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

Xiao Xu; Wan Yee Lau; Tian Yang

doi:10.1016/j.jhep.2022.01.002

Letter to the Editor| Volume 76, ISSUE 5, P1239-1240, May 2022

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

Xiao Xu
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
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Wan Yee Lau
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
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Tian Yang
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.
Contact
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
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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,

^[1]

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).

^[1]

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.

^[2]

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
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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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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
View in Article
- Llovet J.M.
- Bru C.
- Bruix J.
Prognosis of hepatocellular carcinoma: the BCLC staging classification.
Semin Liver Dis. 1999; 19: 329-338
View in Article
- 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
View in Article
- 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
View in Article
- 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
View in Article
- 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
View in Article
- 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
View in Article
- 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
View in Article
- 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
View in Article
- Yang T.
- Melloul E.
- Tabrizian P.
- Schwartz M.
Expanded criteria for resection: are current guidelines too conservative.
Curr Hepatol Rep. 2016; 15: 323-326
View in Article
- Crossref
- Google Scholar

Article info

Publication history

Published online: January 20, 2022

Accepted: January 3, 2022

Received: December 28, 2021

Footnotes

Author names in bold designate shared co-first authorship

Identification

DOI: https://doi.org/10.1016/j.jhep.2022.01.002

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