Hepatocellular Carcinoma Staging 

Updated: Jan 04, 2017
  • Author: Terence D Rhodes, MD, PhD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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TNM Classification for Hepatocellular Carcinoma

The American Joint Committee on Cancer (AJCC) tumor/node/metastasis (TNM) classification, staging, fibrosis score, and histologic grade systems for hepatocellular carcinoma are provided below. [1] Note that these are based on the AJCC Cancer Staging Manual, 7th Edition (2010). Although the 8th edition has been published, implementation of the new system has been delayed until January 1, 2018. The AJCC advises that, "All newly diagnosed cases through December 31st 2017 should be staged with the 7th edition." [2]

Table 1. TNM Classification for Hepatocellular (Open Table in a new window)

Primary tumor (T)
TX Primary tumor cannot be assessed
T0 No evidence of primary tumor
T1 Solitary tumor without vascular invasion
T2 Solitary tumor with vascular invasion or multiple tumors, none > 5 cm
T3a Multiple tumors > 5 cm
T3b Single tumor or multiple tumors of any size involving a major branch of the portal or hepatic vein
T4 Tumor(s) with direct invasion of adjacent organs other than gallbladder or with visceral peritoneum
Regional lymph nodes (N)
NX Regional lymph nodes cannot be assessed
N0 No regional lymph node metastasis
N1 Regional lymph node metastasis
Distant metastasis (M)
M0 No distant metastasis
M1 Distant metastasis

Table 2. Anatomic stage/prognostic groups (Open Table in a new window)

Stage T N M
I T1 N0 M0
II T2 N0 M0
IIIA T3a N0 M0
IIIB T3b N0 M0
IIIC T4 N0 M0
IVA Any T N1 M0
IVB Any T Any N M1

Table 3. Fibrosis score (Open Table in a new window)

Fibrosis score (F)
Fibrosis score as defined by Ishak is recommended because of its prognostic value in overall survival. This scoring system uses a 0-6 scale.
F0 Fibrosis score 0-4 (none to moderate fibrosis)
F1 Fibrosis score 5-6 (severe fibrosis or cirrhosis)

Table. 4 Histologic grade (Open Table in a new window)

Histologic grade (G)
G1 Well differentiated
G2 Moderately differentiated
G3 Poorly differentiated
G4 Undifferentiated