Cited by 4,319Hepatocellular Carcinoma Treatment and PrognosisColorectal Cancer Treatments and StudiesRenal cell carcinoma treatment

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

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Reig, Maria, Forner, Alejandro, Rimola, Jordi, Ferrer-Fàbrega, Joana, Burrel, Marta, Garcia-Criado, Ángeles, Kelley, Robin K., Galle, Peter R., Mazzaferro, Vincenzo, Salem, Riad, Sangro, Bruno, Singal, Amit G., Vogel, Arndt, Fuster, Josep, Ayuso, Carmen, Bruix, Jordi·2022·Journal of Hepatology

DOI 10.1016/j.jhep.2021.11.018PMC PMC8866082

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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.

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Yu, Y., Sun, J., Cai, J., Chen, M., Dai, C., Wen, T., Xia, J., Ying, M., Zhang, Z., Zhang, X., et al. (2024) · Liver Cancer · doi:10.1159/000541622 · Cited by 13
Yttrium-90 glass microsphere radioembolization as frontline treatment for hepatocellular carcinoma with localized portal vein invasion
Choi, J. W., Suh, M., Choi, Y., Lee, M., Paeng, J. C., & Kim, H. (2025) · European Radiology · doi:10.1007/s00330-025-11882-w · Cited by 10
Almonertinib inhibits liver cancer progression by triggering autophagy-dependent ferroptosis through inhibition of the PI3K/Akt1/mTOR pathway
Liang, L., Wang, X., Sun, B., Sun, Y., Chen, J., Jiang, J., Meng, L., He, S., Li, R., & Wang, F. (2025) · Biochemical Pharmacology · doi:10.1016/j.bcp.2025.117628 · Cited by 11
International multisociety Delphi consensus for liver tumour thermal ablation: margin assessment
Paolucci, I., Overduin, C. G., Johnston, E. W., Laimer, G., Ahmed, M., Arellano, R. S., Beermann, M., Beyer, L. P., Breen, D. J., Burgmans, M. C., et al. (2026) · The Lancet Oncology · doi:10.1016/s1470-2045(26)00143-9 · Cited by 10
Radiofrequency Ablation versus Transarterial Chemoembolization for Hepatocellular Carcinoma within Milan Criteria: Prognostic Role of Tumor Burden Score
Ho, S., Liu, P., Hsu, C.-Y., Huang, Y., Liao, J., Su, C., Hou, M., & Huo, T. (2022) · Cancers · doi:10.3390/cancers14174207 · Cited by 10
The prognostic value of the GPAT/AGPAT gene family in hepatocellular carcinoma and its role in the tumor immune microenvironment
Wen, P., Wang, R., Xing, Y., Ouyang, W., Yuan, Y., Zhang, S., Liu, Y., & Peng, Z. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1026669 · Cited by 10
“Many methods are available for staging HCC, such as BCLC staging (37), AJCC-TNM (38), CLIP (39), Tokyo systems (40), and HKLC (41).”
Method
Early changes in immunoglobulin G levels during immune checkpoint inhibitor treatment are associated with survival in hepatocellular carcinoma patients
Balcar, L., Bauer, D. J. M., Pomej, K., Meischl, T., Mandorfer, M., Reiberger, T., Trauner, M. A., Scheiner, B., & Pinter, M. (2023) · PLoS ONE · doi:10.1371/journal.pone.0282680 · Cited by 10
“According to the European Association for the Study of the Liver (EASL) guidelines [3], HCC was diagnosed by histology or dynamic imaging (computed tomography [CT] or magnetic resonance imaging [MRI] scans).”
BackgroundMethod
Laparoscopic and open liver resection for hepatocellular carcinoma with type 2 diabetes mellitus: multicenter propensity score-matched study
Yang, S., Feng, J.-K., Yan, M.-L., Guo, L., Duan, Y., Ye, J., Liu, Z., Xiang, Y., Xu, L., Xue, J., et al. (2023) · Hepatology International · doi:10.1007/s12072-023-10492-2 · Cited by 10
“The clinical diagnosis of HCC was based on the guidelines for Diagnosis and Treatment of Primary Hepatocellular Carcinoma [27], and the Barcelona Clinic Liver Cancer (BCLC) staging system was used for classification [28].”
