title: Pretreatment assessment of hepatocellular carcinoma: expert consensus statement.
abstract: Staging of hepatocellular carcinoma (HCC) is complex and relies on multiple factors including tumor extent and hepatic function. No single staging system is applicable to all patients with HCC. The staging of the American Joint Committee on Cancer / International Union for Cancer Control should be used to predict outcome following resection or liver transplantation. The Barcelona Clinic Liver Cancer scheme is appropriate in patients with advanced HCC not candidate for surgery. Dual phase computed tomography or magnetic resonance imaging can be used for pretreatment assessment of tumor extent but the accuracy of these methods remains poor to characterize < 1 cm lesions. Assessment of tumor response should not rely only on tumor size and new imaging methods are available to evaluate response to therapy in HCC patients. Liver volumetry is part of the preoperative assessment of patients with HCC candidate for resection as it reflects liver function. Preoperative portal vein embolization is indicated in patients with small future liver remnant (≤ 20% in normal liver; ≤ 40% in fibrotic or cirrhotic liver). Tumor size is not a contraindication to liver resection. Liver resection can be proposed in selected patients with multifocal HCC. Besides tumor extent, surgical resection of HCC may be performed in selected patients with chronic liver disease.
authors.affiliation: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA. jvauthey@mdanderson.org
authors.forename: Jean-Nicolas
authors.initials: JN
authors.lastname: Vauthey
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
authors.forename: Eddie K
authors.initials: EK
authors.lastname: Abdalla
authors.forename: W Scott
authors.initials: WS
authors.lastname: Helton
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Pawlik
authors.forename: Bachir
authors.initials: B
authors.lastname: Taouli
authors.forename: Antoine
authors.initials: A
authors.lastname: Brouquet
authors.forename: Reid B
authors.initials: RB
authors.lastname: Adams
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D017024:Chemotherapy, Adjuvant; D006498:Hepatectomy; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging / Q000379:methods; D018579:Patient Selection; D011237:Predictive Value of Tests; D018714:Radiotherapy, Adjuvant; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor