BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update

Maria Reig; Alejandro Forner; Jordi Rimola; Joana Ferrer-Fàbrega; Marta Burrel; Ángeles Garcia-Criado; Robin K Kelley; Peter R Galle; Vincenzo Mazzaferro; Riad Salem; Bruno Sangro; Amit G Singal; Arndt Vogel; Josep Fuster; Carmen Ayuso; Jordi Bruix

doi:10.1016/j.jhep.2021.11.018

BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update

J Hepatol. 2022 Mar;76(3):681-693. doi: 10.1016/j.jhep.2021.11.018. Epub 2021 Nov 19.

Authors

Maria Reig¹, Alejandro Forner², Jordi Rimola³, Joana Ferrer-Fàbrega⁴, Marta Burrel⁵, Ángeles Garcia-Criado³, Robin K Kelley⁶, Peter R Galle⁷, Vincenzo Mazzaferro⁸, Riad Salem⁹, Bruno Sangro¹⁰, Amit G Singal¹¹, Arndt Vogel¹², Josep Fuster¹³, Carmen Ayuso¹⁴, Jordi Bruix¹⁵

Affiliations

¹ BCLC Group, Liver Unit, ICMDM, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain. Electronic address: mreig1@clinic.cat.
² BCLC Group, Liver Unit, ICMDM, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain.
³ BCLC Group, Radiology Department, CDI, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
⁴ BCLC Group, Surgery Department, ICMDM, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
⁵ BCLC Group, Vascular Department, CDI, Hospital Clinic of Barcelona, Barcelona University, University of Barcelona, Barcelona, Spain.
⁶ Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA.
⁷ Department of Internal Medicine, Mainz University Medical Center, Mainz, Germany.
⁸ Department of Oncology, University of Milan and HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
⁹ Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago, IL, USA.
¹⁰ Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain; Liver Unit, Clinica Universidad de Navarra, Pamplona, Spain.
¹¹ Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
¹² Hannover Medical School, Department of Gastroenterology, Hepatology and Endocrinology, Hannover, Germany.
¹³ Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain; BCLC Group, Surgery Department, ICMDM, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
¹⁴ Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain; BCLC Group, Radiology Department, CDI, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
¹⁵ BCLC Group, Liver Unit, ICMDM, IDIBAPS, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Spain. Electronic address: jbruix@clinic.cat.

Abstract

There have been major advances in the armamentarium for hepatocellular carcinoma (HCC) since the last official update of the Barcelona Clinic Liver Cancer prognosis and treatment strategy published in 2018. Whilst there have been advances in all areas, we will focus on those that have led to a change in strategy and we will discuss why, despite being encouraging, data for select interventions are still too immature for them to be incorporated into an evidence-based model for clinicians and researchers. Finally, we describe the critical insight and expert knowledge that are required to make clinical decisions for individual patients, considering all of the parameters that must be considered to deliver personalised clinical management.

Keywords: AFP; ALBI score; BCLC; HCC; TARE; ablation; liver transplantation TACE; surgery; survival; systemic treatment.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Review

MeSH terms

Carcinoma, Hepatocellular / classification*
Carcinoma, Hepatocellular / complications
Female
Humans
Liver Neoplasms / classification
Liver Neoplasms / complications
Male
Middle Aged
Neoplasm Staging / methods
Neoplasm Staging / statistics & numerical data
Prognosis*
Severity of Illness Index

Grants and funding

R01 MD012565/MD/NIMHD NIH HHS/United States