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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Background
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MethodSelf-citation
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Non-Invasive Biomarkers for Immunotherapy in Patients with Hepatocellular Carcinoma: Current Knowledge and Future Perspectives
Pallozzi, M., Tommaso, N. D., Maccauro, V., Santopaolo, F., Gasbarrini, A., Ponziani, F. R., & Pompili, M. (2022) · Cancers · doi:10.3390/cancers14194631 · Cited by 27
Local-Regional Treatment of Hepatocellular Carcinoma: A Primer for Radiologists
Horvat, N. D. S. M. R., Oliveira, A. I., Oliveira, B. C., Araújo-Filho, J. D. A. B., Homsi, M. E., Elsakka, A., Bajwa, R., Martins, G. L. P., Elsayes, K. M., & de Menezes, M. R. (2022) · Radiographics · doi:10.1148/rg.220022 · Cited by 24
Hepatocellular Carcinoma Supplied by the Inferior Phrenic Artery or Cystic Artery: Anatomic and Technical Considerations
Kim, H., Miyayama, S., Choi, J. W., Kim, G. M., & Chung, J. W. (2022) · Radiographics · doi:10.1148/rg.220076 · Cited by 24
An improved diagnostic algorithm for subcentimeter hepatocellular carcinoma on gadoxetic acid–enhanced MRI
Huang, P., Zhou, C., Wu, F., Xiao, Y., Qian, X., Wang, Y., Yang, C., & Zeng, M. (2022) · European Radiology · doi:10.1007/s00330-022-09282-5 · Cited by 24
“Major advances in early diagnosis and treatment bring prognostic benefits to patients with hepatocellular carcinoma (HCC) [1].”
Background
Pathophysiological changes of the liver-muscle axis in end-stage liver disease: what is the right target?
Hénin, G., Lanthier, N., & Dahlqvist, G. (2022) · Acta gastro-enterologica belgica · doi:10.51821/85.4.10899 · Cited by 26
Unraveling the Synergy between Atezolizumab and Bevacizumab for the Treatment of Hepatocellular Carcinoma
Brackenier, C., Kinget, L., Cappuyns, S., Verslype, C., Beuselinck, B., & Dekervel, J. (2023) · Cancers · doi:10.3390/cancers15020348 · Cited by 29
“The first subgroup reaching extended liver transplantation (LTX) criteria can benefit from LTX.”
BackgroundMethodInfluential
The hemoglobin, albumin, lymphocyte, and platelet score is a prognostic factor for Child–Pugh A patients undergoing curative hepatic resection for single and small hepatocellular carcinoma
Toshida, K., Itoh, S., Kayashima, H., Nagao, Y., Yoshiya, S., Tomino, T., Kosai‐Fujimoto, Y., Tsutsui, Y., Nakayama, Y., Harada, N., et al. (2023) · Hepatology Research · doi:10.1111/hepr.13885 · Cited by 24
TBS-Based Preoperative Score to Predict Non-transplantable Recurrence and Identify Candidates for Upfront Resection Versus Transplantation for Hepatocellular Carcinoma
Lima, H. A., Moazzam, Z., Endo, Y., Alaimo, L., Shaikh, C. F., Munir, M. M., Resende, V., Guglielmi, A., Marques, H. P., Cauchy, F., et al. (2023) · Annals of Surgical Oncology · doi:10.1245/s10434-023-13273-1 · Cited by 24
“Of note, the use of ALBI to quantify liver dysfunction has been endorsed by the recently updated Barcelona Clinic Liver Cancer (BCLC) guidelines.(41) In the present study, a higher ALBI grade was associated with a higher risk of NTR (low referent, medium ALBI: HR 1.”
Method
Current status and prospect of treatments for recurrent hepatocellular carcinoma
Yang, Y.-Q., Wen, Z.-Y., Liu, X., Ma, Z.-H., Liu, Y.-E., Cao, X., Hou, L., & Xie, H. (2023) · World Journal of Hepatology · doi:10.4254/wjh.v15.i2.129 · Cited by 25
Evaluation and Application of Drug Resistance by Biomarkers in the Clinical Treatment of Liver Cancer
Huang, P.-S., Wang, L., Wang, Y., Tsai, M.-M., Lin, T.-K., Liao, C., Yeh, C., & Lin, K. (2023) · Cells · doi:10.3390/cells12060869 · Cited by 24
“The combination of atezolizumab (anti-PD-L1 immune checkpoint inhibitors) with bevacizumab (an anti-VEGF monoclonal antibody) is currently the first-choice first-line treatment, as it confers a superior survival benefit compared to sorafenib [13,31,32].”
