title: Grey zone in the Barcelona Clinic Liver Cancer Classification for hepatocellular carcinoma: Surgeons' perspective.
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.
authors.affiliation: 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.
authors.forename: Tian
authors.initials: T
authors.lastname: Yang
authors.affiliation: 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.
authors.forename: Wan-Yee
authors.initials: WY
authors.lastname: Lau
authors.affiliation: 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.
authors.forename: Han
authors.initials: H
authors.lastname: Zhang
authors.affiliation: 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.
authors.forename: Bin
authors.initials: B
authors.lastname: Huang
authors.affiliation: 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.
authors.forename: Jun-Hua
authors.initials: JH
authors.lastname: Lu
authors.affiliation: 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.
authors.forename: Meng-Chao
authors.initials: MC
authors.lastname: Wu
mesh_terms: D000328:Adult; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000145:classification / Q000473:pathology* / Q000601:surgery; D019091:Critical Pathways; D003661:Decision Support Techniques; D005260:Female; D019983:Guideline Adherence; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000145:classification / Q000473:pathology* / Q000601:surgery; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D066231:Surgeons; D014057:Tomography, X-Ray Computed
keywords: Barcelona Clinic Liver Cancer Classification; Hepatectomy; Hepatocellular carcinoma; Prognosis; Staging system; Treatment