Grey zone in the Barcelona Clinic Liver Cancer Classification for hepatocellular carcinoma: Surgeons' perspective
Related Experiment Video
Updated: Sep 30, 2026
A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
Tian Yang1, Wan-Yee Lau1, Han Zhang1
1Tian Yang, Wan-Yee Lau, Han Zhang, Bin Huang, Jun-Hua Lu, Meng-Chao Wu, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China.
Insights
Hepatocellular carcinoma (HCC) treatment guidelines, like the Barcelona Clinic Liver Cancer (BCLC) classification, are not always followed by surgeons in practice. This study examines surgeon perspectives on BCLC accuracy and application for improved clinical use.
Area of Science:
- Hepatology
- Surgical Oncology
- Clinical Practice Guidelines
Background:
- Hepatocellular carcinoma (HCC) is a leading cause of cancer death globally.
- The Barcelona Clinic Liver Cancer (BCLC) classification is the standard for HCC staging and treatment.
- Clinical practice deviates from BCLC guidelines, with many surgeons performing resections on non-ideal candidates.
Purpose of the Study:
- To critically evaluate the BCLC classification from a surgeon's viewpoint.
- To identify limitations in BCLC's assessment criteria, staging definition, and treatment recommendations.
- To foster discussion for enhancing the BCLC classification's clinical applicability.
Main Methods:
- Review and commentary on the BCLC classification system.
- Analysis of BCLC criteria subjectivity and comprehensiveness.
- Evaluation of BCLC therapeutic recommendations' accuracy.
Main Results:
- Surgeons frequently challenge the BCLC classification's accuracy and real-world application.
- Concerns exist regarding the subjectivity of BCLC assessment criteria.
- The comprehensiveness of BCLC staging and accuracy of its treatment advice are questioned.
Conclusions:
- The BCLC classification requires re-evaluation to better align with surgical practice.
- Addressing subjectivity and improving staging/treatment recommendations are crucial.
- Further dialogue is needed to refine the BCLC system for practical HCC management.
Abstract:
Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third most common cause of cancer-related deaths worldwide. The Barcelona Clinic Liver Cancer (BCLC) classification has been endorsed as the optimal staging system and treatment algorithm for HCC by the European Association for the Study of Liver Disease and the American Association for the Study of Liver Disease. However, in real life, the majority of patients who are not considered ideal candidates based on the BCLC guideline still were performed hepatic resection nowadays, which means many hepatic surgeons all around the world do not follow the BCLC guidelines. The accuracy and application of the BCLC classification has constantly been challenged by many clinicians. From the surgeons' perspectives, we herein put forward some comments on the BCLC classification concerning subjectivity of the assessment criteria, comprehensiveness of the staging definition and accuracy of the therapeutic recommendations. We hope to further discuss with peers and colleagues with the aim to make the BCLC classification more applicable to clinical practice in the future.
Related Concept Videos
01:27Liver Histology
Hepatocytes perform a variety of essential functions. They secrete...
01:26Diseases of the Liver and Gallbladder
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...