Clinical calculator summary
CNLC 2024 staging
Clinical calculator summary
CNLC 2024 staging
A seven-stage baseline classification for confirmed hepatocellular carcinoma.
Evidence-based context for fast calculator use
- Purpose:
- Support multidisciplinary description of HCC extent and clinical status.
- Population:
- Patients with confirmed hepatocellular carcinoma undergoing baseline staging.
- Factors:
- ECOG performance status, Child-Pugh class, Tumor count, Largest tumor diameter, Imaging-detected vascular invasion, Extrahepatic metastasis
- Reference:
- China Liver Cancer Guidelines for the Diagnosis and Treatment of Primary Liver Cancer, 2024 edition.
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CNLC 2024 Staging for Hepatocellular Carcinoma
cm
Clinical Context & Background
The China Liver Cancer (CNLC) 2024 staging system classifies confirmed hepatocellular carcinoma at baseline using independently established ECOG performance status and Child-Pugh class, imaging-defined tumor burden, vascular invasion, and extrahepatic metastasis. The stage supports multidisciplinary assessment but does not determine prognosis, transplantation, or treatment eligibility.
Formula Logic
Precedence: ECOG 3-4 or Child-Pugh C → IV; otherwise extrahepatic metastasis → IIIb; otherwise vascular invasion → IIIa; otherwise tumor count and raw maximum diameter determine Ia, Ib, IIa, or IIb.Reference Data
| CNLC stage | Source-defined criteria | Precedence |
|---|---|---|
| Ia | PS 0-2; Child-Pugh A/B; one tumor <=5 cm; no invasion/metastasis | After IV, IIIb, and IIIa exclusions |
| Ib | One tumor >5 cm, or 2-3 tumors with largest diameter <=3 cm | After IV, IIIb, and IIIa exclusions |
| IIa | 2-3 tumors with largest diameter >3 cm | After IV, IIIb, and IIIa exclusions |
| IIb | At least 4 tumors, any diameter | After IV, IIIb, and IIIa exclusions |
| IIIa | Imaging-detected vascular invasion without extrahepatic metastasis | Overrides tumor burden |
| IIIb | Imaging-detected extrahepatic metastasis | Overrides vascular invasion and tumor burden |
| IV | ECOG 3-4 or Child-Pugh C | Highest precedence |
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
When To Use
- At baseline staging of confirmed hepatocellular carcinoma.
- When ECOG status, Child-Pugh class, tumor count, maximum diameter, vascular invasion, and extrahepatic metastasis are established.
How To Interpret
- Stage IV criteria take precedence, followed by IIIb, IIIa, and then tumor-burden stages.
- Solitary 5.0 cm tumors remain Ia; 2-3 tumors measuring 3.0 cm remain Ib.
What To Do Next
- Integrate stage with multidisciplinary imaging review, liver function, comorbidity, preferences, and current guideline recommendations.
Limitations
- Restricted to confirmed HCC; not applicable to cholangiocarcinoma, combined HCC-CCA, or other primary liver tumors.
- Does not calculate Child-Pugh class or classify microscopic-only vascular invasion.
- Does not provide an individualized prognosis or determine treatment or transplant eligibility.
Validated Population
Patients with confirmed HCC staged according to the official Chinese national guideline.
Calculation verification history
Verified
Calculation verification history
Verified: Production browser revalidation
- Three source-backed cases passed through visible production controls at CNLC Stages Ia, IIa, and IIIb.
- Tumor-burden and metastasis precedence branches rendered on first submission.
- No unexpected N/A, literal undefined value, stale control, unsupported gauge, or browser-console error was observed.
Case-level evidence is retained in validation/browser-revalidation/cnlc-china-liver-cancer-staging-2026-08-03.json.
: Local browser remediation
- The complete fresh-page non-HCC submission rendered immediately, and its intentional Not applicable result now uses a CNLC-specific `stage not assigned` receipt instead of a generic missing-or-invalid-input trace.
- Ten source-backed cases passed through visible local browser controls across 11 submissions, covering all seven stages, the 5 cm and 3 cm transitions, vascular/metastasis/poor-host precedence, required-field validation, and reset/repeat behavior.
- The existing calculator-specific audit passed 520/520. The prior one-time missing result is consistent with the separately handled startup hydration condition; production revalidation remains pending deployment.
Local case-level remediation evidence is retained in validation/browser-production/cnlc-china-liver-cancer-staging.local-remediation.json.
: Production browser validation
- Ten source-backed cases were exercised on the public production route through visible browser controls; 9/10 case records passed their expected-versus-observed assertions across 12 visible submissions.
- Overall browser status: failed-calculation-ui-and-console. high: The first complete other-primary-liver-tumor submission produced no result and no validation message. An immediate identical supplemental reproduction returned the correct N/A / Not applicable disposition. | medium: The reproduced correct Not applicable card also displayed `Required input is missing or invalid`, although all controls were complete and the disposition was intentional. | medium: Production emitted minified React error #418 during route loads/reloads used by this run.
- Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.
Case-level production evidence is retained in validation/browser-production/cnlc-china-liver-cancer-staging.json.
: Full validation test
- 520/520 source-oracle, boundary, invalid-input, UI, applicability, trace, registry, report, and isolation checks passed with zero stage mismatch.
- This verifies implementation against the cited CNLC 2024 source; it is not independent clinical validation, prognosis, or treatment advice.
: Calculation and input-contract correction
- Replaced composite self-classification with raw diagnosis, ECOG, Child-Pugh, tumor-count, maximum-diameter, vascular-invasion, and metastasis inputs.
- Corrected the inclusive 5 cm and 3 cm boundaries and implemented Stage IV, IIIb, and IIIa precedence before tumor-burden staging.
- Restricted calculation to confirmed HCC, removed favorable defaults and permissive unknown handling, and separated staging from treatment selection.
Included in the current validation report.
Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.
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Frequently Asked Questions
When should CNLC 2024 Staging for Hepatocellular Carcinoma be used?
Use it for patients undergoing liver-function, hepatocellular carcinoma staging, imaging, or transplant assessment when all required inputs and the intended clinical setting are confirmed.
Can CNLC 2024 Staging for Hepatocellular Carcinoma determine treatment by itself?
No. Interpret the result with the cited evidence, complete clinical assessment, current guidelines, and patient-specific goals.
Evidence-based oncology decision support. Verify with clinical guidelines.