Background
Efficacy and Safety of Distal Radial Access for Transcatheter Arterial Chemoembolization (TACE) of the Liver
Minici, R., Serra, R., Giurdanella, M., Talarico, M., Siciliano, M. A., Carrafiello, G., & Laganà, D. (2023) · Journal of Personalized Medicine · doi:10.3390/jpm13040640 · Cited by 24
Predicting tumor recurrence on baseline MR imaging in patients with early-stage hepatocellular carcinoma using deep machine learning
Kucukkaya, A. S., Zeevi, T., Chai, N., Raju, R., Haider, S. P., Elbanan, M., Petukhova-Greenstein, A., Lin, M., Onofrey, J. A., Nowak, M., et al. (2023) · Scientific Reports · doi:10.1038/s41598-023-34439-7 · Cited by 24
Safety and Efficacy of Atezolizumab/Bevacizumab in Patients with Hepatocellular Carcinoma and Impaired Liver Function: A Systematic Review and Meta-Analysis
Pasta, A., Calabrese, F., Jaffe, A., Labanca, S., Marenco, S., Pieri, G., Torres, M. C. P., Strazzabosco, M., & Giannini, E. G. (2023) · Liver Cancer · doi:10.1159/000533991 · Cited by 25
Injectable hydrogel loaded with lysed OK-432 and doxorubicin for residual liver cancer after incomplete radiofrequency ablation
Cao, Y., Sun, T., Sun, B., Zhang, G., Liu, J., Liang, B., Zheng, C., & Kan, X. (2023) · Journal of Nanobiotechnology · doi:10.1186/s12951-023-02170-0 · Cited by 24
“Thermal ablation, such as the prevalent radiofrequency ablation (RFA), is an important method for eradicating small ( ≤ 3 cm) lesions with minimal invasion [2].”
Method
Immunotherapy, targeted therapy, and their cross talks in hepatocellular carcinoma
Liu, J., Park, K., Shen, Z., Lee, H. M., Geetha, P., Pakyari, M., & Chai, L. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1285370 · Cited by 24
Barcelona Clinic Liver Cancer 2022 update: Linking prognosis prediction and evidence‐based treatment recommendation with multidisciplinary clinical decision‐making
Mauro, E., & Forner, A. (2022) · Liver International · doi:10.1111/liv.15180 · Cited by 24
Self-citation
Life expectancy of patients with hepatocellular carcinoma according to the upfront treatment: A nationwide analysis
Cassinotto, C., Nogué, E., Durand, Q., Panaro, F., Assénat, E., Dohan, A. J. J., Malafaye, N., Guiu, B., & Molinari, N. (2023) · Diagnostic and Interventional Imaging · doi:10.1016/j.diii.2023.01.002 · Cited by 23
Existing and emerging biomarkers in hepatocellular carcinoma: relevance in staging, determination of minimal residual disease, and monitoring treatment response: a narrative review
Dominguez, D. A., WONG, P. W. K., & Melstrom, L. G. (2023) · HepatoBiliary Surgery and Nutrition · doi:10.21037/hbsn-22-526 · Cited by 22
Characterizing hepatocellular carcinoma stem markers and their corresponding susceptibility to NK-cell based immunotherapy
Chiang, J., Chen, P.-C., Pham, J., Nguyen, C.-Q., Kaur, K., Raman, S. S., & Jewett, A. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1284669 · Cited by 23
“The Barcelona Clinic Liver Cancer (BCLC) staging criteria provides a framework for treating HCC based on a combination of disease stage, liver function, and the patient ’ s performance status (2).”
