HCC Staging

Barcelona Clinic Liver Cancer (BCLC) staging of HCC was determined at the time of HCC diagnosis, as recorded in the national VA Cancer Registry or initial ICD-9 diagnosis (28). For each patient, BCLC data elements, including tumor number and size, presence of extrahepatic metastases, Eastern Cooperative Oncology Group performance status, and laboratory and clinical criteria required for determination of Child-Turcotte-Pugh score, were recorded onto a structured form based on review of radiology reports and specialty care clinical notes (i.e., oncology, gastroenterology, surgery, or tumor board review) recorded within three months prior to or after liver tissue sampling (29). When more than one laboratory or clinical assessment was obtained within this time period, we used the assessment obtained closest to liver tissue sampling date.