Prognosis estimation in patients with
hepatocellular carcinoma (HCC) can provide information at diagnosis and can indicate
therapy. Because
cirrhosis underlies HCC in most individuals, their outcome is related to both entities, which determine the applicability and efficacy of
therapy. Accordingly, prognostic modelling should consider
tumor stage, liver function impairment, the patient's general condition, and treatment efficacy. We have developed a system that stratifies patients into four categories, simultaneously setting prognosis and guiding the
therapy. Patients with HCC (single HCC < or =5 cm or three or fewer nodules < or =3 cm) benefit from curative/effective
therapies (resection,
transplantation, and percutaneous ablation), expert application of which provides a 50% to 75% 5-year survival. Those with more advanced disease present a heterogenous outcome. Patients who do not present with
cancer-related symptoms and whose
tumor has not invaded vascular vessels or disseminated outside the liver may reach 50% survival at 3 years, and they benefit from chemoembolization. Those who present with symptoms (
pain, deterioration of physical condition) and/or an aggressive
tumor pattern do not reach
a 10% survival at 3 years, and there is no effective
therapy for them. Finally, those with severe liver function or health status impairment constitute the end-stage category and cannot be expected to survive more than 1 year.