Method
Attempt to Establish Prognostic Predictive System for Hepatocellular Carcinoma Using Artificial Intelligence for Assistance with Selection of Treatment Modality
Hiraoka, A., Kumada, T., Tada, T., Toyoda, H., Kariyama, K., Hatanaka, T., Kakizaki, S., Naganuma, A., Itobayashi, E., Tsuji, K., et al. (2023) · Liver Cancer · doi:10.1159/000530078 · Cited by 11
Combined radiotherapy and immune checkpoint inhibition for the treatment of advanced hepatocellular carcinoma
Shannon, A. H., Manne, A., Diaz, D. A., & Pawlik, T. M. (2023) · Frontiers in Oncology · doi:10.3389/fonc.2023.1193762 · Cited by 12
Four-dimensional flow MR imaging for evaluating treatment response after transcatheter arterial chemoembolization in cirrhotic patients with hepatocellular carcinoma
Moon, C., Lee, Y. Y., Kim, S. K., Jeong, Y. Y., Heo, S. H., & Shin, S. S. (2023) · La radiologia medica · doi:10.1007/s11547-023-01685-8 · Cited by 10
“According to the Barcelona Clinic Liver Cancer (BCLC) staging system and therapeutic strategy, TACE is recommended for intermediate-stage HCC (stage B) patients, including those with Child–Pugh grade A or B liver functional reserve as well as those with large (more than 3 cm) and/or multifocal tumors [4].”
Method
Radiotherapy plus anti-PD1 versus radiotherapy for hepatic toxicity in patients with hepatocellular carcinoma
Zhang, R., Zhou, H., Lu, H., Yu, H., Tang, W., Qiu, M., Yan, L.-Y., Long, M., Su, T., Xiang, B., et al. (2023) · Radiation Oncology · doi:10.1186/s13014-023-02309-1 · Cited by 11
“The patients were diagnosed with HCC histologically and/ or radiologically based on the guidelines of the American Association for the Study of Liver Diseases [20] and staged according to the Barcelona Clinic Liver Cancer (BCLC) system [21].”
Method
Multidisciplinary consensus recommendations for management of hepatocellular carcinoma in Middle East and North Africa region
Waked, I. A., Alsammany, S., Tirmazy, S. H., Rasul, K. I., Bani‐Issa, J., Abdel‐Razek, W., Omar, A., Shafik, A. G., Salem, S., Abdelaal, A. K., et al. (2023) · Liver International · doi:10.1111/liv.15685 · Cited by 10
Mutational Landscape and Precision Medicine in Hepatocellular Carcinoma
Gorji, L., Brown, Z. J., & Pawlik, T. M. (2023) · Cancers · doi:10.3390/cancers15174221 · Cited by 10
“guidelines recom end radiofrequency ablation (RFA), liver r section (LR), and LT based on the stag of HCC and the pa ient’s underlying liver condition [12].”
BackgroundInfluential
Cost-effectiveness analysis of interventional liver-directed therapies for downstaging of HCC before liver transplant
Wu, X. J., Kwong, A. J., Heller, M., Lokken, R. P., Fidelman, N. A., & Mehta, N. J. (2023) · Liver Transplantation · doi:10.1097/lvt.0000000000000249 · Cited by 10
Adjuvant and Neoadjuvant Treatments for Resectable Hepatocellular Carcinoma
Crook, C. J., & Li, D. (2023) · Current Oncology Reports · doi:10.1007/s11912-023-01455-9 · Cited by 11
“Surgical resection, transplantation, and ablation comprise current curative treatment options for patients with HCC [2, 4].”
Prognostic potential of preoperative circulating tumor cells to predict the early progression recurrence in hepatocellular carcinoma patients after hepatectomy
Lu, Z., Ni, H.-H., Yang, X., Tan, L., Zhuang, H., Mo, Y., Wei, X., Qi, L., & Xiang, B. (2023) · BMC Cancer · doi:10.1186/s12885-023-11629-0 · Cited by 10
“The HCC stage was evaluated according to the Barcelona Clinic Liver Cancer (BCLC) staging classification [23], and the degree of tumor differentiation was defined according to the Edmondson grading system [24].”
Method
Survival Prediction Model for Patients with Hepatocellular Carcinoma and Extrahepatic Metastasis Based on XGBoost Algorithm
Lim, J., Jeon, H.-G., Seo, Y., Kim, M., Moon, J. U., & Cho, S. H. (2023) · Journal of Hepatocellular Carcinoma · doi:10.2147/jhc.s429903 · Cited by 10
The Safety and Efficacy of Hepatic Arterial Infusion Chemotherapy Combined with PD-(L)1 Inhibitors and Molecular Targeted Therapies for the Treatment of Intermediate and Advanced Hepatocellular Carcinoma Unsuitable for Transarterial Chemoembolization
Tang, H.-H., Zhang, M., Zhang, Z.-C., Chen, F., Jin, Y. X., & Wang, W.-D. (2023) · Journal of Hepatocellular Carcinoma · doi:10.2147/jhc.s441024 · Cited by 10
“3 Pursuant to the Barcelona Clinic Liver Cancer (BCLC) and China liver cancer (CNLC) staging systems, transarterial chemoembolization (TACE) is the most common treatment for unresectable HCC. 2,4 However, repeated TACE may lead to the deterioration of liver function and affect prognosis.”
