Confirmed HCC (LI-RADS 5 or Biopsy)
Diagnosis confirmed by imaging or pathology
All Pathways
Hepatobiliary SurgeryDiagnostic
HCC Resection Candidacy - BCLC/AASLD 2024
HCC Resection Candidacy - BCLC/AASLD 2024: Confirmed HCC (LI-RADS 5 or Biopsy) → BCLC Staging Assessment → BCLC Stage → BCLC 0: Very Early → Liver Funct...
Pathway Overview
14 steps
Algorithm Steps
14 total
01Start 02Action BCLC Staging Assessment
Tumor burden, liver function, performance status
- Tumor number and size (imaging)
- Child-Pugh score
- ECOG performance status
03Decision BCLC Stage
- 0 (Very Early): Single <2cm
- A (Early): Single or up to 3 ≤3cm
- B (Intermediate): Multinodular, no vascular invasion
- C (Advanced): Vascular invasion or extrahepatic
- D (Terminal): Child-Pugh C or PS >2
04Action BCLC 0: Very Early
Single <2cm, Child-Pugh A, PS 0
05Decision Liver Function Assessment
- Child-Pugh A: proceed to resection eval
- Child-Pugh B: transplant preferred
- Portal HTN (HVPG >10): caution
06Action FLR Assessment
Future liver remnant evaluation
- CT volumetry
- Normal liver: FLR >20%
- Cirrhosis: FLR >40%
- Consider PVE if insufficient
07Action Surgical Resection
Anatomic or non-anatomic hepatectomy
- Parenchymal-sparing when possible
- Laparoscopic if feasible
- R0 resection goal (1cm margin)
08End Treatment & Surveillance
Regular imaging, AFP monitoring, MDT review
09Action Transplant Evaluation
Milan or expanded criteria
- Milan: 1 ≤5cm or 3 ≤3cm
- UCSF, Up-to-7, AFP score
- Bridging/downstaging if needed
- Path rejoins step 08Shared downstream outcome
- Path rejoins step 09Shared downstream outcome
10Action BCLC A: Early
1-3 tumors ≤3cm, preserved function
- Path rejoins step 05Shared downstream outcome
11Action BCLC B: Intermediate
Multinodular, no invasion
12Action Locoregional Therapy
TACE, Y90, ablation
- TACE for multinodular BCLC B
- Ablation for small tumors if not surgical
- Y90 for portal vein involvement
- Path rejoins step 08Shared downstream outcome
13Action BCLC C/D: Advanced
Vascular invasion, mets, or terminal
14Action Systemic Therapy
TKIs, immunotherapy
- Atezolizumab-bevacizumab first-line
- Sorafenib/lenvatinib alternatives
- BSC for terminal (BCLC D)
- Path rejoins step 08Shared downstream outcome
Guideline Source
AASLD Practice Guidance on the Management of Hepatocellular Carcinoma
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- BCLC traditionally conservative - expanded criteria increasingly accepted
- Liver function assessment critical (Child-Pugh, MELD, ALBI)
- Portal hypertension impacts resection candidacy
- Tumor biology (AFP, imaging features) affects prognosis
Applicable Regions
USAUUKEU
EU: EASL-EORTC guidelines
JP: Japanese HCC guidelines (more aggressive resection)
US: AASLD guidelines
Version 1Next review: 2028-01-01
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Related Resources
Frequently Asked Questions
What is the HCC Resection Candidacy - BCLC/AASLD 2024?
The HCC Resection Candidacy - BCLC/AASLD 2024 is a diagnostic clinical algorithm for Hepatobiliary Surgery. It provides a structured decision tree to guide clinical decision-making, based on AASLD Practice Guidance on the Management of Hepatocellular Carcinoma.
What guideline is the HCC Resection Candidacy - BCLC/AASLD 2024 based on?
This algorithm is based on AASLD Practice Guidance on the Management of Hepatocellular Carcinoma (DOI: 10.1002/hep.32219).
What are the limitations of the HCC Resection Candidacy - BCLC/AASLD 2024?
Known limitations include: BCLC traditionally conservative - expanded criteria increasingly accepted; Liver function assessment critical (Child-Pugh, MELD, ALBI); Portal hypertension impacts resection candidacy; Tumor biology (AFP, imaging features) affects prognosis. Individual patient factors may require deviation from these recommendations.
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