The Consensus Panel makes the following recommendations based on the above currently available evidence.
- 1The primary staging should be clinical staging, which can be applied to all patients. The CLIP system should be the clincial staging system of choice, because it is generally applicable to most patients, it includes easily collected variables. Most importantly, it has been externally and prospectively validated. As a caveat, the CLIP system may not be applicable to patients with chronic hepatitis B.
- 2A secondary staging system for patients undergoing resection or liver transplantation is needed. The AJCC version of the modified TNM system should be used because it has been internally validated, although external and prospective validation is still lacking. Furthermore, it conforms to the TNM standard.
- 3Since neither of these systems is free of limitations, other factors which might be included in accessing prognosis include treatment-directed variables (according to BCLC), the etiology of the underlying liver disease, and newly discovered factors affecting tumor biology.
- 4All studies on HCC where it is appropriate to use staging should use one or both of these staging systems (CLIP and AJCC) to define the patient population. Medical journals considering such manuscripts for publication should insist on cohorts being classified according to these staging systems (excluding, of course, those studies looking at improving staging systems).
- 5Further studies on the validation of staging systems and harmonization of the different systems are urgently required.