HCC Staging: What is New in INASL Guidelines (2023)

• INASL modification provides improvement over the previous BarcelonaClinic Liver Cancer (BCLC) staging in terms of:
• ALBI (Albumin-Bilirubin) score: It is the further clinical assessment of liver reserve which had documented to influence outcome (prognostication to therapy) - transarterial radioembolization (TARE) for BCLC-A (option) - single lesion >5 cm.
• Categorizing BCLC-B: into three groups (B1, B2, B3) based on results of therapeutic response- included expanded criteria for transplant in B1 (more burden than A).
• Defined treatment stage migration and UTP: to allocate further treatment with a possibility of further benefit.
• Down staging in BCLC-B an option: end point successful - Transplant.
• Systemic therapy: for BCLC B3/ALL BCLC-C - 1st line/2nd line/third line.