What is the Barcelona-Clinic Liver Cancer staging system for hepatocellular carcinoma (HCC)?

Updated: Mar 23, 2020
  • Author: Anand D Patel, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Answer

Answer

In addition to the TNM staging for HCC, other systems have been proposed to help guide therapeutic strategies. One of these validated systems is the Barcelona-Clinic Liver Cancer staging system (BCLC). The BCLC system stratifies HCC patients based on tumor size, extent, liver function, and performance status. The BCLC staging system is thought to be better than other staging systems for determining prognosis, given the inclusion of liver function and performance status. [3, 4]  

Table 4. Barcelona-Clinic Liver Cancer staging system (Open Table in a new window)

Stage

Performance Status

Tumor Stage

Okuda Stage

Liver function

A: Early HCC

       

A1

0

Single, < 5 cm

I

No portal hypertension, normal bilirubin

A2

0

Single, < 5 cm

I

Portal hypertension, normal bilirubin

A3

0

Single, < 5 cm

I

Portal hypertension, abnormal bilirubin

A4

0

3 tumors, < 3 cm

I-II

Child-Pugh A-B

Stage B: Intermediate HCC

0

Large, multinodular

I-II

Child-Pugh A-B

Stage C: Advanced HCC

1-2

Vascular invasion or extrahepatic spread

I-II

Child-Pugh A-B

Stage D: End-Stage HCC

3-4

Any

I-II

Child-Pugh C

Stage A and B: All criteria need to be fulfilled

Stage C: At least one of the following criteria needs to be filled: performance status 1-2 or vascular invasion/extrahepatic spread.

Stage D: At least one of the following criteria needs to be filled: performance status 3-4 or Okuda Stage III/Child Pugh C.


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