BCLC strategy for prognosis prediction and treatment recommendations: The 2026 update

The 2026 BCLC update incorporates recent therapeutic advances in HCC into its recommendations, while preserving simplicity. Each disease stage remains directly linked to its evidence-based first-line treatment option. The BCLC algorithm provides guidance for evaluating patient prognosis and proposes a therapeutic strategy according to the current scientific evidence. Tumour boards require structured methodologies to address clinical complexity. Beyond published evidence, decision-making should incorporate biological, psychosocial, and contextual factors that may affect morbidity, feasibility, and patient vulnerability. Such a multidimensional approach ensures treatments remain evidence-based and patient-centred. The updated clinical decision-making chapter embeds the CUSE (Complexity, Uncertainty, Subjectivity, Emotion) framework. CUSE turns unavoidable doubt into a shared, iterative process to: (i) define the therapeutic goal (survival, tumour control, quality of life, etc.); (ii) grade each option, noting evidence strength and gaps; (iii) align choices with comorbidities, feasibility, oncologic risk, and patient values and goals; and (iv) select a plan with regular check-ins as new information or needs arise.