BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update
Open accessAbstract
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.
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Self-citationLocal and Regional Therapies for Hepatocellular Carcinoma
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Self-citationWhen to perform hepatic resection for intermediate‐stage hepatocellular carcinoma
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Self-citationOutcomes and Mortality of Grade 1 Ascites and Recurrent Ascites in Patients With Cirrhosis
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Self-citationRole of External Beam Radiotherapy in Hepatocellular Carcinoma
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Self-citationExpanding the Limits of Liver Transplantation for Hepatocellular Carcinoma
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Vogel, A., Meyer, T., Sapisochin, G., Salem, R., & Saborowski, A. (2022) · The Lancet · doi:10.1016/s0140-6736(22)01200-4 · Cited by 2,427 · see citing works
Self-citationAASLD Practice Guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma
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Self-citationEASL Clinical Practice Guidelines on the management of hepatocellular carcinoma
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“Nevertheless, specific treatment decisions for individual patients are best made by mutidisciplinary teams of providers (for example, transplant hepatologists, surgeons, interventional radiologists and medical oncologists), nurses and patient navigators 91,167,168 .”
BackgroundMethodSelf-citationManagement of Hepatocellular Carcinoma
Brown, Z. J., Tsilimigras, D. I., Ruff, S. M., Mohseni, A., Kamel, I. R., Cloyd, J. M., & Pawlik, T. M. (2023) · JAMA Surgery · doi:10.1001/jamasurg.2022.7989 · Cited by 779 · see citing works
Evolving therapeutic landscape of advanced hepatocellular carcinoma
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Single test-based diagnosis of multiple cancer types using Exosome-SERS-AI for early stage cancers
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2022 KLCA-NCC Korea practice guidelines for the management of hepatocellular carcinoma
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Liver diseases: epidemiology, causes, trends and predictions
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Self-citationNeoadjuvant immune checkpoint blockade: A window of opportunity to advance cancer immunotherapy
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Hepatocellular carcinoma: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up
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Self-citationBiomarkers for diagnosis and therapeutic options in hepatocellular carcinoma
Chan, Y.-T., Zhang, C., Wu, J., Lu, P., Xu, L., Yuan, H., Feng, Y., Chen, Z.-S., & Wang, N. (2024) · Molecular Cancer · doi:10.1186/s12943-024-02101-z · Cited by 309 · see citing works
“The 2022 BCLC staging strategy recommended the ALBI score and AFP concentration for hepatic function assessment regardless of tumor burden [26].”
MethodPredictors of early and late hepatocellular carcinoma recurrence
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Biomarkers for immunotherapy of hepatocellular carcinoma
Greten, T. F., Villanueva, A., Korangy, F., Ruf, B., Yarchoan, M., Ma, L., Ruppin, E., & Wang, X. W. (2023) · Nature Reviews Clinical Oncology · doi:10.1038/s41571-023-00816-4 · Cited by 227 · see citing works
“Transarterial chemoembolization (TACE) has been globally adopted as the standard of care for patients with intermediate-stage (multinodular disease limited to the liver, and preserved liver function 17 ) HCC leading to a median OS >2.5 years 3,15,18–21 .”
BackgroundInfluentialBCLC strategy for prognosis prediction and treatment recommendations: The 2026 update
Reig, M., Sanduzzi‐Zamparelli, M., Forner, A., Rimola, J., Ferrer, J., Burrel, M., García‐Criado, Á., Díaz, A., Llarch, N., Iserte, G., et al. (2025) · Journal of Hepatology · doi:10.1016/j.jhep.2025.10.020 · Cited by 253 · see citing works
Self-citationHepatitis B Virus-Associated Hepatocellular Carcinoma
Rizzo, G. E. M., Cabibbo, G., & Craxı̀, A. (2022) · Viruses · doi:10.3390/v14050986 · Cited by 235 · see citing works
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Hepatocellular carcinoma surveillance — utilization, barriers and the impact of changing aetiology
Huang, D. Q., Singal, A. G., Kanwal, F., Lampertico, P., Buti, M., Sirlin, C. B., Nguyen, M. H., & Loomba, R. S. (2023) · Nature Reviews Gastroenterology & Hepatology · doi:10.1038/s41575-023-00818-8 · Cited by 199 · see citing works
“This lack of sensitivity for early disease is a major problem given that curative options are limited for advanced-stage HCC 11,17,28,53,54 .”
BackgroundSelf-citationXie, D., Shi, J., Zhou, J., Fan, J., & Gao, Q. (2023) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2022.0402 · Cited by 177 · see citing works
“The China liver cancer staging (CNLC) system(Figure 1) incorporating tumor characteristics, liver function and performance status, similar to the Barcelona Clinic of Liver Cancer(BCLC) system[21], was established in 2017 and has been adopted ever since.”
