Advertisement

The updated BCLC staging system needs further refinement: A surgeon’s perspective

  • Xiao Xu
    Affiliations
    Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China

    Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University, Nantong University, Jiangsu, China
    Search for articles by this author
  • Wan Yee Lau
    Affiliations
    Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, China

    Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
    Search for articles by this author
  • Tian Yang
    Correspondence
    Corresponding author. Address: Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China; Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), 225 Changhai Road, Shanghai 200438, China.
    Affiliations
    Department of General Surgery, Cancer Center, Division of Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China

    Department of Hepatobiliary Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
    Search for articles by this author
Published:January 20, 2022DOI:https://doi.org/10.1016/j.jhep.2022.01.002
      We read with great interest the recent update to 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.
      which needed updating based on the remarkable high-level evidence on hepatocellular carcinoma (HCC) management that has been generated in recent years. The main updated contents included updating the recommended first- and second-line systemic drugs for advanced stage HCC (BCLC stage C), and refining intermediate stage HCC (BCLC stage B).
      • 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.
      To our knowledge, it is the fifth “major” update since the BCLC staging system was first introduced in 1999 by 3 well-known hepatologists.
      • Llovet J.M.
      • Bru C.
      • Bruix J.
      Prognosis of hepatocellular carcinoma: the BCLC staging classification.
      We, hepatic surgeons, appreciate the continuous efforts to improve the BCLC staging system, but we believe that this updated BCLC staging system is still not entirely satisfactory, and we have the following comments:

      Keywords

      Abbreviations:

      BCLC (Barcelona Clinic Liver Cancer), ECOG (Eastern Cooperative Oncology Group), HCC (hepatocellular carcinoma), PS (performance status)

      Linked Article

      • BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update
        Journal of HepatologyVol. 76Issue 3
        • Preview
          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.
        • Full-Text
        • PDF
      • 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.
        • Full-Text
        • PDF
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Hepatology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • 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.
        J Hepatol. 2022; 76: 681-693
        • Llovet J.M.
        • Bru C.
        • Bruix J.
        Prognosis of hepatocellular carcinoma: the BCLC staging classification.
        Semin Liver Dis. 1999; 19: 329-338
        • Hsu C.Y.
        • Lee Y.H.
        • Hsia C.Y.
        • Huang Y.H.
        • Su C.W.
        • Lin H.C.
        • et al.
        Performance status in patients with hepatocellular carcinoma: determinants, prognostic impact, and ability to improve the Barcelona Clinic Liver Cancer system.
        Hepatology. 2013; 57: 112-119
        • Wu H.
        • Xing H.
        • Liang L.
        • Huang B.
        • Li C.
        • Lau W.Y.
        • et al.
        Real-world role of performance status in surgical resection for hepatocellular carcinoma: a multicenter study.
        Eur J Surg Oncol. 2019; 45: 2360-2368
        • Yang T.
        • Sun Y.F.
        • Zhang J.
        • Lau W.Y.
        • Lai E.C.
        • Lu J.H.
        • et al.
        Partial hepatectomy for ruptured hepatocellular carcinoma.
        Br J Surg. 2013; 100: 1071-1079
        • Marrero J.A.
        • Kulik L.M.
        • Sirlin C.B.
        • Zhu A.X.
        • Finn R.S.
        • Abecassis M.M.
        • et al.
        Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the American association for the study of liver diseases.
        Hepatology. 2018; 68: 723-750
        • Kim D.S.
        • Kim B.W.
        • Hatano E.
        • Hwang S.
        • Hasegawa K.
        • Kudo A.
        • et al.
        Surgical outcomes of hepatocellular carcinoma with bile duct tumor thrombus: a Korea-Japan multicenter study.
        Ann Surg. 2020; 271: 913-921
        • Kokudo T.
        • Hasegawa K.
        • Matsuyama Y.
        • Takayama T.
        • Izumi N.
        • Kadoya M.
        • et al.
        Liver resection for hepatocellular carcinoma associated with hepatic vein invasion: a Japanese nationwide survey.
        Hepatology. 2017; 66: 510-517
        • Yang T.
        • Lau W.Y.
        • Zhang H.
        • Wu M.C.
        • Shen F.
        Hepatic surgeons are like the child who rescued dying fishes.
        Hepatology. 2016; 63: 1054
        • Yang T.
        • Melloul E.
        • Tabrizian P.
        • Schwartz M.
        Expanded criteria for resection: are current guidelines too conservative.
        Curr Hepatol Rep. 2016; 15: 323-326