A 55-year-old man with Child-Pugh A cirrhosis (HBV-related) presents with a single 4.5 cm hepatocellular carcinoma on background cirrhosis. BCLC staging places him at Stage B. He has ECOG performance status 0. According to current BCLC 2022 guidelines, the preferred treatment is:
- A Radiofrequency ablation
- B Transarterial chemoembolisation (TACE)
- C Sorafenib systemic therapy
- D Surgical resection, as adequate future liver remnant exists ✓
Explanation
The BCLC 2022 update made a major revision: resection is now considered the preferred first-line option for BCLC B (intermediate stage, multinodular or solitary >3 cm) patients with Child-Pugh A cirrhosis, adequate future liver remnant (FLR >20-25% for compensated cirrhosis), and preserved performance status. TACE remains the standard only when resection and ablation are not feasible. This revision aligns BCLC with real-world evidence showing significantly better OS with resection in selected BCLC-B patients. ECOG PS 0 with Child-Pugh A makes this patient an excellent resection candidate.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.