The Barcelona Clinic Liver Cancer (BCLC) system integrates tumour burden, hepatic functional reserve (Child-Pugh score), and patient performance status to allocate patients to one of five stages, each linked to a defined first-line treatment strategy. It is endorsed by the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD).
Stage 0 (Very Early): Single tumour ≤2 cm, PS 0, Child-Pugh A, no portal hypertension, bilirubin normal. Ideal candidates for surgical resection or percutaneous ablation with curative intent.
Stage A (Early): Single tumour >2 cm, or up to 3 nodules each ≤3 cm, PS 0, Child-Pugh A or B. Treatment options include resection, orthotopic liver transplantation (OLT), or ablation depending on functional reserve and tumour location.
Stage B (Intermediate): Multinodular tumour without vascular invasion or extrahepatic spread, PS 0, Child-Pugh A or B. First-line therapy is transarterial chemoembolisation (TACE).
Stage C (Advanced): Macrovascular invasion (portal vein thrombosis) or extrahepatic metastases, or PS 1–2 with Child-Pugh A/B. Systemic therapy is the standard of care.
Stage D (Terminal): PS 3–4 or Child-Pugh C. Best supportive care only; active anti-tumour treatment confers no survival benefit and significant toxicity.
| Stage | Criteria | First-line Treatment | Survival |
|---|---|---|---|
| 0 | Single ≤2 cm, PS 0, CP-A, no PHT, normal bilirubin | Resection or ablation | ~80% 5-yr |
| A | Single >2 cm OR 3 nodules ≤3 cm, PS 0, CP-A/B | Resection / OLT / ablation | 50–70% 5-yr |
| B | Multinodular, no vascular invasion, PS 0, CP-A/B | TACE | ~20 months median |
| C | PV invasion OR extrahepatic spread, PS 1–2, CP-A/B | Atezolizumab-bevacizumab / sorafenib / lenvatinib | 12–15 months |
| D | PS 3–4 OR Child-Pugh C | Best supportive care | 3–4 months |