Patient-centered approach

A patient-centered approach, whereby MDT members, patients, and their caregivers collaborate through shared decision making, allows for thorough consideration of patient and physician treatment goals together with the patient’s specific disease setting.1–3

Patient-Centered Approach

Patient factors

Patient factors

  • Patient symptoms4
  • Treatment preference5
  • Range of comorbidities5
  • Performance status5
  • Disease etiology6
  • Lifestyle choices7
  • Bleeding risk spectrum5
  • Socioeconomic8
  • Age9
  • Proximity5
  • Tolerability5

Liver factors

Liver factors

  • MELD score10
  • Cirrhosis5
  • ALBI grade10
  • Underlying liver function5
  • Ascites10
  • Liver volume10
  • Child-Pugh class10
  • Portal hypertension10
  • Hepatic encephalopathy10

Tumor factors

Tumor factors

  • Tumor grade differentiation11
  • Clinical stage12
  • Size and number7
  • Distribution13,14
  • Location5
  • EHS or MVI5
  • Prognostic biomarkers7
Treatment Selection Treatment Selection

PATIENT FACTORS

Considering patient-specific factors during treatment planning can enhance shared decision making.15 Examples include:

Comorbidities Icon

Comorbidities may have an influence on the treatment journey16

Primary liver diseases such as HBV, HCV, and MASLD are prominent underlying causes of HCC which can lead to cirrhosis, impacting liver function and consequently treatment eligibility7

Cardiovascular disease occurs in approximately 25–30% of patients; this can increase risk associated with certain HCC therapies and complicate treatment planning17

Metabolic conditions such as obesity (occurring in 25–30% of patients with HCC) and diabetes (occurring in 35–40% of patients with HCC) may worsen prognosis17,18

Gastrointestinal comorbidities, such as portal hypertension which affects 35–52% of patients with early HCC and an even higher percentage of patients with advanced HCC, pose a substantial mortality risk and require careful monitoring19

Patient Preferences Icon

Patient preferences also play a crucial role in treatment decisions, often shaped by treatment regimen attributes such as efficacy, adverse events, dosing frequency, time commitment required for clinic visits, and quality of life1

Socioeconomic Status Icon

Socioeconomic status is a key consideration that impacts a patient’s ability to access specialized care and MDTs5,15

LIVER FACTORS

Most patients with HCC have underlying liver disease; approximately 75% of US patients with HCC have cirrhosis at the time of their diagnosis.20,21 While liver function declines over time as part of natural history for HCC, it may be further exacerbated by treatments.22 Impaired liver function has a two-fold impact in HCC, potentially limiting the treatment options available as well as diminishing benefit from therapies received,23 which makes liver function assessment an essential part of treatment planning.22,24

Measurements of liver function, such as the Child-Pugh, ALBI grade, and MELD scores are essential tools which help guide treatment decisions and may predict patient outcomes.25-27

Clinical uses

Child–Pugh

Assessing liver functional reserve in patients with advanced chronic liver disease and HCC28

ALBI grade

Identifying subtle differences in liver function that might not be captured by the Child–Pugh scoring system, particularly in patients with preserved liver function31

MELD 3.0

Predicting short-term survival in patients with end-stage liver disease and assessing for transplant32

 

Advantages

  • Well established25
  • Proven prognostic value29
  • More holistic than ALBI score as it captures a wider range of factors29
  • A simplified, objective, and highly prognostic assessment across all chronic liver disease stages31
  • Greater nuance and potentially better prognosis stratification than the Child–Pugh score31

Encompasses factors that influence transplant waiting list times27

 

Limitations

  • Includes subjective clinician-led assessments30
  • Interrelation of factors26
  • Potential bias26
  • Lack of sensitivity31
  • Prospective trials needed to confirm prognostic efficacy30
  • Limited data on patients with ALBI Grade 330
  • No accounting for portal hypertension biomarkers30
  • Does not account for significant clinical manifestations of liver decompensation31
  • Includes subjective assessments31
  • Difficulty in capturing portal hypertension complications33
  • Does not account for individual patient factors (eg, malnutrition, gender, hyponatremia)33
 

Calculate

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Child–Pugh score tool

Click hereThe link open in a new tab for an online

ALBI grade calculator

Click hereThe link open in a new tab to calculate

MELD 3.0 score

Child–Pugh

Clinical uses

Assessing liver functional reserve in patients with advanced chronic liver disease and HCC28

