{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:27:22Z","timestamp":1786944442225,"version":"build-2736575974"},"reference-count":68,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":39,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Evidence-based medicine (EBM) was conceived to support decisions for individual patients by integrating the best available evidence, clinical expertise, and patient values. However, the application of EBM in many fields has become associated with rigid algorithms and guideline pathways, sometimes interpreted as prescriptive rather than as aids to decision-making. Hepatocellular carcinoma (HCC) offers an informative case study of this dichotomy. This paper traces the evolution of personalized decision-making in HCC over two decades and its implications for the future of EBM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This is a narrative, conceptual review. Rather than a systematic synthesis, it draws selectively on landmark staging frameworks, guidelines, and methodological literature to construct a schematic account of how clinical reasoning in HCC has evolved.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>HCC decision-making has evolved through a sequence of schematic frames: from stage-centred algorithms (the Ptolemaic frame), to recognition of differential treatment effects (the Copernican shift), to multiparametric expert deliberation (the Newtonian perspective), and finally to dynamic, time-dependent, bidirectional strategies (the Einsteinian perspective). The expansion of systemic immunotherapy options has reinforced this bidirectional logic while complicating stage reassessment. This trajectory culminates in a Heisenberg moment, in which uncertainty is acknowledged as intrinsic to individual decisions. The multiparametric therapeutic hierarchy, developed within multidisciplinary HCC practice, reflects this maturation towards a personalized, transparent, context-sensitive approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HCC is a paradigmatic example of personalized decision-making in complex, multidisciplinary care. The future of EBM lies not in choosing between algorithms and personalization, but rather in transparent approaches that apply evidence rigorously while acknowledging uncertainty and respecting patient values and local context.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/bjsopen\/zrag113","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T11:49:36Z","timestamp":1783165776000},"source":"Crossref","is-referenced-by-count":0,"title":["Personalised decision-making in hepatocellular carcinoma: conceptual evolution over two decades"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4548-8308","authenticated-orcid":false,"given":"Alessandro","family":"Vitale","sequence":"first","affiliation":[{"name":"Department of Surgical Oncological and Gastroenterological Sciences, Padova University , Padova ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2352-5718","authenticated-orcid":false,"given":"Gordon","family":"Guyatt","sequence":"additional","affiliation":[{"name":"Department of Health Research Methods, Evidence, and Impact, McMaster University , Hamilton, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masatoshi","family":"Kudo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine , Osaka ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Kulik","sequence":"additional","affiliation":[{"name":"Section of Gastroenterology and Hepatology, Department of Medicine, Northwestern Memorial Hospital , Chicago, Illinois ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Pinato","sequence":"additional","affiliation":[{"name":"Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital , London ,","place":["UK"]},{"name":"Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale , Novara ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8160-0483","authenticated-orcid":false,"given":"Laura","family":"Crocetti","sequence":"additional","affiliation":[{"name":"Department of Radiology and Interventional Radiology, Division of Interventional Radiology, University of Pisa , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8526-837X","authenticated-orcid":false,"given":"Edoardo G","family":"Giannini","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Internal Medicine, University of Genova , Genova ,","place":["Italy"]},{"name":"Azienda