Barcelona-Clinic Liver Cancer (BCLC) Staging Classification and Treatment Guidelines

Why Use

Links stage and prognosis to treatment strategy. Alternative staging systems include TNM and Okuda classifications. TNM staging only accounts for tumor/node/metastasis characteristics (excludes liver function and patient functional status) and Okuda classification is less precise in stratifying earlier-stage tumors. Child-Pugh and MELD scores also stratify HCC patients by prognostic factors.

When to Use

Patients diagnosed with hepatocellular carcinoma (HCC). This calc reflects the 2022 updates.

Formula

Pearls / Pitfalls

Classifies hepatocellular carcinoma into one of 5 stages (0 and A-D), with corresponding recommendations for treatment modalities. Takes into account tumor features AND liver functional status, which are both known to affect prognosis. Also accounts for presence of cancer-related symptoms. Staging system of choice of the American Association for the Study of Liver Disease (AASLD) and European Association for the Study of the Liver (EASL).

Advice

Patients with stage 0 (very early stage) should be considered for ablation or resection. Patients with stage A HCC (early) may be considered for surgical resection, ablation, or transplant depending on clinical factors. Patients with stage B or C HCC (intermediate or advanced, respectively) should be considered for palliative treatment including transarterial chemoembolization (TACE) or novel chemotherapy agents. Patients with stage D HCC (end-stage) should undergo supportive treatment only.