Advantages

  • Well established25
  • Proven prognostic value29
  • More holistic than ALBI score as it captures a wider range of factors29

Limitations

  • Includes subjective clinician-led assessments30
  • Interrelation of factors26
  • Potential bias26
  • Lack of sensitivity31

Calculate

Click hereThe link open in a new tab for the Child–Pugh score tool

 

ALBI grade

Clinical uses

Identifying subtle differences in liver function that might not be captured by the Child–Pugh scoring system, particularly in patients with preserved liver function31

Advantages

  • A simplified, objective, and highly prognostic assessment across all chronic liver disease stages31
  • Greater nuance and potentially better prognosis stratification than the Child–Pugh score31

Limitations

  • Prospective trials needed to confirm prognostic efficacy30
  • Limited data on patients with ALBI Grade 330
  • No accounting for portal hypertension biomarkers30
  • Does not account for significant clinical manifestations of liver decompensation31
  • Includes subjective assessments31

Calculate

Click hereThe link open in a new tab for an online ALBI grade calculator

 

MELD 3.0

Clinical uses

Predicting short-term survival in patients with end-stage liver disease and assessing for transplant32

Advantages

Encompasses factors that influence transplant waiting list times27

Limitations

  • Difficulty in capturing portal hypertension complications33
  • Does not account for individual patient factors (eg, malnutrition, gender, hyponatremia)33

Calculate

Click hereThe link open in a new tab to calculate MELD 3.0 score

TUMOR FACTORS

Factors such as tumor size, location, and distribution may influence treatment choices and potential clinical outcomes.34,35 Tailoring treatment based on tumor characteristics may optimize outcomes and improve survival rates.10

Liver Size Icon

Size

Small tumors (2–5 cm) Icon

Small tumors (2–5 cm) that are poorly differentiated may benefit most from anatomical resection10

Tumors <3 cm Icon

Tumors <3 cm that are well differentiated are best suited for non-anatomic resection10

Larger tumors >5 cm Icon

Larger tumors (>5 cm) may have a predictive value for early recurrence and death34

 
Location Icon

Location

  • HCC located on the left side is associated with worse survival and recurrence-free survival after hepatectomy35
  • Careful selection of surgical options and frequent follow-up may improve survival35

Solitary lesions smaller than 3 cm with well-preserved liver function can have various treatment strategies depending on location10

  • Laparoscopic limited resection is the preferred treatment option for subcapsular tumors
  • Percutaneous thermal ablation is recommended for deeply located tumors <2 cm, except those adjacent to the Glissonean system
  • Laparoscopic anatomic resection is preferred for deep-seated nodules <2–3 cm in the left lobe of the liver, while open anatomic resection is advised for deep nodules <2–3 cm located in the right lobe

Multifocal HCC represents a heterogeneous group, with TACE being the most utilized treatment strategy for this tumor type36

 
Distribution Icon

Distribution

While TACE is usually considered as a first-line therapy for intermediate stage HCC, large bilobar or infiltrative tumors within this stage may require consideration of upfront systemic therapy14

Unilobar lesions staged BCLC B1 and fall within the “up-to-7” criteria may have a curative treatment with surgical resection37

  • Treatment strategies for patients with PVT are more limited than for patients without PVT13
  • Patients with PVT are more likely to have metastatic disease, decreased overall survival, and high rates of tumor recurrence after transplantation compared to patients without PVT13
  • Both transplantation and surgical resection are not recommended for patients with PVT due to being associated with poorer outcomes13
  • For those that are not surgical candidates, treatment options for patients with PVT may include13:
    • Systemic therapies
    • TACE
    • Y90 SIRT

An MDT approach is increasingly recognized 
as a cornerstone of effective care.

EXPLORE FURTHER

Let HORIZONS HCC be your compass in navigating the complexities and latest developments in HCC patient care.

Abbreviations:

ALBI=albumin-bilirubin; BCLC=Barcelona Clinic Liver Cancer; EHS=extrahepatic spread; HBV=hepatitis B virus; HCC=hepatocellular carcinoma; HCV=hepatitis C virus; MASLD=metabolic dysfunction-associated steatotic liver disease; MDT=multidisciplinary team; MELD=Model for End-Stage Liver Disease; MVI=major vascular invasion; PVT=portal vein thrombosis; TACE=transarterial chemoembolization; Y90=Yttrium-90.