Background
Spleen‐dedicated stiffness measurement performed well to rule out high‐risk varices in HBV ‐related hepatocellular carcinoma
Cheng, X., Tang, Y., He, Q., Song, J., Wang, K., Li, H., Huang, J., Wang, W., Li, J., Wang, H., et al. (2023) · Alimentary Pharmacology & Therapeutics · doi:10.1111/apt.17850 · Cited by 10
Management of varices but not anticoagulation is associated with improved outcome in patients with HCC and macrovascular tumour invasion
Balcar, L., Mrekva, A., Scheiner, B., Pomej, K., Meischl, T., Mandorfer, M., Reiberger, T., Trauner, M. A., Tamandl, D., & Pinter, M. (2024) · Cancer Imaging · doi:10.1186/s40644-024-00657-z · Cited by 10
“While immune checkpoint inhibitor (ICI)-based combination therapies have replaced tyrosine kinase inhibitors (TKIs) as preferred standard of care in systemic front-line, TKIs are frequently used in the second-line setting [10].”
Background
Radiation Segmentectomy for the Treatment of Hepatocellular Carcinoma: A Practical Review of Evidence
Mourad, S. N., la Garza‐Ramos, C. D., & Toskich, B. B. (2024) · Cancers · doi:10.3390/cancers16030669 · Cited by 10
“Patients with BCLC B-C disease or Child-Pugh B7-C liver function can be considered for radioembolization as a definitive therapy or as a bridging or downstaging to a transplant approach [1–3].”
Background
Systemic Drugs for Hepatocellular Carcinoma: What Do Recent Clinical Trials Reveal About Sequencing and the Emerging Complexities of Clinical Decisions?
Himmelsbach, V., Koch, C., Trojan, J., & Finkelmeier, F. (2024) · Journal of Hepatocellular Carcinoma · doi:10.2147/jhc.s443218 · Cited by 10
Construction of a prognostic model for hepatocellular carcinoma patients receiving transarterial chemoembolization treatment based on the Tumor Burden Score
Lin, J., Li, J., Kong, Y., Yang, J., Zhang, Y., Zhu, G., Yu, Z., & Xia, J. (2024) · BMC Cancer · doi:10.1186/s12885-024-12049-4 · Cited by 10
“TACE is the most commonly used treat-ment method for mid-term HCC [3, 4].”
BackgroundMethod
A meta-analysis: laparoscopic versus open liver resection for large hepatocellular carcinoma
Peng, Z., Zhu, Z., He, C., & Huang, H. Y. (2024) · Minimally Invasive Therapy & Allied Technologies · doi:10.1080/13645706.2024.2334762 · Cited by 10
“Macroscopic vascular invasion has been considered an absolute contraindication for liver resection in many Western centers [42].”
Adverse Events as Potential Predictive Factors of Activity in Patients with Advanced HCC Treated with Atezolizumab Plus Bevacizumab
Persano, M., Rimini, M., Tada, T., Suda, G., Shimose, S., Kudo, M., Rossari, F., Yoo, C., Cheon, J., Finkelmeier, F., et al. (2024) · Targeted Oncology · doi:10.1007/s11523-024-01061-0 · Cited by 11
“Although this combination is indicated in international guidelines as the new standard of care for first-line HCC treatment, it is not yet reimbursed in all countries [7].”
Inhibition of the transmembrane transporter ABCB1 overcomes resistance to doxorubicin in patient-derived organoid models of HCC
Blukacz, L., Nuciforo, S., Fucile, G., Trulsson, F., Duthaler, U., Wieland, S. F., & Heim, M. H. (2024) · Hepatology Communications · doi:10.1097/hc9.0000000000000437 · Cited by 10
“[3] At the molecular level, we have recently established a predict response to TACE (PRETACE) algorithm applicable to tumor biopsy tissue that could improve patient selection.”
