Clinical calculator summary
BCLC 2026 Hepatocellular Carcinoma Stage
Clinical calculator summary
BCLC 2026 Hepatocellular Carcinoma Stage
A corrected 2026 BCLC stage-only implementation for confirmed HCC.
Evidence-based context for fast calculator use
- Purpose:
- Describe current HCC stage from source-defined burden, attributable ECOG, and liver-status context.
- Population:
- Confirmed HCC with or without cirrhosis, assessed initially or at an explicitly identified reassessment.
- Factors:
- Tumor count, Largest raw diameter, Macrovascular invasion, Extrahepatic spread, HCC-attributable ECOG, Liver decompensation and externally established liver transplantation candidacy
- Reference:
- Reig et al. BCLC strategy for prognosis prediction and treatment recommendations: the 2026 update, corrected by the April 2026 erratum.
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BCLC 2026 Hepatocellular Carcinoma Stage
Clinical Context & Background
This source-locked interpreter assigns BCLC 2026 Stage 0, A, B, C, or D for confirmed hepatocellular carcinoma. It applies raw tumor count and diameter, macrovascular invasion, extrahepatic spread, explicitly HCC-attributable ECOG performance status, and decompensation/liver-transplantation-candidacy context. Child-Pugh is not requested because it never independently determines stage. The result does not recommend treatment, estimate survival, or determine transplant eligibility.
Formula Logic
Precedence: HCC-attributable ECOG 3-4 -> D; decompensated/not a liver transplantation candidate -> D; unresolved decompensation states -> Indeterminate; invasion/spread or HCC-attributable ECOG 1-2 -> C; otherwise raw tumor count and diameter -> 0/A/B.Reference Data
| BCLC 2026 stage | Source-locked staging criterion | Computation boundary |
|---|---|---|
| 0 | ECOG 0; one tumor with raw diameter <=2 cm; no invasion/spread | Stage only |
| A | ECOG 0; one tumor >2 cm, or two to three tumors with largest diameter <=3 cm | No solitary-size maximum |
| B | ECOG 0; two to three tumors >3 cm, or more than three tumors | Heterogeneous stage; no invented subgroup |
| C | Macrovascular invasion, extrahepatic spread, or HCC-attributable ECOG 1-2 | Precedes burden staging |
| D | HCC-attributable ECOG 3-4, or decompensated and externally established not a liver transplantation candidate | Highest applicable precedence |
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
When To Use
- For confirmed hepatocellular carcinoma with current imaging-defined burden.
- When ECOG impairment can be attributed to HCC rather than unrelated or uncertain causes.
- At initial assessment or a clearly labeled pretreatment/post-treatment reassessment.
How To Interpret
- Stage D and indeterminate decompensation states are evaluated before Stage C and tumor-burden stages.
- Exactly 2 cm remains Stage 0 for one tumor; exactly 3 cm remains Stage A for two to three tumors.
- A solitary tumor greater than 2 cm remains Stage A regardless of size when no Stage C/D criterion is present.
What To Do Next
- Use the stage as one input to multidisciplinary review; consult the complete current BCLC strategy and other applicable guidance separately.
Limitations
- No treatment recommendation, named therapy, survival estimate, transplant decision, or downstaging rule is calculated.
- Child-Pugh context does not independently determine stage.
- Treatment-stage migration and untreatable progression do not automatically rewrite anatomical stage.
- Post-treatment reassessment does not automatically claim an earlier stage.
Validated Population
Confirmed HCC assessed under the corrected BCLC 2026 staging framework.
Calculation verification history
Verified
Calculation verification history
Verified: Child-Pugh trace remediation verified locally
- Replaced the literal null in valid-stage clinical summaries with `Not supplied (not requested)`, matching the public contract that Child-Pugh is not requested and does not independently determine stage.
- Three source-backed visible-control cases passed locally for Outside Scope, the exact Stage 0 two-centimeter boundary, and Stage D ECOG precedence.
- No valid trace contained a literal null, reset behavior passed, and the browser console was clean; the BCLC implementation audit remains 991/991.
Local evidence is retained in validation/browser-revalidation/bclc-liver-cancer-staging-local-remediation-2026-08-03.json. Fresh production confirmation remains pending.
: Production browser revalidation
- Three source-backed calculations returned the expected Outside Scope, Stage 0, and Stage D dispositions through visible production controls with no console errors.
- The former generic invalid trace on the intentional Outside Scope path was absent.
