BCLC 2026 HCC Staging Calculator: Source-Locked Stage Interpretation

What this calculator does

The BCLC 2026 Hepatocellular Carcinoma Stage calculator assigns Stage 0, A, B, C, or D from the corrected 2026 BCLC framework. It is limited to confirmed hepatocellular carcinoma and uses:

• exact tumor count and raw largest diameter;
• macrovascular invasion and extrahepatic spread;
• ECOG performance status with explicit HCC attribution;
• compensated or decompensated liver status;
• an externally established liver-transplant-candidate context when liver disease is decompensated; and
• initial, pretreatment-reassessment, or post-treatment-reassessment context.

Child-Pugh may be recorded as context, but it is not an independent stage switch in this implementation.

Exact burden boundaries

• One tumor measuring exactly 2 cm remains Stage 0 when no higher-precedence criterion applies.
• One tumor greater than 2 cm is Stage A without an invented maximum diameter.
• Two or three tumors measuring exactly 3 cm remain Stage A.
• Two or three tumors greater than 3 cm, or more than three tumors, are Stage B when Stage C or D criteria are absent.

The raw diameter is compared without preclassification rounding.

Ordered precedence

1. HCC-attributable ECOG 3 or 4 maps to Stage D.
2. Decompensated cirrhosis with externally established non-candidacy for liver transplantation maps to Stage D.
3. Unknown transplant context in decompensated disease is indeterminate.
4. A stated transplant-candidate context combined with macrovascular invasion or extrahepatic spread is indeterminate pending clinician reconciliation.
5. Macrovascular invasion, extrahepatic spread, or HCC-attributable ECOG 1 or 2 maps to Stage C.
6. ECOG 0 cases then use the exact Stage 0/A/B burden rules.

ECOG impairment attributed to another condition, or with uncertain attribution, is not silently used to upstage HCC.

What remains outside the calculator

The result is an anatomical and clinical stage description. It does not:

• select a drug, procedure, or treatment pathway;
• calculate survival;
• decide transplant eligibility;
• create a BCLC B subgroup cutoff;
• automate treatment-stage migration or downstaging; or
• claim an earlier stage after treatment.

BCLC B is heterogeneous, and treatment-stage migration is a clinical strategy rather than an automatic change to anatomical stage.

Source lock

• Corrected BCLC 2026 full text
• PubMed record, PMID 41151697
• April 2026 erratum
• BCLC 2022 publication, retained as historical provenance
• Barcelona Clinic Liver Cancer program

The linked validation report documents source-to-code implementation verification. It is not independent clinical validation.