Development and validation of nomograms to predict survival and recurrence after hepatectomy for intermediate/advanced (BCLC stage B/C) hepatocellular carcinoma
Diao, Y., Sun, L., Wang, M.-D., Han, J. S., Zeng, Y., Yao, L., Sun, X.-D., Li, C., Shao, G., Gu, L., et al. (2024) · Surgery · doi:10.1016/j.surg.2024.03.028 · Cited by 10
A natural killer T cell nanoagonist-initiated immune cascade for hepatocellular carcinoma synergistic immunotherapy
Luo, T., Tan, X., Qing, G., Yu, J., Liang, X., & Liang, P. (2024) · Nanoscale · doi:10.1039/d4nr00847b · Cited by 11
The roles of cancer stem cell-derived secretory factors in shaping the immunosuppressive tumor microenvironment in hepatocellular carcinoma
Muliawan, G. K., & Lee, T. K. (2024) · Frontiers in Immunology · doi:10.3389/fimmu.2024.1400112 · Cited by 12
Selective internal radiation therapy for unresectable HCC: The SIRT downstaging study
Regnault, H., Chalaye, J., Pregliasco, A. G., Perrin, C., Derbel, H., Amaddeo, G., Mulé, S., Lequoy, M., Kobeiter, H., Reizine, É., et al. (2024) · Hepatology Communications · doi:10.1097/hc9.0000000000000475 · Cited by 10
“[12] However, to date, there have been few reports describing clinical experience in this context, particularly for larger tumors and those with vascular invasion.”
Background
The treatment of primary biliary cholangitis: from shadow to light
Dražilová, S., Koky, T., Macej, M., Janíčko, M., Simkova, D., & Jarčuška, P. (2024) · Therapeutic Advances in Gastroenterology · doi:10.1177/17562848241265782 · Cited by 12
Clinical Effectiveness and Safety of Transarterial Chemoembolization: Hepatic Artery Infusion Chemotherapy Plus Tyrosine Kinase Inhibitors With or Without Programmed Cell Death Protein-1 Inhibitors for Unresectable Hepatocellular Carcinoma—A Retrospective Study
Chen, Y., Jia, L., Li, Y., Cui, W., Wang, J., Zhang, C., Bian, C., Wang, Z., Lin, D., & Luo, T. (2024) · Annals of Surgical Oncology · doi:10.1245/s10434-024-15933-2 · Cited by 10
Immune-targeted therapy with transarterial chemo(embolization) for unresectable HCC: a systematic review and meta-analysis
Fang, H., Ke, Q., Wu, S., Tu, Q., & Wang, L. (2024) · Frontiers in Immunology · doi:10.3389/fimmu.2024.1421520 · Cited by 10
“Advanced HCC often coexists with extrahepatic metastasis (6, 42), making additional local treatment debatable.”
BackgroundInfluential
External Beam Radiation therapy After Transarterial Chemoembolization Versus Transarterial Chemoembolization Alone for Treatment of Inoperable Hepatocellular Carcinoma: A Randomized Phase 3 Trial
Chen, Y., Hu, Y., Jie, S., Du, S., Yan, J., Zhou, L., Wang, Z., Lu, H., Xiao, L., Yang, P., et al. (2024) · International Journal of Radiation Oncology*Biology*Physics · doi:10.1016/j.ijrobp.2024.09.021 · Cited by 10
The Impact of Radiation Dose and Tumour Burden on Outcomes in Hepatocellular Carcinoma: 11-Year Experience in a 413-Patient Cohort Treated with Yttrium-90 Resin Microsphere Radioembolisation
Chen, K., Tong, A. K. T., Moe, F. N. N., Ng, D. C. E., Lo, R., Gogna, A., Yan, S. X., Thang, S. P., Loke, K. S. H., Venkatanarasimha, N. K., et al. (2024) · Liver Cancer · doi:10.1159/000541539 · Cited by 10
Rethinking Immune Check Point Inhibitors Use in Liver Transplantation: Implications and Resistance
Ortiz, V., & Loeuillard, E. J. (2024) · Cellular and Molecular Gastroenterology and Hepatology · doi:10.1016/j.jcmgh.2024.101407 · Cited by 11
Partial hepatectomy versus interventional treatment in patients with hepatitis B virus‐related hepatocellular carcinoma and clinically significant portal hypertension: a randomized comparative clinical trial
Yuan, Y., Peng, X., He, W. A., Zheng, Y., Qiu, J., Chen, B., Zou, R., Wang, C., Lau, W. Y., Li, B., et al. (2024) · 癌症：英文版 · doi:10.1002/cac2.12614 · Cited by 10
Multiparametric MRI-based Machine Learning Radiomics for Predicting Treatment Response to Transarterial Chemoembolization Combined with Targeted and Immunotherapy in Unresectable Hepatocellular Carcinoma: A Multicenter Study.
