Hepatocellular Carcinoma — BCLC

Barcelona Clinic Liver Cancer staging, 2022 update

Tumour burden

Single nodule ≤ 2 cm, no vascular invasion or spread

Single nodule > 2 cm, no vascular invasion or spread

Up to 3 nodules, each ≤ 3 cm, no vascular invasion or spread

Multinodular (> 3 nodules, or > 3 cm each) confined to the liver

Macrovascular (portal vein) invasion and/or extrahepatic spread

Liver function (Child-Pugh)

Child-Pugh A (preserved liver function)

Child-Pugh B

Child-Pugh C (advanced liver failure)

Performance status (ECOG)

ECOG 0 — fully active

ECOG 1–2 — restricted but self-caring

ECOG 3–4 — largely confined to bed/chair

Evidence

Original publication

Reig M, Forner A, Rimola J, et al. BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update. Refines the mapping of tumour burden, liver function and performance status to stages 0/A/B/C/D and to first-line treatment, and adds a subclassification of stage B and the concept of stage migration.

Journal of Hepatology, 2022

Open source

Guideline

European Association for the Study of the Liver (EASL) and AASLD HCC guidelines endorse the BCLC framework. Liver function is assessed by Child-Pugh (and increasingly by the ALBI grade). Confirm the stage against the 2022 publication.

Last reviewed: 2026-09

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