BCLC

The Barcelona Clinic Liver Cancer (BCLC) staging system is a widely used framework for hepatocellular carcinoma (HCC). Developed in the 1990s by clinicians at the Barcelona Clinic Liver Cancer group, it integrates prognosis with treatment recommendations to guide management across disease stages.

The system divides patients into five stages: 0 (very early), A (early), B (intermediate), C (advanced), and D (terminal). It relies on three core domains: liver function (commonly assessed by Child-Pugh class), performance status (ECOG), and tumor characteristics (size, number of nodules, vascular invasion, and distant spread). The conventional definitions are: Stage 0: very early disease with a single lesion ≤2 cm and preserved liver function; Stage A: early disease, a single lesion >2 cm or up to 3 nodules each ≤3 cm; Stage B: intermediate, multinodular disease without vascular invasion; Stage C: advanced, involving vascular invasion or extrahepatic metastasis; Stage D: end-stage disease with poor liver function or performance status.

Treatment implications: Stage 0/A aim for potentially curative options such as surgical resection, liver transplantation, or ablation in selected patients; Stage B typically treated with locoregional therapies like transarterial chemoembolization (TACE); Stage C generally managed with systemic therapy; Stage D focuses on palliative care. The scheme aims to balance tumor control with liver function and overall health.

BCLC remains a reference framework in many guidelines, though it has been refined and debated as new therapies emerge. Critics note its rigid stage-specific recommendations may not suit all patients, and alternative systems or modifications, including considerations of ALBI liver function grading or immunotherapy-specific approaches, have been proposed.