Liver dysfunction in Barcelona Clinic Liver Cancer-2022 update: Clear as day or still in fog?

  • Anshuman Elhence
    Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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  • Shalimar
    Corresponding author. Address: Department of Gastroenterology, Room No 127, Human Nutrition Unit, Old OT block, AIIMS, New Delhi, India 110029.
    Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, India
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Published:December 23, 2021DOI:
      We read with great interest the article by Reig and colleagues presenting the 2022 update of one of the most used staging systems for hepatocellular carcinoma (HCC), the Barcelona Clinic Liver Cancer (BCLC) staging system.
      • Reig M.
      • Forner A.
      • Rimola J.
      • Ferrer-Fábrega J.
      • Burrel M.
      • Garcia-Criado A.
      • et al.
      BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update.
      The current version is improved over its predecessor, with further stratification of the heterogenous BCLC-B group, the addition of newer immunotherapy options for the BCLC-C group and consideration of liver transplant (LT) as an option for those with tumor burden acceptable for transplant regardless of their liver dysfunction. However, there remains a lot to be desired, especially regarding the use of liver function in BCLC stage allocation and linking the first treatment option to be considered with the current system.


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      • BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update
        Journal of HepatologyVol. 76Issue 3
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          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.
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      • Reply to: “Correspondence on the <BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update>”
        Journal of HepatologyVol. 76Issue 5
        • Preview
          We appreciate the interest garnered by the BCLC 2022 model update. The new version has incorporated the evidence-based novelties generated in recent years, while also adding a section devoted to clinical decision making at the time of first evaluation and during a patient’s clinical evolution. No clinical practice guideline or recommendation review will ever have enough granularity to firmly recommend the most beneficial approach for an individual patient.
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