Stage T N M
    I T1 N0 M0
    II T2 N0 M0
    IIIA T3a N0 M0
    IIIB T3b N0 M0
    IIIC T4 N0 M0
    IVA Any T N1 M0
    IVB Any T Any N M1

    Survival by stage, from Kee et al, 2013:

    Stage 5-year survival
    With treatment Without treatment
    I 37.9% 9.4%
    II 36.1% 7.3%
    IIIA 26.3% 6.6%
    IIIB 18.8% 6.0%
    IIIC 29.1% 14.3%
    IVA 28.6% 20.0%
    IVB 20.9% 17.1%

    Evidence Appraisal

    • The TNM staging system for HCC, like all TNM staging systems, was developed by the American Joint Committee on Cancer (AJCC).
    • The data have been validated with prospective data from 8,828 patients (Kee 2013), showing significant differences in survival among stages. 

    Literature

    Dr. Stephen Edge

    About the Creator

    Stephen B. Edge, MD, FACS, FASCO, is an adjunct professor of surgery at Vanderbilt University and the current director of the Baptist Cancer Center. Dr. Edge has co-chaired the 2010 Breast Cancer Symposium and Guideline Panel for Postmastectomy Radiation and is serving on the editorial board of the Journal of Oncology Practice. His research focuses on staging systems and risk stratification for many types of cancers.

    To view Dr. Stephen Edge's publications, visit PubMed