Pathogenesis and Current Treatment Strategies of Hepatocellular Carcinoma
Tümen, D., Heumann, P., Gülow, K., Demirci, C. N., Cosma, L.-S., Müller, M., & Kandulski, A. (2022) · Biomedicines · doi:10.3390/biomedicines10123202 · Cited by 182 · see citing works
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“When HCC is diagnosed at an early stage, there are existing acceptable and curative therapies, for example, surgical resection, local ablation, or liver transplantation [291].”
Kim, E., Sher, A., Abboud, G., Schwartz, M., Facciuto, M. E., Tabrizian, P., Knešaurek, K., Fischman, A. M., Patel, R. S., Nowakowski, S. F., et al. (2022) · The Lancet. Gastroenterology & hepatology · doi:10.1016/s2468-1253(22)00091-7 · Cited by 171 · see citing works
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“The results from one phase III trial showed that compared with TACE, hepatic arterial infusion of chemotherapy with oxaliplatin plus intravenous 5-fluorouracil (5-FU) and folinic acid significantly improved the overall survival with a significantly lower incidence of grade 3-4 adverse events for large and unresectable…”
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Breakthroughs in Hepatocellular Carcinoma Therapies
Singal, A. G., Kudo, M., & Bruix, J. (2023) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2023.01.039 · Cited by 163 · see citing works
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Safety and Efficacy of Robotic vs Open Liver Resection for Hepatocellular Carcinoma
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InfluentialEASL-ERN position paper on liver involvement in patients with Fontan-type circulation
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“Since 2017 there have been major breakthroughs in systemic therapeutic options, now with immunotherapy at the forefront of treatment 95 .”
InfluentialMultidisciplinary care for patients with HCC: a systematic review and meta-analysis
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“[6] In contrast to prior treatment allocation algorithms in which one treatment was recommended for a specific tumor stage, there are now multiple treatment options to consider based on several factors including tumor burden, liver dysfunction, performance status, transplant eligibility, local expertise, and patient p…”
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Targeted Therapy for Hepatocellular Carcinoma: Old and New Opportunities
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Molecular and immune landscape of hepatocellular carcinoma to guide therapeutic decision-making
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- Authors
- Reig, M., Forner, A., Rimola, J., Ferrer-Fàbrega, J., Burrel, M., Garcia-Criado, Á., Kelley, R. K., Galle, P. R., Mazzaferro, V., Salem, R., Sangro, B., Singal, A. G., Vogel, A., Fuster, J., Ayuso, C., & Bruix, J.
- Affiliations
- Hospital Clínic de Barcelona (ES)
- University of California, San Francisco (US)
- University Medical Center of the Johannes Gutenberg University Mainz (DE)
- University of Milan (IT)
- Northwestern University (US)
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (ES)
- The University of Texas Southwestern Medical Center (US)
- Medizinische Hochschule Hannover (DE)
- Corresponding author
- Bruix, Jordi
- ORCID
- Venue
- Journal of Hepatology
- Publisher
- Elsevier BV
- Published
- 2022-03
- Volume
- 76
- Issue
- 3
- Pages
- 681-693
- ISSN
- 0168-8278 (ISSN-L)
- PMC
- PMC8866082
- OpenAlex
- W3213277274
- Cited by
- 4,319
- References
- 136
- Citations by year
- 2026: 684 · 2025: 1071 · 2024: 1166 · 2023: 962 · 2022: 424 · 2021: 2 · 2015: 1 · 2013: 1
- FWCI
- 83.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Hepatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Fundación Científica de la Asociación Española Contra el Cáncer (PI044031)
- National Institutes of Health (R01 R01 MD012565, PI18/00768)
- Horizon 2020 Framework Programme (952103)
- Instituto de Salud Carlos III (AC16/00065, PI18/0358, PI15/00145, PI18/00542, PI19/00742, PI18/00768)
- European Association for the Study of the Liver
- Horizon 2020
- Topics
- Health Sciences › Medicine › Hepatology › Hepatocellular Carcinoma Treatment and Prognosis
- Health Sciences › Medicine › Oncology › Colorectal Cancer Treatments and Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal cell carcinoma treatment
- Keywords
- hepatocellular carcinoma, Barcelona Clinic Liver Cancer staging, outcome prediction, treatment guidelines, evidence-based clinical decision-making
- MeSH terms
- Female, Carcinoma, Hepatocellular, Humans, Liver Neoplasms, Male, Middle Aged, Neoplasm Staging, Prognosis, Severity of Illness Index
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