Liver cancer (BCLC staging)

Last revised by Bruno Di Muzio on 16 Apr 2020

Barcelona clinic liver cancer (BCLC) staging uses a set of criteria to guide the management of patients with hepatocellular carcinoma (HCC).

The classification takes the following variables into account 1,2:

The classification system sorts patients into one of four categories:

  • stage 0 (very early stage)
    • asymptomatic early tumors
      • PS 0
      • Child-Pugh A
      • solitary lesion measuring less than 2 cm in diameter
    • management
      • resection
      • if portal hypertension/hyperbilirubinemia, transplant is then recommended  
  • stage A (early stage)
    • asymptomatic early tumors
      • PS 0-2
      • Child-Pugh A to C
      • solitary lesion > 2 cm or early multifocal disease characterized by up to 3 lesions measuring less than 3 cm
    • management
      • usually, resection is viable for single lesions  
      • if multiple lesions, transplant is then recommended  
      • if other clinical comorbidities are present, radiofrequency ablation is then recommended   
  • stage B (intermediate stage)
    • asymptomatic multifocal disease 
      • PS 0
      • Child-Pugh A to C
      • multifocal disease: more than one lesion with at least one over 3 cm, or more than 3 lesions regardless of their size
    • management is usually recommended with transcatheter arterial chemoembolisation (TACE)
  • stage C (advanced stage)
    • symptomatic tumors and invasive and/or metastatic disease
      • PS 1-2
      • Child-Pugh A to C
      • vascular invasion and/or nodal disease and/or metastatic disease
    • management is usually palliative: sorafenib, phase II trial agents, or other palliative treatments
  • stage D (end-stage disease)
    • terminal stage
      • PS > 2
      • Child-Pugh C
      • it is not a radiological stage, only clinical
    • symptomatic treatment only
    • equivalent to Okuda stage III

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