A 58-year-old man with non-alcoholic steatohepatitis (NASH)-related cirrhosis (Child-Pugh B, MELD 14) has hepatocellular carcinoma detected: single lesion 3 cm, AFP 450 ng/mL, portal vein patent. ECOG performance status 0. According to Barcelona Clinic Liver Cancer (BCLC) staging and treatment algorithm, the appropriate management is:
- A Radiofrequency ablation or liver transplantation evaluation (bridge therapy) ✓
- B Systemic sorafenib
- C Surgical resection
- D Transarterial chemoembolization (TACE)
Explanation
This patient has BCLC Stage A HCC (single nodule <5 cm on cirrhotic background, PS 0). BCLC Stage A treatment hierarchy: resection for Child-Pugh A with preserved portal pressure; transplantation for patients meeting Milan criteria (single ≤5 cm or ≤3 nodules each ≤3 cm); ablation (RFA/MWA) as equivalent alternative for lesions ≤3 cm. Child-Pugh B status with cirrhosis makes resection risky; transplant evaluation is appropriate as this lesion is within Milan criteria. Bridge therapy (RFA or TACE) prevents dropout while awaiting transplant. Sorafenib is for BCLC C (advanced stage). TACE is for BCLC B (multinodular).
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.