Analysis of BCLC treatment indications. Have BCLC modified our choice of treatment in HCC patients? A retrospective study

The Barcelona Clinic Liver Cancer (BCLC) classification has been recently validated as the best system for treatment guidance for hepatocellular carcinoma (HCC), but it doesn't properly consider liver dysfunction. The aim of this retrospective study is to evaluate the usefulness of BCLC for hepatic surgeons comparing our treatment decision and BCLC algorithm indications.A retrospective analysis of 102 patients affected by HCC observed from 1991 to 2002 was performed. The treatment choice was compared with the treatment schedule proposed by BCLC.Of 102 patients, in 44 (43.1%) cases, the present study treatment and BCLC system agreed, while in the remnant 58 (56.9%) cases, there was an under treatment in 47 (81.1%) patients and an overtreatment in 11 (18.9%). About the undertreatment cases we didn't perform hepatic resection such as BCLC suggests because of advanced age and/or high level of IGC; in patients in whom BCLC would suggest chemoembolization, we supposed this treatment as high risk therapy. Regarding the overtreatment, we choose hepatic resection, because early Child B class and good liver functional status.Analysing our aprroach in the treatment of HCC during ten years before introduction of BCLC classification, we can conclude that even if our treatment choice disagreed with BCLC systems, this wouldn't changed our decision especially in surgical indications.