# BCLC — Barcelona Clinic Liver Cancer staging

> Stages hepatocellular carcinoma by tumor burden, liver function, and performance status to guide treatment and prognosis.

**Situação:** vigente · **Órgão:** Fígado · **Órgão emissor:** Barcelona Clinic Liver Cancer group · **Versão:** 2022 · **Ano:** 2022

## Procedência e vigência
- Família: algoritmo
- Tipo de lógica: flat
- Modalidade: CT, MRI, US
- Fonte primária: Reig M, Forner A, Rimola J, et al.. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update (2022) — https://pmc.ncbi.nlm.nih.gov/articles/PMC8866082/
- Última verificação: 2026-06-26
- Última checagem: 2026-06-26

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| 0 | Stage 0, very early | Very early stage: a single tumor up to 2 cm, no vascular invasion or extrahepatic spread; preserved liver function (Child-Pugh A) and ECOG performance status 0. | Ablation (radiofrequency or microwave) is the usual first option; resection where feasible, and liver transplantation in selected candidates. | Best prognosis: median survival exceeds 5 years. | PMC8866082 (Reig et al., J Hepatol 2022), BCLC 2022 algorithm/summary and treatment-strategy section; criteria corroborated by NCBI Bookshelf NBK569796 BCLC staging table (single <=2 cm, CP A, PS 0). | ✓ |
| A | Stage A, early | Early stage: a solitary tumor of any size, or up to 3 nodules each up to 3 cm, with no macrovascular invasion or extrahepatic spread; preserved liver function (Child-Pugh A-B) and ECOG performance status 0. | Curative options: resection (preferred without clinically significant portal hypertension), ablation for tumors up to 3 cm, or transplant when high recurrence-risk pathology is present. | Favorable prognosis: median survival exceeds 5 years. | PMC8866082, BCLC 2022 algorithm and treatment-strategy section; criteria corroborated by NBK569796 table (single, or <=3 nodules <=3 cm, CP A-B, PS 0). | ✓ |
| B | Stage B, intermediate | Intermediate stage: multinodular hepatocellular carcinoma exceeding early-stage limits, without macrovascular invasion or extrahepatic spread; preserved liver function and ECOG performance status 0. | Transarterial chemoembolization is the reference treatment when liver function is preserved; transplant under extended criteria for selected patients, and systemic therapy for extensive or diffuse bilobar disease unsuitable for chemoembolization. | Median survival around 2.5 years. | PMC8866082, BCLC 2022 algorithm and treatment-strategy section; criteria corroborated by NBK569796 table (multinodular, CP A-B, PS 0). | ✓ |
| C | Stage C, advanced | Advanced stage: macrovascular (portal) invasion and/or extrahepatic spread; preserved or compensated liver function (Child-Pugh A-B) and ECOG performance status 1-2. | First-line systemic therapy: atezolizumab plus bevacizumab is the first choice; tremelimumab plus durvalumab, sorafenib, or lenvatinib are alternatives. | Median survival around 2 years. | PMC8866082, systemic-therapy section; criteria corroborated by NBK569796 table (vascular invasion or extrahepatic spread, CP A-B, PS 1-2). | ✓ |
| D | Stage D, terminal | Terminal stage: end-stage liver function (Child-Pugh C, not transplant-eligible) and/or ECOG performance status 3-4 or major cancer-related symptoms; any tumor burden. | Best supportive and symptomatic care with palliative-care coordination. | Poor prognosis: median survival around 3 months. | PMC8866082, treatment-strategy section; criteria corroborated by NBK569796 table (any tumor, CP C, PS 3-4). | ✓ |

### Citações por categoria
- **0**: Reig M, Forner A, Rimola J, et al.. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update (2022) — https://pmc.ncbi.nlm.nih.gov/articles/PMC8866082/ · PMC8866082 (Reig et al., J Hepatol 2022), BCLC 2022 algorithm/summary and treatment-strategy section; criteria corroborated by NCBI Bookshelf NBK569796 BCLC staging table (single <=2 cm, CP A, PS 0).
- **A**: Reig M, Forner A, Rimola J, et al.. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update (2022) — https://pmc.ncbi.nlm.nih.gov/articles/PMC8866082/ · PMC8866082, BCLC 2022 algorithm and treatment-strategy section; criteria corroborated by NBK569796 table (single, or <=3 nodules <=3 cm, CP A-B, PS 0).
- **B**: Reig M, Forner A, Rimola J, et al.. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update (2022) — https://pmc.ncbi.nlm.nih.gov/articles/PMC8866082/ · PMC8866082, BCLC 2022 algorithm and treatment-strategy section; criteria corroborated by NBK569796 table (multinodular, CP A-B, PS 0).
- **C**: Reig M, Forner A, Rimola J, et al.. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update (2022) — https://pmc.ncbi.nlm.nih.gov/articles/PMC8866082/ · PMC8866082, systemic-therapy section; criteria corroborated by NBK569796 table (vascular invasion or extrahepatic spread, CP A-B, PS 1-2).
- **D**: Reig M, Forner A, Rimola J, et al.. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update (2022) — https://pmc.ncbi.nlm.nih.gov/articles/PMC8866082/ · PMC8866082, treatment-strategy section; criteria corroborated by NBK569796 table (any tumor, CP C, PS 3-4).

## Referências cruzadas
- _fronteira compartilhada_ → [Couinaud — Couinaud liver segmentation with Brisbane terminology](https://radcommons.laudos.ai/systems/couinaud.md) — BCLC stages HCC for treatment planning; Couinaud localizes the tumor for resection planning.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2022-01-01 | revised | BCLC strategy 2022 update published in the Journal of Hepatology. | confirmed |


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