Several classifications can be distinguished for hepatocellular carcinoma (hepatocellular carcinoma; HCC):
Eggel macroscopic classification
- Diffuse – about five percent of cases
- Expansive – up to 20% of cases.
- Mixed type – in up to > 40% of cases.
- Infiltrative – circa 33% of cases.
Microscopic classification
- Acinar type (pseudoglandular) – with glandular structures.
- Solid type (compact) – with poorly differentiated liver cells.
- Trabecular type – with highly differentiated tumor cells, similar to liver cells.
- Cirrhotic type (cell-poor).
CLIP score (Cancer of the Italian Liver Program).
Parameters | 0 points | 1 point | 2 points |
Tumor node | Singular | Multiple | – |
Affected liver in % | < 50 | < 50 | > 50 |
Child-Pugh score | A | B | C |
α-Fetoprotein | <400 ng/ml | ≥ 400 ng/ml | – |
Portal vein thrombosis on CT | No | Yes | – |
CLIP 0 – 0 points CLIP 1 – 1 point CLIP 2 – 2 points CLIP 3 – 3 points
Okuda classification
Extent of affected liver | Ascites | Albumin in g/l | Bilirubin in mg/dl | ||||
≥ 50 % | < 50 | + | – | ≤3 | > 3 | ≥ 3 | < 3 |
(+) | (-) | (+) | (-) | (+) | (-) | (+) | (-) |
Okuda stage 1 – all (-) Okuda stage 2 – 1-2 x (+) Okuda stage 3 – 3-4 x (+)
TNM classification
T | Infiltration depth of the tumor |
T1 | No vascular invasion |
T2 | Vascular invasion or multiple tumors <5 cm |
T3 | Multiple tumors > 5 cm or involvement of a branch of the hepatica/V. portae vein |
T4 | Invasion of an adjacent organ (not gallbladder!) or perforation of visceral peritoneum |
N | Lymph node involvement |
N0 | No lymph node metastases |
N1 | Regional lymph node metastases |
M | Metastases |
M0 | No distant metastases |
M1 | Distant metastases |
UICC/TNM classification for staging (increasingly rarely used).
UICC stage | TNM stages | ||
I | T1 | N0 | M0 |
II | T2 | N0 | M0 |
IIIa | T3 | N0 | M0 |
IIIb | T4 | N0 | M0 |
IIIc | Any T | N1 | M0 |
IIId | each T | Each N | M1 |
Milan criteria (Milan criteria)
Patients transplanted within the Milan criteria have better long-term survival (75% at four years). The Milan criteria are defined as follows:
- A lesion smaller than 5 cm
- Up to three lesions, each smaller or no larger than 3 cm
- No extrahepatic manifestation
- No vascular invasion (e.g., tumor thrombosis of the portal vein or hepatic veins)
Consideration of AFP may complement the Milan criteria: AFP concentration (= proliferation marker of HCC) of less than 100 ng/ml lowered the five-year recurrence risk from 47.6% ± 11.1% to 14.4% ± 5.3% (p = 0.006). AFP concentrations greater than 1,000 ng/ml increased the five-year recurrence risk (37.1% ± 8.9% vs. 13.3% ± 2.0%).