Background
Yttrium-90 Radioembolization Dosimetry: Dose Considerations, Optimization, and Tips
Villalobos, A., du Pisanie, J. L., Gandhi, R. T., & Kokabi, N. (2024) · Seminars in Interventional Radiology · doi:10.1055/s-0044-1779715 · Cited by 23
Advances in Understanding Hepatocellular Carcinoma Vasculature: Implications for Diagnosis, Prognostication, and Treatment
Rhee, H., Park, Y. N., & Choi, J. (2024) · Korean Journal of Radiology · doi:10.3348/kjr.2024.0307 · Cited by 23
“During hepatocarcinogenesis, changes in vascular drainage contribute to microscopic and macroscopic vascular invasion, which is a significant determinant of treatment decisions and a well-established prognostic indicator [7].”
Influential
Interventional Oncology Meets Immuno-oncology: Combination Therapies for Hepatocellular Carcinoma
Bitar, R. D., Salem, R., Finn, R. S., Greten, T. F., Goldberg, S. N., & Chapiro, J. (2024) · Radiology · doi:10.1148/radiol.232875 · Cited by 25
Self-citation
Chinese expert consensus on sequential surgery following conversion therapy based on combination of immune checkpoint inhibitors and antiangiogenic targeted drugs for advanced hepatocellular carcinoma (2024 edition)
Tang, H., Zhang, W., Cao, J., Cao, Y., Bi, X., Zhao, H., Zhang, Z., Liu, Z., Wan, T., Lang, R., et al. (2024) · BioScience Trends · doi:10.5582/bst.2024.01394 · Cited by 23
Multicenter single-arm phase II trial of lenvatinib in patients with advanced hepatocellular carcinoma after progression on first-line atezolizumab plus bevacizumab
Kim, H., Sym, S. J., Chon, H. J., Kim, M., Kang, J. H., Ryoo, B., Lee, C., Hong, J.-H., Ryu, H., Bae, W. K., et al. (2025) · Journal of Hepatology · doi:10.1016/j.jhep.2025.08.020 · Cited by 25
Current Landscape of Immune Checkpoint Inhibitor Therapy for Hepatocellular Carcinoma
Machairas, N., Tsilimigras, D. I., & Pawlik, T. M. (2022) · Cancers · doi:10.3390/cancers14082018 · Cited by 24
First-Line Targeted Therapy for Hepatocellular Carcinoma: Role of Atezolizumab/Bevacizumab Combination
Tella, S. H., Kommalapati, A., Mahipal, A., & Jin, Z. (2022) · Biomedicines · doi:10.3390/biomedicines10061304 · Cited by 23
First-Line Systemic Therapies for Advanced Hepatocellular Carcinoma: A Systematic Review and Patient-Level Network Meta-Analysis
Fong, K. Y., Zhao, J. J., Sultana, R., Lee, J. J. X., Lee, S. Y., Chan, S. L., Yau, T. C. C., Tai, D. W. M., Sundar, R., & Too, C. W. (2022) · Liver Cancer · doi:10.1159/000526639 · Cited by 23
Holistic Management of Hepatocellular Carcinoma: The Hepatologist’s Comprehensive Playbook
Jaffe, A., Taddei, T. H., Giannini, E., Ilagan-Ying, Y. C., Colombo, M., & Strazzabosco, M. (2022) · Liver international (Print) · doi:10.1111/liv.15432 · Cited by 23
Transarterial chemoembolization plus apatinib with or without camrelizumab for unresected hepatocellular carcinoma: A two-center propensity score matching study
Zhu, D., Ma, K., Yang, W., Zhou, H., Shi, Q. W., Ren, J.-W., Xie, Y.-G., Liu, S., Shi, H., & Zhou, W.-Z. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.1057560 · Cited by 23
Yttrium-90 Radioembolization: Current Indications and Outcomes
Hamad, A. B., Aziz, H., Kamel, I. R., Diaz, D. A., & Pawlik, T. M. (2022) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-022-05559-8 · Cited by 23
Outcomes of hepatocellular carcinoma by etiology with first-line atezolizumab and bevacizumab: a real-world analysis
Brown, T. J., Mamtani, R., Gimotty, P. A., Karasic, T. B., & Yang, Y. (2023) · Journal of Cancer Research and Clinical Oncology · doi:10.1007/s00432-023-04590-9 · Cited by 24
Comparison of survival benefit between salvage surgery after conversion therapy versus surgery alone for hepatocellular carcinoma with portal vein tumor thrombosis: a propensity score analysis
Cao, Y., Tang, H., Hu, B., Zhang, W., Wan, T., Han, J., Jiao, T., Li, J., Li, X., Yang, Z., et al. (2023) · HPB · doi:10.1016/j.hpb.2023.03.004 · Cited by 23
Main factors influencing long-term outcomes of liver transplantation in 2022
Fuochi, E., Anastasio, L., Lynch, E. N., Campani, C., Dragoni, G., Milani, S., Galli, A., & Innocenti, T. (2023) · World Journal of Hepatology · doi:10.4254/wjh.v15.i3.321 · Cited by 24
Current Landscape of Immune Checkpoint Inhibitor Therapy for Hepatocellular Carcinoma
Ruff, S. M., Manne, A., Cloyd, J. M., Dillhoff, M., Ejaz, A. M., & Pawlik, T. M. (2023) · Current Oncology · doi:10.3390/curroncol30060439 · Cited by 23
“When diagnosed early, HCC is best treated with surgical resection, liver transplantation (based on the Milan criteria or the expanded San Francisco criteria), or liver-directed therapy for small tumors [2,3].”