Ospedaliera Metropolitana IRCCS Policlinico San Martino , Genoa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2310-0245","authenticated-orcid":false,"given":"Umberto","family":"Cillo","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncological and Gastroenterological Sciences, Padova University , Padova ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"2026081701213436600_zrag113-B1","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1136\/ebm.13.4.101","article-title":"Evidence-based medicine targets the individual patient, part 1: how clinicians can use study results to determine optimal individual care","volume":"13","author":"Bassler","year":"2008","journal-title":"Evid Based Med"},{"key":"2026081701213436600_zrag113-B2","first-page":"131","article-title":"Evidence-based medicine targets the individual patient, part 2: guides and tools for individual decision-making","volume":"13","author":"Bassler","year":"2008","journal-title":"Evid Based Med"},{"key":"2026081701213436600_zrag113-B3","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1001\/jama.284.10.1290","article-title":"Users\u2019 guides to the medical literature: XXV. Evidence-based medicine: principles for applying the users\u2019 guides to patient care. Evidence-based medicine working group","volume":"284","author":"Guyatt","year":"2000","journal-title":"JAMA"},{"key":"2026081701213436600_zrag113-B4","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1055\/s-2007-1007122","article-title":"Prognosis of hepatocellular carcinoma: the BCLC staging classification","volume":"19","author":"Llovet","year":"1999","journal-title":"Semin Liver Dis"},{"key":"2026081701213436600_zrag113-B5","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/S0168-8278(01)00130-1","article-title":"Clinical management of hepatocellular carcinoma. Conclusions of the Barcelona-2000 EASL conference. European Association for the Study of the Liver","volume":"35","author":"Bruix","year":"2001","journal-title":"J Hepatol"},{"key":"2026081701213436600_zrag113-B6","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/S0140-6736(11)61347-0","article-title":"Hepatocellular carcinoma","volume":"379","author":"Forner","year":"2012","journal-title":"Lancet"},{"key":"2026081701213436600_zrag113-B7","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1002\/hep.27745","article-title":"The role of hepatic resection in the treatment of hepatocellular cancer","volume":"62","author":"Roayaie","year":"2015","journal-title":"Hepatology"},{"key":"2026081701213436600_zrag113-B8","doi-asserted-by":"crossref","first-page":"1490","DOI":"10.1111\/liv.13107","article-title":"The recommended treatment algorithms of the BCLC and HKLC staging systems: does following these always improve survival rates for HCC patients?","volume":"36","author":"Kim","year":"2016","journal-title":"Liver Int"},{"key":"2026081701213436600_zrag113-B9","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1111\/liv.13242","article-title":"Curative therapies are superior to standard of care (transarterial chemoembolization) for intermediate stage hepatocellular carcinoma","volume":"37","author":"Pecorelli","year":"2017","journal-title":"Liver Int"},{"key":"2026081701213436600_zrag113-B10","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.annonc.2021.02.014","article-title":"Updated treatment recommendations for hepatocellular carcinoma (HCC) from the ESMO clinical practice guidelines","volume":"32","author":"Vogel","year":"2021","journal-title":"Ann Oncol"},{"key":"2026081701213436600_zrag113-B11","doi-asserted-by":"crossref","first-page":"iv238","DOI":"10.1093\/annonc\/mdy308","article-title":"Hepatocellular carcinoma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up","volume":"29","author":"Vogel","year":"2018","journal-title":"Ann Oncol"},{"key":"2026081701213436600_zrag113-B12","doi-asserted-by":"crossref","first-page":"1954","DOI":"10.1053\/j.gastro.2017.02.040","article-title":"Association of provider specialty and multidisciplinary care with hepatocellular carcinoma treatment and mortality","volume":"152","author":"Serper","year":"2017","journal-title":"Gastroenterology"},{"key":"2026081701213436600_zrag113-B13","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1002\/hep.30185","article-title":"Restaging patients with hepatocellular carcinoma before additional treatment