TNM staging of hepatocellular carcinoma

In 2015, the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC) issued the eighth edition of the TNM staging for liver cancer.

In the TNM staging system:

  • T (for tumor Tumor) refers to the condition of the primary tumor site;
  • N (for lymph node Node) refers to regional lymph node involvement;
  • M (for Metastasis) refers to distant metastases (usually hematologic).

On this basis, a specific stage is delineated using a combination of the three TNM indicators.

T Category T Criteria
Tx Primary tumors cannot be evaluated
T0 No significant evidence of primary tumor
T1

Single tumor no larger than 2 cm, or single tumor no smaller than 2 cm and no vascular invasion

T1a Single tumor no larger than 2cm
T1b Single tumor not less than 2cm and no vascular invasion

T2

Single tumor not less than 2 cm with vascular invasion, or multiple tumors up to 5 cm

T3 Multiple tumors with a maximum tumor diameter of not less than 5cm
T4

Regardless of tumor number or tumor size, as long as there is vascular invasion of the portal vein or major branches of the hepatic vein; or direct tumor invasion of the gallbladder or other organs other than the peritoneum

T Category N Criteria
Nx Lymph nodes in the region cannot be measured

N0

No lymph node metastasis
N1 with lymph node metastasis

M Categories M Criteria
Mx Distant transfer cannot be measured
M0 No distant metastases
M1 With distant transfer

Staging

T

N M
IA

T1a

N0

M0

IB

T1b

N0

M0

II

T2

N0

M0

IIIA

T3

N0

M0

IIIB

T4

N0

M0

IVA

Any T

N1

M0

IVB

Any T

Any N

M1