Hepatocellular carcinoma: From clinical practice to evidence-based treatment protocols

Table 1 Limitations of the barcelona-clinic liver cancer staging system[78]

No	BCLC classification system
1	Does not consider nodule location, which is essential for defining respectability
2	Does not respect etiology of cirrhosis
3	Is based on variables measured at diagnosis, which might change over time
4	Does not consider the possibility of liver transplantation for patients with Child C cirrhosis with hccs within the Milan criteria
5	Does not reflect contraindications of TACE
6	Recommends liver resection to single nodules only in absence of portal hypertension in very early (BCLC 0) and early stage (BCLC A), however probably portal hypertension might not affect survival in resected patients
7	Recommends liver resection in very early (BCLC 0) and early stage (BCLC A), however in selected patients hepatic resection is associated with good survival even in more advanced BCLC stages
8	Does not consider treatment sequences or combination therapies
9	Includes a very heterogeneous population in the intermediate stage (BCLC B) in respect to tumor burden and liver function
10	Does not consider other therapies than sorafenib in selected patients with advanced stage C with performance status 1
11	Is not favorable as classification system in non-cirrhotic patients

BCLC: Barcelona-clinic liver cancer; TACE: Transarterial chemoembolization.