References:

1. Moon AM, Richardson D, Lupu GV, et al. MDM Policy Pract. 2025;10(1):1–16; 2. Wörns MA, Burns D, Paskow M, Makin H, Miller J, Turner LM, Sah J. Adv Ther. 2024;41(9):3598–3614; 3. Kinsey E, Lee HM. Cancers (Basel). 2024;16(3):666; 4. Reig M, Sanduzzi-Zamparelli M, Forner A, et al. J Hepatol. 2025:S0168-8278(25)02571-1; 5. Gordan JD, Kennedy EB, Abou-Alfa G, et al. J Clin Oncol. 2024;42:1830–1850; 6. Sacco R, Ramai D, Tortora R, et al. Cancers (Basel). 2023;15(2):381; 7. Llovet JM, Kelley RK, Villanueva A, et al. Nat Rev Dis Primers. 2021;7(1):6; 8. Zhou K, Pickering TA, Gainey CS, et al. JNCI Cancer Spectr. 2020;5(1):pkaa100; 9. Wen N, Cai Y, Li F, et al. Biosci Trends. 2022;16(1):20–30; 10. Li X, Xu Y, Ou Y, Li H, Xu W. J Hepatocell Carcinoma. 2025;12:777–790; 11. Tsurusaki M, Sofue K, Murakami T, Tanigawa N. Cancers (Basel). 2024;17(1):101; 12. Liu W, Quan B, Lu S, et al. Front Oncol. 2021;11:771045; 13. Quirk M, Kim Y, Saab S, Lee E. World J Gastroenterol. 2015;21(12):3462–3471; 14. Coffman-D'Annibale K, Xie C, Hrones D, Ghabra S, Greten T, Monge C. Carcinogenesis. 2023;44(7):537–548; 15. Moon A, Kappelman M, Barritt A, et al. J Hepatocell Carcinoma. 2025;12:497–511; 16. Mu X, Wang W, Jiang Y, Feng J. Int J Environ Res Public Health. 2020;17(9):3108; 17. Karim H, Rahman A, Fatin M. Clin Epidemiol Pub Health. 2025;3(1):1–9; 18. Shinkawa H, Kaibori M, Ueno M, et al. Liver Cancer. 2024;14(1):80–91; 19. Lin TY, Su TH. J Formos Med Assoc. 2024;123(8):916–919; 20. Lee Y, Karim M, Kum H, et al. Clin Mol Hepatol. 2023;29(2):453–464; 21. Vaz J, Strömberg U, Midlöv P, et al. J Intern Med. 2023;293(2):184–199; 22. Celsa C, Giuffrida P, Giacchetto C, et al. Liver Cancer Int. 2021;2:82–95; 23. Pantea R, Bednarsch J, Schmitz S, et al. Expert Rev Gastroenterol Hepatol. 2024;18(12):779–794; 24. Pinter M, Trauner M, Peck-Radosavljevic M, Sieghart W. ESMO Open. 2016;1(2):e000042; 25. Tsoris A, Marlar CA. StatPearls [Internet]. Accessed October 2025. https://www.ncbi.nlm.nih.gov/books/NBK542308/; 26. Johnson P, Berhane S, Kagebayashi C, et al. J Clin Oncol. 2015;33(6):550–558; 27. Kim WR, Mannalithara A, Heimbach JK, et al. Gastroenterology. 2021;161(6):1887–1895.e4; 28. UpToDate. Accessed November 1, 2025. https://www.uptodate.com/contents/image?imageKey=GAST%2F78401; 29. Cleveland Clinic. Accessed November 1, 2025. https://my.clevelandclinic.org/health/diagnostics/child-pugh-score; 30. Rimini M, Fornaro L, Rizzato M, et al. Ann Transl Med. 2020;8(17):1044; 31. Toyoda H, Johnson PJ. JHEP Reports. 2022;4(10):100557; 32. Cleveland Clinic. Accessed November 1, 2025; https://my.clevelandclinic.org/health/diagnostics/meld-score; 33. Bernardi M, Gitto S, Biselli M. J Hepatol. 2011;54(6):1297–1306; 34. Dai C, Lin C, Tsai P, et al. J Chin Med Assoc. 2018;81(2):155–163; 35. Tang S, Lin K, Huang T, et al. Eur J Surg Oncol. 2023;49(7):1234–1241; 36. Risaliti M, Bartolini I, Campani C, et al. World J Gastroenterol. 2022;28(29):3981–3993; 37. Wee JY, Moe NNF, Sultana R. J Hepatocell Carcinoma. 2022;9:839–851.

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