Semin Liver Dis 2012; 32(04): 348-359
DOI: 10.1055/s-0032-1329906
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Heterogeneity of Patients with Intermediate (BCLC B) Hepatocellular Carcinoma: Proposal for a Subclassification to Facilitate Treatment Decisions

Luigi Bolondi
1   Division of Internal Medicine, Department of Digestive Disease and Internal Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
,
Andrew Burroughs
2   The Royal Free Sheila Sherlock Liver Centre, The Royal Free Hospital and UCL Institute for Liver and Digestive Health, UCL London, London, UK
,
Jean-François Dufour
3   University Clinic for Visceral Surgery and Medicine, Inselspital, Bern and Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland
,
Peter R. Galle
4   University Medical Center, I. Medical Department, Johannes Gutenberg University, Mainz, Germany
,
Vincenzo Mazzaferro
5   Istituto Nazionale Tumori (National Cancer Institute) IRCCS Foundation, Milan, Italy
,
Fabio Piscaglia
1   Division of Internal Medicine, Department of Digestive Disease and Internal Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
,
Jean Luc Raoul
6   Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
,
Bruno Sangro
7   Liver Unit, Clinica Universidad de Navarra, and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBERehd), Pamplona, Spain
› Author Affiliations
Further Information

Publication History

Publication Date:
08 February 2013 (online)

Abstract

The intermediate stage of hepatocellular carcinoma (HCC) comprises a highly heterogeneous patient population and therefore poses unique challenges for therapeutic management, different from the early and advanced stages. Patients classified as having intermediate HCC by the Barcelona Clinic Liver Cancer (BCLC) staging system present with varying tumor burden and liver function. Transarterial chemoembolization (TACE) is currently recommended as the standard of care in this setting, but there is considerable variation in the clinical benefit patients derive from this treatment.

In April 2012, a panel of experts convened to discuss unresolved issues surrounding the application of current guidelines when managing patients with intermediate HCC. The meeting explored the applicability of a subclassification system for intermediate HCC patients to tailor therapeutic interventions based on the evidence available to date and expert opinion. The present report summarizes the proposal of the expert panel: four substages of intermediate HCC patients, B1 to B4.