BackgroundInfluential
Contrast-Enhanced Imaging in the Management of Intrahepatic Cholangiocarcinoma: State of Art and Future Perspectives
Cerrito, L., Ainora, M. E., Borriello, R., Piccirilli, G., Garcovich, M., Riccardi, L., Pompili, M., Gasbarrini, A., & Zocco, M. A. (2023) · Cancers · doi:10.3390/cancers15133393 · Cited by 23
“EASL guidelines state that particular MRI sequences (DWI) are not reliable in the diagnostic differentiation of iCCA from HCC [59,60], but DWI can be useful in the identification of small metastases by iCCA [29].”
Background
The role of lenvatinib in the era of immunotherapy of hepatocellular carcinoma
Lee, M., Chan, L. L., & Chan, S. L. (2023) · Journal of Liver Cancer · doi:10.17998/jlc.2023.07.17 · Cited by 23
Potential predictive role of gut microbiota to immunotherapy in HCC patients: a brief review
Muscolino, P., Granata, B., Omero, F., Pasquale, C. D., Campana, S., Calabrò, A., D’Anna, F., Drommi, F., Pezzino, G., Cavaliere, R., et al. (2023) · Frontiers in Oncology · doi:10.3389/fonc.2023.1247614 · Cited by 28
Prediction of postembolization syndrome after transarterial chemoembolization of hepatocellular carcinoma and its impact on prognosis
Roehlen, N., Stoehr, F., Müller, L., Luxenburger, H., Gairing, S. J., Reincke, M., Schultheiß, M., Berisha, F., Weinmann, A., Foerster, F., et al. (2023) · Hepatology Communications · doi:10.1097/hc9.0000000000000252 · Cited by 23
Self-citation
Clinical Outcomes With Lenvatinib in Patients Previously Treated With Atezolizumab/Bevacizumab for Advanced Hepatocellular Carcinoma
Muto, H., Kuzuya, T., Kawabe, N., Ohno, E., Funasaka, K., Nagasaka, M., Nakagawa, Y., Miyahara, R., Shibata, T., Hashimoto, S., et al. (2023) · Anticancer Research · doi:10.21873/anticanres.16663 · Cited by 23
Hepatocellular Carcinoma: Surveillance, Diagnosis, Evaluation and Management
Elderkin, J., Hallak, N. A., Azmi, A. S., Aoun, H. D., Critchfield, J., Tobon, M. E., & Beal, E. W. (2023) · Cancers · doi:10.3390/cancers15215118 · Cited by 26
“Patients are placed into one of ﬁve categories depending on the aforementioned characteristics, and a corresponding therapy is recommended [51,55].”
Short-term and long-term outcomes after robotic versus open hepatectomy in patients with large hepatocellular carcinoma: a multicenter study
Zhang, X., Jiang, N., Zhu, L. D., Lin, Z.-Y., Guo, W., Chen, X., Ma, Y., Zhang, F., Tang, Y., Chen, Z.-L., et al. (2023) · International Journal of Surgery · doi:10.1097/js9.0000000000000873 · Cited by 23
“We used the BCLC staging system, which was widely used and had an updated version in 2022 [36] .”

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

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