A 58-year-old man with hepatitis B-related cirrhosis (Child-Pugh A, MELD 10) has a 3.2 cm hepatocellular carcinoma on a background of cirrhosis. AFP is 280 ng/mL. CT shows arterial enhancement with washout (LI-RADS 5). He is being evaluated for treatment. According to the Barcelona Clinic Liver Cancer (BCLC) classification and current guidelines, which treatment offers the BEST chance of cure?
- A Liver resection (hepatectomy) ✓
- B Transarterial chemoembolization (TACE)
- C Sorafenib systemic therapy
- D Microwave ablation
Explanation
For BCLC stage A (single HCC ≤5 cm or up to 3 nodules ≤3 cm each) with preserved liver function (Child-Pugh A), liver resection offers the best chance of cure with 5-year survival rates of 50-70%. Despite cirrhosis, Child-Pugh A indicates adequate hepatic reserve. The key assessment before resection is future liver remnant volume. TACE is palliative (BCLC B — intermediate stage). Sorafenib is for advanced/metastatic disease (BCLC C). Ablation (RFA/microwave) has comparable local control for lesions ≤3 cm but slightly inferior long-term survival compared to resection for resectable disease.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.