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HCC Prognostic Factors — RACP Adult Medicine MCQ

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ModerateMedical OncologyHCC Prognostic FactorsRACP Adult Medicine

A 45-year-old man presents with right-sided abdominal pain and a large right-sided pleural effusion. CT shows a 12 cm hepatic mass with arterial enhancement. AFP is 85,000 µg/L. He has no known liver disease. Hepatitis B surface antigen is positive. What is the most important prognostic factor determining treatment options?

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Correct answer: B — Underlying liver function (Child-Pugh/MELD score)

In HCC, the underlying liver function (Child-Pugh score, MELD score) is the most important factor determining treatment options and prognosis. Even if the tumour is technically resectable, surgery is only feasible with adequate hepatic reserve (typically Child-Pugh A). The BCLC staging system integrates tumour burden, liver function, and performance status to guide treatment. A large HCC in a Child-Pugh C liver may only be suitable for best supportive care, whereas the same tumour in a Child-Pugh A liver might be treated with surgery, TACE, or systemic therapy.

Reference: Cancer Council Australia – 2020 – HCC Guidelines; AASLD – 2023 – HCC Guidelines