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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 21, 2015; 21(27): 8256-8261
Published online Jul 21, 2015. doi: 10.3748/wjg.v21.i27.8256
Grey zone in the Barcelona Clinic Liver Cancer Classification for hepatocellular carcinoma: Surgeons’ perspective
Tian Yang, Wan-Yee Lau, Han Zhang, Bin Huang, Jun-Hua Lu, Meng-Chao Wu
Tian Yang, Wan-Yee Lau, Han Zhang, Bin Huang, Jun-Hua Lu, Meng-Chao Wu, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai 200438, China
Wan-Yee Lau, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
Author contributions: Yang T, Zhang H, Huang B and Wu MC designed the research; Yang T, Lau WY and Lu JH wrote the paper; and Wu MC gave their critical comments.
Supported by National Natural Science Foundation of China, No. 81472284, No. 81172020 and No. 81372262 (to Tian Yang and Jun-Hua Lu).
Conflict-of-interest statement: All authors declared no potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Meng-Chao Wu, MD, Professor, Director of Eastern Hepatobiliary Surgery Hospital, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, No. 225, Changhai Road, Yangpu District, Shanghai 200438, China. mengchao_wu@sina.com
Telephone: +86-81875009 Fax: +86-21-65566085
Received: January 13, 2015
Peer-review started: January 14, 2015
First decision: April 13, 2015
Revised: April 29, 2015
Accepted: May 21, 2015
Article in press: May 21, 2015
Published online: July 21, 2015
Processing time: 189 Days and 21.3 Hours
Abstract

Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third most common cause of cancer-related deaths worldwide. The Barcelona Clinic Liver Cancer (BCLC) classification has been endorsed as the optimal staging system and treatment algorithm for HCC by the European Association for the Study of Liver Disease and the American Association for the Study of Liver Disease. However, in real life, the majority of patients who are not considered ideal candidates based on the BCLC guideline still were performed hepatic resection nowadays, which means many hepatic surgeons all around the world do not follow the BCLC guidelines. The accuracy and application of the BCLC classification has constantly been challenged by many clinicians. From the surgeons’ perspectives, we herein put forward some comments on the BCLC classification concerning subjectivity of the assessment criteria, comprehensiveness of the staging definition and accuracy of the therapeutic recommendations. We hope to further discuss with peers and colleagues with the aim to make the BCLC classification more applicable to clinical practice in the future.

Keywords: Hepatocellular carcinoma; Staging system; Barcelona Clinic Liver Cancer Classification; Treatment; Hepatectomy; Prognosis

Core tip: The accuracy and application of the Barcelona Clinic Liver Cancer (BCLC) classification for hepatocellular carcinoma has constantly been challenged by many clinicians. From the surgeons’ perspectives, we herein put forward some comments with an aim to make the BCLC classification more applicable to clinical practice in the future.