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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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“13,14 However, these ICI-based fi rst-line treatments showed relatively poor therapeutic effects in patients with HCC and macrovascular invasion (MVI) 15 or excluded main portal invasion cases in clinical trials.”
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Self-citationTransarterial Chemoembolization Treatment Paradigms for Hepatocellular Carcinoma
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“…broadly incorporates the following: (1) tumor characteristics, defined by the size and number of nodules as well as vascular invasion of the tumor; (2) liver function using the Child–Pugh scoring system; and (3) performance status using the Eastern Cooperative Oncology Group (ECOG) system [15].”
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“…criteria for early-stage HCC in the Western world are the Milan Criteria (most common criteria for liver transplantation) and BCLC stage 0/A. [7,32] One of the primary distinctions between the 2 is how large unifocal lesions are classified, with these being classified as early-stage HCC by…”
BackgroundSelf-citationla Garza‐Ramos, C. D., Montazeri, S. A., Croome, K. P., LeGout, J. D., Sella, D. M., Cleary, S. P., Burns, J. M., Mathur, A. K., Overfield, C. J., Frey, G. T., et al. (2022) · Journal of Vascular and Interventional Radiology · doi:10.1016/j.jvir.2022.03.021 · Cited by 32
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“Currently, the BCLC staging update in 2022 recommends ablation for very early stage (BCLC-0) who are not candidates for liver transplant and early stage (BCLC-A) patients who have increased portal pressure or bilirubin and contraindications to liver transplant.(15)”
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“The current treatment algorithm for intermediate stage hepatocellular carcinoma (HCC) includes trans-arterial chemoembolization, which combines tumor embolization with intra-arterial delivery of doxorubicin [34].”
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“Systemic therapies, such as targeted therapy and immune checkpoint inhibitors, are not recommended for inoperable patients due to the tumor size [3,6] .”
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Recent Progress in Systemic Therapy for Advanced Hepatocellular Carcinoma
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“It incorporates Eastern Cooperative Oncology Group (ECOG) performance status; Child–Pugh class, which is an estimate of mortality in cirrhosis patients; size and number of tumors; vascular involvement; and extrahepatic spreading of the tumor [4].”
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Differences between hepatocellular carcinoma caused by alcohol and other aetiologies
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Metadata
- 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
- 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 › 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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