BCLC Staging Calculator for Hepatocellular Carcinoma
What is BCLC Staging?
The Barcelona Clinic Liver Cancer (BCLC) staging system is the most widely used classification system for hepatocellular carcinoma (HCC). It provides a comprehensive framework for prognosis prediction and treatment allocation based on tumor burden, liver function, and physical status of the patient.
The BCLC system classifies HCC patients into five distinct stages (0, A, B, C, D) and directly links each stage with specific treatment recommendations, making it a valuable tool for clinicians managing HCC patients.
Patient Assessment
The Barcelona-Clinic Liver Cancer (BCLC) staging system is a widely used tool for classifying hepatocellular carcinoma (HCC) and linking stage with prognosis and recommended treatments. It was developed by the Barcelona group in the late 1990s and refined over time, and is now endorsed by major societies including AASLD and EASL.onlinelibrary.wiley.com+2wjgnet.com+2
Unlike purely anatomic systems (like TNM), BCLC incorporates:pmc.ncbi.nlm.nih.gov+1
- Tumor burden – number and size of nodules, presence of vascular invasion or extrahepatic spread
- Liver function – usually via Child–Pugh class (A–C)
- Performance status – patient’s general condition using ECOG PS (0–4)
BCLC stages (simplified)
Most guidelines describe five BCLC stages:wjgnet.com+2en.wikipedia.org+2
- Stage 0 – Very early
- Single nodule < 2 cm, Child–Pugh A, ECOG 0
- Candidates for curative therapy (ablation or resection; sometimes transplant).pmc.ncbi.nlm.nih.gov+1
- Stage A – Early
- Single nodule or up to 3 nodules ≤ 3 cm, good liver function (Child A–B), ECOG 0
- Curative options: resection, liver transplantation, percutaneous ablation.mdcalc.com+1
- Stage B – Intermediate
- Multinodular disease, preserved liver function, ECOG 0
- Typically treated with trans-arterial therapies (e.g. TACE / other intra-arterial approaches), though this group is heterogeneous and increasingly sub-stratified.
- Stage C – Advanced
- Vascular invasion and/or extrahepatic spread and/or ECOG 1–2, with Child A–B liver function
- Usually treated with systemic therapy (immunotherapy- or TKI-based regimens).
- Stage D – Terminal
- Poor performance status (ECOG ≥3) and/or decompensated liver disease (Child–Pugh C)
- Focus is on best supportive and palliative care; transplant is rarely feasible.
The BCLC system is popular because it combines staging with a treatment algorithm, but it has limitations: intermediate (BCLC-B) and advanced (BCLC-C) groups are very heterogeneous, and management often “migrates” between stages based on individual factors and evolving evidence.
