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Management strategy of HCC based on CTP class, size, and performance status

for Health Care Providers

Table 12. Management strategy of HCC based on CTP class, size, and performance status

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CTP, Child-Turcotte-Pugh; HCC, hepatocellular carcinoma, HVPG; hepatic venous pressure gradient; PEI, percutaneous ethanol injection; PS, performance status; RFA, radiofrequency ablation.
CTP A, PS 0Single HCC <2 cmHVPG <10 mm Hg and bilirubin <1.5 mg/dl
  • Surgical resection
Varices/collaterals or HVPG >10 mm Hg or bilirubin >1.5 mg/dl
  • Liver transplant evaluation
  • RFA/PEI
CTP A-B, PS 0-2Single HCC 2-5 cmHVPG <10 mm Hg and bilirubin <1.5 mg/dl
  • Surgical resection
Varices/collaterals or HVPG >10 mm Hg or bilirubin >1.5 mg/dl
  • Liver transplant evaluation
  • RFA/PEI
2 or 3 HCC masses <3 cm (the largest)
  • Liver transplant evaluation
  • Radiofrequency ablation
Intermediate stage (multinodular , PS 0)Transarterial chemoembolization
Advanced stage (portal invasion, metastases)Sorafenib
CTP C, PS >2Terminal stageSymptomatic treatment

From Management and Treatment of Patients with Cirrhosis and Portal Hypertension