In China, we stage liver cancer according to the number and size of tumors, vascular invasion, extrahepatic metastases, Child-Pugh score (commonly used to evaluate liver reserve function in patients with cirrhosis, the higher the grade, the worse the reserve function), and physical status score (PS, the higher the score, the worse the physical status), including: stage Ia, stage Ib, stage IIa, stage IIb, stage IIIa, stage Stage IIIb, Stage IV, and we usually consider Stage Ia, Stage Ib, and Stage IIa to be early stages.
For early stage patients, physicians will preferentially recommend surgical resection, liver transplantation:
- Stage Ia: patient with a single tumor ≤ 5 cm in maximum diameter, no vascular invasion, extrahepatic metastases; liver function Child-Pugh A/B; PS0-2 (mild symptoms, comfortable living, able to perform light physical activities).
- Stage Ib: Patient with a single tumor >5 cm in maximum diameter, no vascular invasion, extrahepatic metastases; liver function Child-Pugh A/B; PS0-2 . Or patients with 2-3 tumors, single tumor maximal diameter ≤ 3 cm, no vascular invasion, extrahepatic metastases; liver function Child-Pugh A/B; PS0-2.
- Stage IIa: Patients with 2 to 3 tumors, single tumor >3 cm in maximum diameter, no vascular invasion, extrahepatic metastases; liver function Child-Pugh A/B; PS0-2.
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Local ablation is recommended for patients with the following conditions:
- Patients presenting with lesions ≤5 cm in diameter suitable for local ablation;
- Patients with 2-3 lesions in different regions
- If the patient presents with deep or central hepatocellular carcinoma ≤3 cm, local ablation is also able to achieve the efficacy of surgical resection.
- Ablation alone is not recommended for lesions >5 cm.
Patients who are not candidates/refusers for surgical resection, liver transplantation with ablation will be recommended for interventional therapy.