Prognostic indicators in hepatocellular carcinoma: a systematic review of 72 studies

Hepatocellular carcinoma (HCC) is responsible for significant morbidity and mortality in cirrhosis. It commonly leads to decompensation of cirrhosis and is one of the leading causes of death in cirrhotic patients (1, 2). Identifying the accurate prognostic indicators of death for HCC allows the provider to counsel individual patients and also forms the basis of any decision-making process. Most cases of HCC in the western world occur in the setting of cirrhosis and, therefore, prognosis is determined not only by factors related to the tumour but also by factors related to cirrhosis. In fact, current prognostic models for HCC include parameters of liver dysfunction and parameters related to HCC (3–5). However, studies on the prediction of death in HCC include patients both with and without underlying cirrhosis, and this heterogeneity may impact the clinical utility of current prognostic models. Additionally, one could hypothesize that, as in cirrhosis not associated with HCC (2), the prognostic factors for HCC would be different in patients with underlying compensated vs. decompensated cirrhosis, with factors related to the tumour having a greater prognostic significance in the former and factors related to both tumour and liver disease being more important in the latter. The purpose of this systematic review is to evaluate the predictors of death in patients with HCC and underlying cirrhosis to determine whether the predictors differ between patients with compensated and decompensated cirrhosis.