Kang, W., Tang, P., Luo, Y.-G., Lian, Q., Zhou, X., Ren, J., Cong, T., Miao, L., Li, H., Huang, X.-Y., et al. (2024) · Academic Radiology · doi:10.1016/j.acra.2024.10.038 · Cited by 9
Second-line therapies in advanced hepatocellular carcinoma following first-line atezolizumab and bevacizumab: multicenter single institution cohort experience
Marell, P. S., Kournoutas, I. A., Gile, J. J., Peersen, A. F., Shah, P., Babiker, H. M., Fonkoua, L. A. K., Washburn, L. A., Graham, R. P., Truty, M. J., et al. (2024) · The Oncologist · doi:10.1093/oncolo/oyae342 · Cited by 11
High Steatosis-Associated Fibrosis Estimator scores predict hepatocellular carcinoma in viral and non-viral hepatitis and metabolic dysfunction-associated steatotic liver disease
Su, T., Yang, S., Lee, M., Kao, W., Huang, S., Chen, F.-F., Poon, F. S., Tsai, L.-W., Chen, Y.-T., Lin, C., et al. (2025) · Clinical and Molecular Hepatology · doi:10.3350/cmh.2024.0822 · Cited by 13
Transarterial Radioembolisation with Y90 Resin Microspheres and the Effect of Reimbursement Criteria in France: Final Results of the CIRT-FR Prospective Observational Study
Ronot, M., Loffroy, R., Arnold, D., Greget, M., Sengel, C., Pinaquy, J., Pellerin, O., Maleux, G. A., Peynırcıoğlu, B., Pelage, J., et al. (2025) · CardioVascular and Interventional Radiology · doi:10.1007/s00270-024-03955-y · Cited by 10
“Considering the 2022 BCLC guidelines [3] that recommend that BCLC 0 or BCLC A patients could receive TARE if neither ablation, resection, nor TACE is feasible [49], Group 2a was selected to assess the beneﬁt of TARE Y90 in this subpopulation compared to more advanced-stage patients in Group 2b.”
Self-citation
Hepatobiliary and Pancreatic Neoplasms: Essential Predictive Imaging Features for Personalized Therapy
Irizato, M., Minamiguchi, K., Uchiyama, T., Kunichika, H., Tachiiri, T., Taiji, R., Kitao, A., Marugami, N., Inaba, Y., & Tanaka, T. (2025) · Radiographics · doi:10.1148/rg.240068 · Cited by 10
Integrating CT Radiomics and Clinical Features to Optimize TACE Technique Decision-Making in Hepatocellular Carcinoma
Masthoff, M., Irle, M., Kaldewey, D., Rennebaum, F., Morgul, H. M., Pöhler, G. H., Trebicka, J., Wildgruber, M., Köhler, M., & Schindler, P. (2025) · Cancers · doi:10.3390/cancers17050893 · Cited by 10
“…HCC may be amenable to curative interventions such as surgical resection, transplantation, or ablation, many patients presented with intermediate or advanced disease, for which locoregional therapies, particularly transarterial chemoembolization (TACE), play a pivotal role in treatment [2–4].”
Long-term outcomes of Yttrium-90 transarterial radioembolization for patients with hepatocellular carcinoma
Muglia, R., Giorgio, M. D., Marra, P., Carbone, F. S., Dulcetta, L., Prussia, C., Loglio, A., Ghirardi, A., Grikke, L. A., Bianchi, C., et al. (2025) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-025-07185-3 · Cited by 10
“All patients, including non-cirrhotic ones, were staged according to the BCLC system [9].”

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: Reig, Maria
Forner, Alejandro
Rimola, Jordi
Burrel, Marta
Garcia-Criado, Ángeles
Kelley, Robin K.
Galle, Peter R.
Mazzaferro, Vincenzo
Salem, Riad
Sangro, Bruno
Singal, Amit G.
Vogel, Arndt
Fuster, Josep
Ayuso, Carmen
Bruix, Jordi
Venue: Journal of Hepatology
Publisher: Elsevier BV
Published: 2022-03
Volume: 76
Issue: 3
Pages: 681-693
ISSN: 0168-8278 (ISSN-L)
DOI: 10.1016/j.jhep.2021.11.018
PMC: PMC8866082
OpenAlex: W3213277274
Cited by: 4,319
References: 136
Citations by year: 2026: 684 · 2025: 1071 · 2024: 1166 · 2023: 962 · 2022: 424
FWCI: 83.72
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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 › Oncology › 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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