decisions: a multicenter cohort study","volume":"68","author":"Vitale","year":"2018","journal-title":"Hepatology"},{"key":"2026081701213436600_zrag113-B14","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.14309\/ajg.0000000000001256","article-title":"Effect of diameter and number of hepatocellular carcinomas on survival after resection, transarterial chemoembolization, and ablation","volume":"116","author":"Kawaguchi","year":"2021","journal-title":"Am J Gastroenterol"},{"key":"2026081701213436600_zrag113-B15","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.jhep.2014.10.037","article-title":"Survival benefit of liver resection for patients with hepatocellular carcinoma across different Barcelona Clinic Liver Cancer stages: a multicentre study","volume":"62","author":"Vitale","year":"2015","journal-title":"J Hepatol"},{"key":"2026081701213436600_zrag113-B16","doi-asserted-by":"crossref","first-page":"1624","DOI":"10.1111\/liv.13888","article-title":"Multimodality treatment of hepatocellular carcinoma: how field practice complies with international recommendations","volume":"38","author":"Sangiovanni","year":"2018","journal-title":"Liver Int"},{"key":"2026081701213436600_zrag113-B17","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.jhep.2014.03.012","article-title":"Partial hepatectomy vs. transcatheter arterial chemoembolization for resectable multiple hepatocellular carcinoma beyond Milan criteria: a randomized controlled trial","volume":"61","author":"Yin","year":"2014","journal-title":"J Hepatol"},{"key":"2026081701213436600_zrag113-B18","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1016\/S1470-2045(20)30224-2","article-title":"Liver transplantation in hepatocellular carcinoma after tumour downstaging (XXL): a randomised, controlled, phase 2b\/3 trial","volume":"21","author":"Mazzaferro","year":"2020","journal-title":"Lancet Oncol"},{"key":"2026081701213436600_zrag113-B19","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1016\/j.jhep.2016.05.044","article-title":"Survival benefit of liver resection for hepatocellular carcinoma associated with portal vein invasion","volume":"65","author":"Kokudo","year":"2016","journal-title":"J Hepatol"},{"key":"2026081701213436600_zrag113-B20","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1002\/hep.29225","article-title":"Liver resection for hepatocellular carcinoma associated with hepatic vein invasion: a Japanese nationwide survey","volume":"66","author":"Kokudo","year":"2017","journal-title":"Hepatology"},{"key":"2026081701213436600_zrag113-B21","doi-asserted-by":"crossref","DOI":"10.3389\/fonc.2020.00573","article-title":"Resection vs. sorafenib for hepatocellular carcinoma with macroscopic vascular invasion: a real world, propensity score matched analytic study","volume":"10","author":"Mei","year":"2020","journal-title":"Front Oncol"},{"key":"2026081701213436600_zrag113-B22","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1159\/000515554","article-title":"Comparison of surgical resection and systemic treatment for hepatocellular carcinoma with vascular invasion: national cancer database analysis","volume":"10","author":"Govalan","year":"2021","journal-title":"Liver Cancer"},{"key":"2026081701213436600_zrag113-B23","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1097\/SLA.0000000000005373","article-title":"Hepatectomy versus sorafenib in advanced nonmetastatic hepatocellular carcinoma: a real-life multicentric weighted comparison","volume":"275","author":"Famularo","year":"2022","journal-title":"Ann Surg"},{"key":"2026081701213436600_zrag113-B24","doi-asserted-by":"crossref","first-page":"2206","DOI":"10.1002\/hep.31187","article-title":"Treatment of hepatocellular carcinoma in the precision medicine era: from treatment stage migration to therapeutic hierarchy","volume":"72","author":"Vitale","year":"2020","journal-title":"Hepatology"},{"key":"2026081701213436600_zrag113-B25","doi-asserted-by":"crossref","first-page":"e312","DOI":"10.1016\/S1470-2045(23)00186-9","article-title":"Personalised management of patients with hepatocellular carcinoma: a multiparametric therapeutic hierarchy concept","volume":"24","author":"Vitale","year":"2023","journal-title":"Lancet Oncol"},{"key":"2026081701213436600_zrag113-B26","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2024-081903","article-title":"Core GRADE 1: overview of the core GRADE approach","volume":"389","author":"Guyatt","year":"2025","journal-title":"BMJ"},{"key":"2026081701213436600_zrag113-B27","doi-asserted-by":"crossref","DOI":"10.1016\/j.jclinepi.2025.112047","article-title":"Core GRADE unpacked: a summary of recent innovations in complementary GRADE methodology","volume":"189","author":"Colunga-Lozano","year":"2026","journal-title":"J Clin Epidemiol"},{"key":"2026081701213436600_zrag113-B28","article-title":"GRADE evidence to decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction","volume":"353","author":"Alonso-Coello","year":"2016","journal-title":"BMJ"},{"key":"2026081701213436600_zrag113-B29","article-title":"GRADE evidence to decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines","volume":"353","author":"Alonso-Coello","year":"2016","journal-title":"BMJ"},{"key":"2026081701213436600_zrag113-B30","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.jhep.2021.11.018","article-title":"BCLC strategy for prognosis prediction and treatment recommendation: the 2022 update","volume":"76","author":"Reig","year":"2022","journal-title":"J Hepatol"},{"key":"2026081701213436600_zrag113-B31","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.jhep.2024.01.010","article-title":"Merits and boundaries of the BCLC staging and treatment algorithm: learning from the past to improve the future with a novel proposal","volume":"80","author":"Trevisani","year":"2024","journal-title":"J Hepatol"},{"key":"2026081701213436600_zrag113-B32","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1002\/hep.20933","article-title":"Management of hepatocellular carcinoma","volume":"42","author":"Bruix","year":"2005","journal-title":"Hepatology"},{"key":"2026081701213436600_zrag113-B33","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1002\/hep.24199","article-title":"Management of hepatocellular carcinoma: an update","volume":"53","author":"Bruix","year":"2011","journal-title":"Hepatology"},{"key":"2026081701213436600_zrag113-B34","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1016\/j.jhep.2011.12.001","article-title":"EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma","volume":"56","author":"European Association for the Study of the Liver","year":"2012","journal-title":"J Hepatol"},{"key":"2026081701213436600_zrag113-B35","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1001\/jamasurg.2024.1184","article-title":"Liver resection vs nonsurgical treatments for patients with early multinodular hepatocellular carcinoma","volume":"159","author":"Vitale","year":"2024","journal-title":"JAMA Surg"},{"key":"2026081701213436600_zrag113-B36","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1111\/liv.14154","article-title":"The concept of therapeutic hierarchy for patients with hepatocellular carcinoma: a multicenter cohort study","volume":"39","author":"Vitale","year":"2019","journal-title":"Liver Int"},{"key":"2026081701213436600_zrag113-B37","doi-asserted-by":"crossref","first-page":"1734","DOI":"10.1016\/S0140-6736(02)08649-X","article-title":"Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial","volume":"359","author":"Llovet","year":"2002","journal-title":"Lancet"},{"key":"2026081701213436600_zrag113-B38","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1053\/jhep.2002.33156","article-title":"Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma","volume":"35","author":"Lo","year":"2002","journal-title":"Hepatology"},{"key":"2026081701213436600_zrag113-B39","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.jhep.2025.10.020","article-title":"BCLC strategy for prognosis prediction and treatment recommendations: the 2026 update","volume":"84","author":"Reig","year":"2026","journal-title":"J Hepatol"},{"key":"2026081701213436600_zrag113-B40","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1159\/000507370","article-title":"A changing paradigm for the treatment of intermediate-stage hepatocellular carcinoma: Asia-Pacific primary liver cancer expert consensus","volume":"9","author":"Kudo","year":"2020","journal-title":"Liver Cancer"},{"key":"2026081701213436600_zrag113-B41","doi-asserted-by":"crossref","first-page":"112086","DOI":"10.1016\/j.jclinepi.2025.112086","article-title":"Grading of recommendations, assessment, development, and evaluation guidance 44: strategies to enhance the utilization of randomized and non-randomized studies in