A 58-year-old man with HCV cirrhosis (Child-Pugh A, MELD 8) is found to have a 2.8 cm arterially enhancing, washout-positive hepatic lesion on dynamic MRI. AFP is 120 ng/mL. The Barcelona Clinic Liver Cancer (BCLC) stage is 0/A. He has adequate liver remnant. What is the first-line recommended treatment?
- A Liver resection or thermal ablation ✓
- B Sorafenib systemic therapy
- C Transarterial chemoembolization (TACE)
- D Orthotopic liver transplantation immediately
Explanation
For BCLC 0/A HCC in a Child-Pugh A patient with adequate functional reserve and a tumor ≤3 cm, liver resection (if no portal hypertension and adequate remnant) or thermal ablation (RFA/MWA) are first-line potentially curative options per updated BCLC 2022 guidelines. Sorafenib is first-line only for advanced BCLC C disease. TACE is reserved for BCLC B (intermediate) multinodular disease. Liver transplantation is the preferred option when the patient meets Milan criteria AND resection is contraindicated by portal hypertension or inadequate remnant; it is not the immediate first-line when resection is technically feasible.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.