- Browser status remains failed-ui: each valid stage trace visibly rendered `Child-Pugh context` with the literal value `null`, although Child-Pugh is intentionally not requested and does not independently determine BCLC stage.
Case-level evidence and reproduction are retained in validation/browser-revalidation/bclc-liver-cancer-staging-2026-08-03.json.
: Local browser remediation
- Intentional Outside Scope and Indeterminate dispositions now retain a source-specific staging receipt that says the BCLC stage was not assigned, rather than the generic and inaccurate missing-or-invalid-input trace.
- Ten source-backed cases passed through visible local browser controls across 11 submissions, covering stages 0-D, outside-scope and indeterminate paths, raw 2 cm and 3 cm transitions, invasion and ECOG precedence, and reset/repeat behavior.
- The existing calculator-specific audit passed 991/991. Production status remains open until this commit is deployed and the public route is revalidated.
Local case-level remediation evidence is retained in validation/browser-production/bclc-liver-cancer-staging.local-remediation.json.
: Production browser validation
- Ten source-backed cases were exercised on the public production route through visible browser controls; 10/10 case records passed their expected-versus-observed assertions across 11 visible submissions.
- Overall browser status: failed-ui-and-console. medium: The complete unconfirmed-HCC and unresolved-transplant-candidacy cases correctly returned Outside Scope and Indeterminate with no stage, but both unavailable-result traces also displayed `Required input is missing or invalid`, inaccurately describing intentional source-defined dispositions. | medium: Production emitted minified React error #418 during route loads/reloads used by this run.
- Case-level inputs, expected and observed results, reset/repeat behavior, failure reproductions, and console evidence are retained in the production-browser evidence record.
Case-level production evidence is retained in validation/browser-production/bclc-liver-cancer-staging.json.
: Exact input guidance for indeterminate staging
- Expanded liver transplantation terminology and removed unexplained LT shorthand from the form and result explanation.
- Conflicting candidacy and advanced-disease states now use "Please review" and identify (Liver status), (Macrovascular invasion), and (Extrahepatic spread).
- All 991 implementation assertions pass; no stage precedence, threshold, projection, or applicability rule changed.
User-interface guidance update; current implementation-verification report remains applicable.
: Full validation
- 991/991 deterministic source-oracle, boundary, precedence, invalid-input, applicability, attribution, UI, trace, panel parity, registry, report, history, and content checks passed with zero stage mismatch.
- This is source-to-code implementation verification, not independent clinical validation, prognosis, treatment advice, or transplant eligibility.
: Calculation/input correction
- Replaced defaulted composite tumor and Child-Pugh switches with exact raw count, diameter, invasion, spread, liver-status, LT-status, assessment, HCC-confirmation, and ECOG-attribution fields.
- Corrected exact 2 cm and 3 cm equalities, solitary-tumor Stage A handling without a fabricated maximum, ordered D/C precedence, and indeterminate conflict states.
- Removed coercion, favorable defaults, Child-Pugh-only staging, treatment directives, fixed prognosis, and automatic treatment-stage-migration logic.
Included in the current validation report.
: Content reconciliation
- Updated the dedicated guide, liver panel guide, HCC overview, liver hub, glossary, catalog identity, and panel copy from the 2022 treatment-linked description to corrected BCLC 2026 stage-only wording.
- The liver panel now consumes the canonical BCLC engine while HKLC and overall synthesis remain In review.
Directly linked English content only.
: Public form simplified
- Removed the optional Child-Pugh question because it was trace-only and never independently determined BCLC stage.
- Combined ECOG with HCC attribution and combined decompensation with externally established LT status, using the same explicit options verified in the Liver/HCC panel.
- Kept assessment timing as a separate result-context input and retained every burden, invasion, and spread determinant. The strict eleven-key engine is unchanged; BCLC 991/991 and the shared compact-adapter audit passed.
Verification confirms the calculator implementation against the cited model; it is not independent clinical validation, regulatory approval, or medical advice.
Related Tools
Frequently Asked Questions
When should BCLC 2026 Hepatocellular Carcinoma Stage be used?
Use it for patients undergoing liver-function, hepatocellular carcinoma staging, imaging, or transplant assessment when all required inputs and the intended clinical setting are confirmed.
Can BCLC 2026 Hepatocellular Carcinoma Stage determine treatment by itself?
No. Interpret the result with the cited evidence, complete clinical assessment, current guidelines, and patient-specific goals.
Evidence-based oncology decision support. Verify with clinical guidelines.