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If you have liver cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect a person and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with a person’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together, and they both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic and predictive factors for liver cancer.
The stage is one of the most important prognostic factors for hepatocellular carcinoma. People with liver cancer that is BCLC stage 0 or A have a more favorable prognosis than people with liver cancer that is BCLC stage B, C or D.
People with poor liver function caused by the tumour, scarring of the liver (called cirrhosis) or hepatitis have a less favourable prognosis.
Performance status is the measure of how well a person can do ordinary tasks and carry out daily activities. People with a poor performance status have a less favourable prognosis than people with a good or fair performance status.
People with multiple tumours have a less favourable prognosis than those with only one tumour. When the tumours are in both lobes, the prognosis is poorer than when the tumours are all in one lobe of the liver.
A tumour that has grown into, or invaded, blood vessels has a poor prognosis.
A tumour growing inside the blood vessels has a poor prognosis.
A tumour larger than 5 cm has a less favourable prognosis than smaller tumours.
Fibrolamellar carcinoma has a more favourable prognosis than other types of liver cancer. These tumours do not grow very deeply into the surrounding tissues, so doctors can usually completely remove them with surgery.
The Child-Pugh score is used to determine when it is safe to perform surgery. It is a scoring system that measures the level of liver damage or failure caused by cirrhosis (an abnormal condition in which healthy liver tissue is replaced by scar tissue). It looks at the following factors (each factor is given between 1 and 3 points):
|Factor||Number of points given|
grade 1 – mild
some changes to mental and physical function
grade 2 – moderate
many changes to mental and physical function
grade 3 – poor
significant changes to mental and physical function
grade 4 – severe
significant changes to mental and physical function or coma
less than 2
between 2 and 3
greater than 3
greater than 3.5
between 2.8 and 3.4
less than 2.8
prolongation of prothrombin time (seconds)
between 1 and 3
between 4 and 6
greater than 6
The total number of points across the categories are added together to get the Child-Pugh score:
A high Child-Pugh score means that surgery is not safe to do and should not be performed. People who can’t have surgery have a less favourable prognosis than people who can have surgery to remove liver cancer.
I’m extremely grateful to the Canadian Cancer Society for funding my research with an Innovation Grant.
The Canadian Cancer Society’s peer support program is a telephone support service that matches cancer patients and their caregivers with specially trained volunteers.