Prognosis

The 5-year relative survival rate (i.e., rate compared with that of the age/gender/race-matched general population) for liver cancer is 22%. However, hepatocellular carcinoma (HCC) is a very aggressive tumour, and the clinical course and survival depends upon the stage and overall functional status of the liver.[6][161]​ In patients with localised primary liver cancer, the 5-year relative survival is 37%, compared with 3% for patients with distant spread.[6]​

Liver transplantation is the main course of therapy in patients with cirrhosis (including poor liver functional status), and post-transplant outcomes are very good with excellent long-term survival.[162] The 4-year survival rate after liver transplantation is 75%, with a tumour recurrence rate of 8% to 20%.[74][162]

Patients with well-compensated liver disease and good liver functional status may be candidates for surgical resection. The survival rates in non-cirrhotic patients treated with surgical resection are 58% at 3 years and 42% at 5 years.[80]

Patients with intermediate-stage HCC treated with transarterial chemoembolisation (TACE) have a median overall survival of 19-20 months; some cohort studies have reported median survival of up to 40 months in well-selected patients with good TACE response.[163][164] Patients with advanced-stage HCC have been reported to have an overall median survival of 10.7 months.[125]

Barcelona Clinic Liver Cancer (BCLC) staging

Overall, BCLC staging has the best prognostic assessment for survival compared with other staging systems.[77]​ The expected median survival for patients with HCC is >5 years for BCLC stages 0 and A, >2.5 years for BCLC stage B, >2 years for BCLC stage C, and 3 months for BCLC stage D.​[77]

For more information on the BCLC staging system, see Diagnostic criteria.

Cancer of the Liver Italian Programme (CLIP) staging

  • CLIP score of 0: survival is 31 months

  • CLIP score of 1: survival is 27 months

  • CLIP score of 2: survival is 13 months

  • CLIP score of 3: survival is 8 months

  • CLIP scores 4-6: survival is 2 months.

For more information on CLIP staging system see Diagnostic criteria.

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