Making HKLC Staging Practical at the Point of Care

Hepatocellular carcinoma (HCC) is one of the few cancers where staging must describe both the tumor and the underlying liver disease, and that complexity can make bedside decision‑making challenging. At OncoToolkit, we’ve built an HKLC staging calculator that turns the Hong Kong Liver Cancer (HKLC) algorithm into a fast, interactive tool that any clinician can use in less than a minute at the point of care.¹²³

2. From paper algorithm to usable calculator

The original HKLC publication presents a multi‑step decision tree that can feel cumbersome in a busy clinic or MDT. The OncoToolkit calculator translates this paper algorithm directly into a guided form: you enter ECOG performance status, Child‑Pugh class, vascular invasion, metastasis, tumor number, and maximum diameter, and the tool outputs an HKLC stage with a matched treatment recommendation.³¹

Figure 1. HKLC calculator input panel guiding clinicians through entry of key HKLC variables.⁴

Clinicians simply:

• Select ECOG (PS 0, 1, or ≥2) and Child‑Pugh (A–C).
• Indicate presence or absence of extrahepatic metastasis and intrahepatic venous invasion.
• Choose tumor number (solitary, 2–3 nodules, or >3 nodules) and maximum tumor diameter (≤3 cm, 3–5 cm, or >5 cm).³

Behind the scenes, the calculator follows the published HKLC logic without modification, so each combination maps to the same stage as the original decision tree.¹³

3. Clinical context, evidence, and reference at a glance

For trainees and non‑hepatology oncologists, understanding why a system exists is as important as the final stage label. To support this, the HKLC calculator includes an embedded clinical background panel that summarizes the purpose and evidence base of the system.³

Figure 2. Clinical background section highlighting HKLC’s goal to identify candidates for more aggressive treatment and citing the original Yau et al. Gastroenterology paper.⁵¹

This panel briefly:

• Explains that HKLC was designed to identify intermediate and locally advanced patients who might still benefit from aggressive locoregional or surgical treatments compared with BCLC recommendations.¹³
• Cites the primary source (Yau et al., Gastroenterology 2014) so users can quickly locate the original study for deeper reading.³¹
• Outlines the core formula logic: algorithmic classification based on performance status, Child‑Pugh class, tumor size/number, vascular invasion, and metastasis.³

For quick bedside checking, the calculator also exposes a concise reference table of HKLC stages and treatment suggestions:

Figure 3. Embedded HKLC stage–treatment reference table for rapid review at the point of care.⁶

This table shows:

• Stage I: early disease (solitary ≤5 cm or 2–3 nodules ≤3 cm) → resection or ablation.³
• Stage IIa/IIb: intermediate solitary or multinodular disease → resection (IIa) or TACE (IIb).³
• Stage IIIa/IIIb: locally advanced (PS 1 or Child‑Pugh B, or vascular invasion) → TACE, with resection considered in selected vascular invasion cases.³
• Stage IVa: metastatic disease → systemic therapy.
• Stage IVb: terminal stage (PS >1 or Child‑Pugh C) → supportive care.³

Having this table inline means clinicians can sanity‑check the output and use it for teaching without leaving the calculator page.

4. Making staging decisions transparent

Black‑box scores can be frustrating when you are explaining options to patients or junior colleagues. The OncoToolkit HKLC calculator therefore includes a “calculation logic” section that shows how the stage was assigned for a given patient.³

Figure 4. HKLC calculator result card illustrating terminal Stage IVb with best supportive care and the explicit rule used to reach this classification.⁷

In the example above:

• A patient with ECOG 2 and Child‑Pugh A is immediately classified as HKLC Stage IVb (Terminal), with “Best Supportive Care” highlighted as the recommended pathway.⁷
• The logic section explicitly states the decision rule used, e.g. “Poor PS (2) → Stage IVb,” giving clinicians a transparent rationale for the assignment.⁷

This transparency:

• Helps MDTs and tumor boards trace back how the classification was reached.
• Supports education for trainees learning HKLC criteria.
• Facilitates documentation and communication with patients and families when discussing treatment goals.

6. Try the HKLC calculator in your next MDT

HKLC staging will likely continue to play a major role in regions with HBV‑predominant HCC and in centers that favor more aggressive management of intermediate and locally advanced disease. At OncoToolkit, the goal is to make evidence‑based tools like HKLC easy to use, transparent, and accessible to both specialists and general clinicians.⁸⁹¹

You can explore the HKLC staging calculator, run sample cases, or use it in clinic today at: