Indian Journal of Gastroenterology

, Volume 37, Issue 6, pp 481–491 | Cite as

Staging systems of hepatocellular carcinoma: A review

  • Sreeshma TellapuriEmail author
  • Patrick D. Sutphin
  • Muhammad S. Beg
  • Amit G. Singal
  • Sanjeeva P. Kalva
Review Article


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.


Alberta algorithm BCLC staging CLIP score HKLC staging ITA.LI.CA MESIAH score 


Compliance with ethical standards

Conflict of interest

ST, PDS, MSB, AGS, and SPK declare that they have no conflict of interest.


The authors are solely responsible for the data and the content of the paper. In no way the Honorary Editor-in-Chief, Editorial Board Members, or the printer/publishers are responsible for the results/findings and content of this article.


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Copyright information

© Indian Society of Gastroenterology 2018

Authors and Affiliations

  • Sreeshma Tellapuri
    • 1
    Email author
  • Patrick D. Sutphin
    • 1
  • Muhammad S. Beg
    • 2
  • Amit G. Singal
    • 3
  • Sanjeeva P. Kalva
    • 1
  1. 1.Division of Vascular and Interventional Radiology, Department of RadiologyUniversity of Texas Southwestern Medical CenterDallasUSA
  2. 2.Department of Medical OncologyUniversity of Texas Southwestern Medical CenterDallasUSA
  3. 3.Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasUSA

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