Adherence to AASLD guidelines for the treatment of hepatocellular carcinoma in clinical practice: Experience of the Bologna Liver Oncology Group

External validation of the ITA.LI.CA prognostic system for patients with hepatocellular carcinoma: A multicenter cohort study

“…In addition, the high heterogeneity of patients included in any given stage, especially in BCLC intermediate/advanced ones, implies a wide range of possible managing treatments (including no treatment) with a consequent potential for a wide variation of their impact on overall survival. Rigidity of the BCLC therapeutic algorithm as well as its difficulty to be applied in clinical practice have been repeatedly underlined . For these reasons, Farinati et al decided not to include a prefixed treatment algorithm in their integrated prognostic system.…”

Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma

“…Considering the advancement of HCC management in the last years, this indication sounds too restrictive and somehow obsolete. Therefore, it is frequently disregarded in clinical practice in favour of a more flexible and individually tailored therapeutic approach …”

“…However, increasing evidence suggests that the BCLC system is an imperfect tool in selecting the best treatment option for HCC, and the advancements in HCC management prompts the refinement of an algorithm created more than 10 years ago. The current inadequacy of the BCLC staging system is widely perceived so that both Japanese and Italian guidelines propose, instead of a single stage‐specific first‐line treatment, a “box” of therapeutic options allowing a more flexible and individualized decision, and a number of referral centres report frequent deviations from the BCLC indications . The therapeutic boundaries are perceived as especially narrow for the intermediate stage (BCLC B), which includes an extremely heterogeneous population so that the standard‐of‐care treatment –transarterial chemoembolization (TACE) – may represent an “undertreatment” for some patients and an “overtreatment” for others.…”

Treatment Stage Migration Maximizes Survival Outcomes in Patients with Hepatocellular Carcinoma Treated with Sorafenib: An Observational Study

“…Treatment options for HCC have widened and improved over time to include surgical, locoregional, and systemic therapies [4], and staging algorithms including the Barcelona Clinical Liver Cancer (BCLC) system have facilitated a rational treatment allocation process. Despite increasing efforts addressed at harmonizing management decisions, there is recognized geographical variation in the provision of radical and palliative treatments in HCC where regional preferences and the availability of each treatment modality among the treating multidisciplinary tumour board affect outcomes [5,6]. …”