Prognosis of hepatocellular carcinoma: The BCLC staging classification

The classifications of hepatocellular carcinoma (HCC) currently used are ba sed on prognostic factors obtained from studies performed years ago when mo st tumors were diagnosed at advanced stages and the survival rates were sub stantially poor. Recent investigations have reviewed the survival of early tumors properly selected to receive radical therapies and the natural outco me of nonsurgical HCC patients. These data enable a new staging system to b e proposed, the Barcelona Clinic Liver Cancer (BCLC) staging classification , that comprises four stages that select the best candidates for the best t herapies currently available. Early stage (A) includes patients with asympt omatic early tumors suitable for radical therapies-resection, transplantati on or percutaneous treatments. Intermediate stage (B) comprises patients wi th asymptomatic multinodular HCC Advanced stage (C) includes patients with symptomatic tumors and/or an invasive tumoral pattern (vascular invasion/ex trahepatic spread). Stage B and C patients may receive palliative treatment s/new agents in the setting of phase II investigations or randomized contro lled trials. End-stage disease (D) contain patients with extremely grim pro gnosis (Okuda stage III or PST3-4) that should merely receive symptomatic t reatment.