Alberto Pimentel: Classifying a Cirrhosis Patient with HCC and Multinodular Disease: Barcelona B or C?
Alberto Pimentel, Gastrointestinal oncologist and clinical researcher at Hospital of Oncology CMN SXXI IMSS, Mexico City, posted on X:
“I have a question.
What if you have a patient with cirrhosis, HCC, and multinodular disease (8 lesions, each no larger than 3 cm) without vascular invasion but ECOG 1, you consider that it is Barcelona B or C?
Do you consider locoregional or systemic therapy?”
Nina Niu Sanford, Assistant Professor at UT Southwestern Medical Center, shared this post on X, adding:
“Good question, this case brings up several points.
Given ECOG 1, the patient is technically BCLC C, but really depends on what’s driving the ECOG.
If it’s underlying cirrhosis rather than tumor-related symptoms, many discount the ECOG 1 when deciding treatment. Based on tumor burden alone, the patient is stage B/intermediate.
With bilobar, multifocal disease (appears the case based on what you wrote), would recommend systemic therapy first. If try to treat all tumors with local therapy, risk of liver decompensation.
If the patient has a great response, could consider local therapy or transplant if gets to Milan criteria. The patient is outside of UNOS DS so won’t get exception points. Transplant would need to be through living donor or natural MELD.”
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