Hepatocellular carcinoma classification
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dildar Hussain, MBBS [2]
Overview
Hepatocellular carcinoma (HCC) may be classified into different histological subtypes based on the microscopic features. The TNM staging system is widely used for the staging of hepatocellular carcinoma, the Cancer of the Liver Italian Program (CLIP) system is used widely because it is adapted from the original Okuda classification system that takes cirrhosis into account.
Classification
Classification based on histological features
- Hepatocellular carcinoma may be classified into different histological subtypes based on the microscopic features:[1][2][3]
- Fibrolamellar carcinoma
- Sarcomatoid HCC
- Undifferentiated carcinoma
- Combined HCC-
cholangiocarcinoma (HCC-CC) - Lymphoepithelioma
- Scirrhous hepatocellular carcinoma (scirrhous HCC)
- Trabecular hepatocellular carcinoma
- Pseudoglandular hepatocellular carcinoma
- Acinar hepatocellular carcinoma
- Compact hepatocellular carcinoma
| Hepatocellular carcinoma | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Fibrolamellar carcinoma | Undifferentiated carcinoma | Sarcomatoid HCC | Combined HCC-CC* | Lymphoepithelioma | Scirrhous HCC | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Abbreviations: Combined HCC-cholangiocarcinoma (HCC-CC)*
Classification based on TNM staging
According to the TNM staging system, there are four stages of hepatocellular carcinoma based on the tumor size, lymph node involvement, and distant metastasis. Although the TNM staging system is widely used for the staging of hepatocellular carcinoma, the Cancer of the Liver Italian Program (CLIP) system is preferable because it is adopted from the original Okuda classification system that takes cirrhosis into account.
TNM staging system
According to the TNM staging system, there are four stages of hepatocellular carcinoma based on the tumor size, lymph node involvement, and distant metastasis.[4]
Primary tumor
| Primary tumor | Interpretation |
| TX | Primary tumor cannot be assessed |
| T0 | No evidence of primary tumor |
| T1 | A single tumor with no invasion into the blood vessels of the liver |
| T2 | A single tumor with invasion into the blood vessels or multiple tumors, none more than 5 cm in size |
| T3a | Multiple tumors, with any tumor larger than 5 cm |
| T3b | The tumor has grown into either the portal or hepatic vein |
| T4 | The tumor has grown into nearby organs (other than the gallbladder) or the tumor has grown into the layer of tissue that covers the organs in the abdomen (visceral peritoneum) |
Regional lymph node
| Lymph node involvement | Interpretation |
| NX | Regional lymph nodes cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Regional lymph node metastasis |
Distant metastasis
| M0 | No distant metastasis |
| M1 | Distant metastasis |
Clip and Okuda staging systems for hepatocellular carcinoma
Cancer of the Liver Italian Program (CLIP) system is used widely because it is adopted from the original Okuda classification system that takes cirrhosis into account.
CLIP Classification
| Variable | Points | ||
|---|---|---|---|
| 0 | 1 | 2 | |
| i.Tumor number (%) | Single | Multiple | – |
| Hepatic replacement by tumor | <50 | <50 | >50 |
| ii. Child-Pugh score | A | B | C |
| iii. α fetoprotein level (ng/mL) | <400 | ≥400 | – |
| iv.Portal vein thrombosis (CT) | No | Yes | – |
| CLIP stages (score = sum of points): CLIP 0, 0 points; CLIP 1, 1 point; CLIP 2, 2 points; CLIP 3, more than 3
points. | |||
OKUDA Classification
| OKUDA Classification | |||||||
| Tumor extenta | Bilirubin (mg/dL) | Albumin (g/L) | Ascites | ||||
| ≥50% | <50 | ≥ 3 | <3 | ≤3 | >3 | + | – |
| (+) | (−) | (+) | (−) | (+) | (−) | (+) | (−) |
| Okuda stages: stage 1, all (−); stage 2, 1 or 2 (+); stage 3, 3 or 4 (+) | |||||||
a. Liver span occupied by the tumor.
Adopted from Harrison's Textbook of Medicine*
References
- ↑ Shafizadeh N, Kakar S (2013). "Hepatocellular Carcinoma: Histologic Subtypes". Surg Pathol Clin. 6 (2): 367–84. doi:10.1016/j.path.2013.03.007. PMID 26838979.
- ↑ Matsuura S, Aishima S, Taguchi K, Asayama Y, Terashi T, Honda H, Tsuneyoshi M (2005). "'Scirrhous' type hepatocellular carcinomas: a special reference to expression of cytokeratin 7 and hepatocyte paraffin 1". Histopathology. 47 (4): 382–90. doi:10.1111/j.1365-2559.2005.02230.x. PMID 16178893.
- ↑ Drebber, U.; Dienes, H. P. (2006). "Diagnose und Differenzialdiagnose des hepatozellulären Karzinoms". Der Pathologe. 27 (4): 294–299. doi:10.1007/s00292-006-0842-1. ISSN 0172-8113.
- ↑ Canadian Cancer Society.http://www.cancer.ca/en/cancer-information/cancer-type/liver/staging/?region=ab