evidence syntheses of health interventions","volume":"190","author":"Cuello-Garcia","year":"2026","journal-title":"J Clin Epidemiol"},{"key":"2026081701213436600_zrag113-B42","doi-asserted-by":"crossref","first-page":"e178","DOI":"10.1016\/j.jhep.2024.06.007","article-title":"Evidence-based failure of stage hierarchy therapeutic approach to HCC","volume":"81","author":"Trevisani","year":"2024","journal-title":"J Hepatol"},{"key":"2026081701213436600_zrag113-B43","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2024-083867","article-title":"Core GRADE 7: principles for moving from evidence to recommendations and decisions","volume":"389","author":"Guyatt","year":"2025","journal-title":"BMJ"},{"key":"2026081701213436600_zrag113-B44","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.jhep.2024.08.028","article-title":"EASL clinical practice guidelines on the management of hepatocellular carcinoma","volume":"82","author":"European Association for the Study of the Liver","year":"2025","journal-title":"J Hepatol"},{"key":"2026081701213436600_zrag113-B45","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/j.annonc.2025.02.006","article-title":"Hepatocellular carcinoma: ESMO clinical practice guidelines","volume":"36","author":"Vogel","year":"2025","journal-title":"Ann Oncol"},{"key":"2026081701213436600_zrag113-B46","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.1097\/HEP.0000000000000466","article-title":"AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma","volume":"78","author":"Singal","year":"2023","journal-title":"Hepatology"},{"key":"2026081701213436600_zrag113-B47","doi-asserted-by":"crossref","first-page":"725","DOI":"10.1001\/jama.2019.9751","article-title":"Evidence vs consensus in clinical practice guidelines","volume":"322","author":"Djulbegovic","year":"2019","journal-title":"JAMA"},{"key":"2026081701213436600_zrag113-B48","first-page":"743","article-title":"The concept of \u2018converse therapeutic hierarchy\u2019 for patients with hepatocellular carcinoma","volume":"14","author":"Vitale","year":"2025","journal-title":"Liver Cancer"},{"key":"2026081701213436600_zrag113-B49","doi-asserted-by":"crossref","first-page":"1908","DOI":"10.1016\/j.dld.2025.07.041","article-title":"From hierarchy to conversion: a watermill approach","volume":"57","author":"Giannini","year":"2025","journal-title":"Dig Liver Dis"},{"key":"2026081701213436600_zrag113-B50","doi-asserted-by":"crossref","first-page":"227","DOI":"10.21037\/hbsn-21-328","article-title":"Chinese expert consensus on conversion therapy for hepatocellular carcinoma (2021 edition)","volume":"11","author":"Sun","year":"2022","journal-title":"Hepatobiliary Surg Nutr"},{"key":"2026081701213436600_zrag113-B51","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000538627","article-title":"Oncological resectability criteria for hepatocellular carcinoma in the era of novel systemic therapies: the Japan Liver Cancer Association and Japanese Society of Hepato-Biliary-Pancreatic Surgery expert consensus statement 2023","volume":"13","author":"Akahoshi","year":"2024","journal-title":"Liver Cancer"},{"key":"2026081701213436600_zrag113-B52","first-page":"298","article-title":"Improving the conversion success rate of hepatocellular carcinoma: focus on the use of combination therapy with a high objective response rate","volume":"12","author":"Chen","year":"2024","journal-title":"J Clin Transl Hepatol"},{"key":"2026081701213436600_zrag113-B53","first-page":"223","article-title":"Consensus of Chinese experts on neoadjuvant and conversion therapies for hepatocellular carcinoma: 2023 update","volume":"14","author":"Bi","year":"2025","journal-title":"Liver Cancer"},{"key":"2026081701213436600_zrag113-B54","doi-asserted-by":"crossref","first-page":"1968","DOI":"10.1002\/hep.27752","article-title":"Downstaging of hepatocellular cancer before liver transplant: long-term outcome compared to tumors within Milan criteria","volume":"61","author":"Yao","year":"2015","journal-title":"Hepatology"},{"key":"2026081701213436600_zrag113-B55","doi-asserted-by":"crossref","DOI":"10.3390\/cancers13102406","article-title":"Sustained complete response after biological downstaging in patients with hepatocellular carcinoma: XXL-like prioritization for liver transplantation or \u2018wait and see\u2019 strategy?","volume":"13","author":"Vitale","year":"2021","journal-title":"Cancers (Basel)"},{"key":"2026081701213436600_zrag113-B56","doi-asserted-by":"crossref","first-page":"e54","DOI":"10.1097\/TP.0000000000005204","article-title":"Transarterial radioembolization can downstage intermediate and advanced hepatocellular carcinoma to liver transplantation","volume":"109","author":"Berardi","year":"2025","journal-title":"Transplantation"},{"key":"2026081701213436600_zrag113-B57","doi-asserted-by":"crossref","first-page":"1894","DOI":"10.1056\/NEJMoa1915745","article-title":"Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma","volume":"382","author":"Finn","year":"2020","journal-title":"N Engl J Med"},{"key":"2026081701213436600_zrag113-B58","doi-asserted-by":"crossref","DOI":"10.1056\/EVIDoa2100070","article-title":"Tremelimumab plus durvalumab in unresectable hepatocellular carcinoma","volume":"1","author":"Abou-Alfa","year":"2022","journal-title":"NEJM Evid"},{"key":"2026081701213436600_zrag113-B59","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.dld.2023.10.029","article-title":"Multidisciplinary treatment of hepatocellular carcinoma in 2023: Italian practice treatment guidelines of the Italian Association for the Study of the Liver (AISF), Italian Association of Medical Oncology (AIOM), Italian Association of Hepato-Bilio-Pancreatic Surgery (AICEP), Italian Association of Hospital Gastroenterologists (AIGO), Italian Association of Radiology and Clinical Oncology (AIRO), Italian Society of Pathological Anatomy and Diagnostic Cytology (SIAPeC-IAP), Italian Society of Surgery (SIC), Italian Society of Gastroenterology (SIGE), Italian Society of Medical and Interventional Radiology (SIRM), Italian Organ Transplant Society (SITO), and Association of Patients with Hepatitis and Liver Disease (EpaC)\u2014part I\u2014surgical treatments","volume":"56","author":"Cabibbo","year":"2024","journal-title":"Dig Liver Dis"},{"key":"2026081701213436600_zrag113-B60","first-page":"587","article-title":"Multidisciplinary treatment of hepatocellular carcinoma in 2023: Italian practice treatment guidelines of the Italian Association for the Study of the Liver (AISF), Italian Association of Medical Oncology (AIOM), Italian Association of Hepato-Bilio-Pancreatic Surgery (AICEP), Italian Association of Hospital Gastroenterologists (AIGO), Italian Association of Radiology and Clinical Oncology (AIRO), Italian Society of Pathological Anatomy and Diagnostic Cytology (SIAPeC-IAP), Italian Society of Surgery (SIC), Italian Society of Gastroenterology (SIGE), Italian Society of Medical and Interventional Radiology (SIRM), Italian Organ Transplant Society (SITO), and Association of Patients with Hepatitis and Liver Disease (EpaC)\u2014part II\u2014non-surgical treatments","volume":"56","author":"Cabibbo","year":"2024","journal-title":"Dig Liver Dis"},{"key":"2026081701213436600_zrag113-B61","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.e5595","article-title":"Prognosis research strategy (PROGRESS) 1: a framework for researching clinical outcomes","volume":"346","author":"Hemingway","year":"2013","journal-title":"BMJ"},{"key":"2026081701213436600_zrag113-B62","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001380","article-title":"Prognosis research strategy (PROGRESS) 2: prognostic factor research","volume":"10","author":"Riley","year":"2013","journal-title":"PLoS Med"},{"key":"2026081701213436600_zrag113-B63","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001381","article-title":"Prognosis research strategy (PROGRESS) 3: prognostic model research","volume":"10","author":"Steyerberg","year":"2013","journal-title":"PLoS Med"},{"key":"2026081701213436600_zrag113-B64","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.e5793","article-title":"Prognosis research strategy (PROGRESS) 4: stratified medicine research","volume":"346","author":"Hingorani","year":"2013","journal-title":"BMJ"},{"key":"2026081701213436600_zrag113-B65","article-title":"Integrating artificial intelligence into multidisciplinary evaluations of HCC: opportunities and challenges","volume":"11","author":"Abdelhamed","year":"2025","journal-title":"Hepatoma Res"},{"key":"2026081701213436600_zrag113-B66","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1038\/s41591-018-0300-7","article-title":"High-performance medicine: the convergence of human and artificial intelligence","volume":"25","author":"Topol","year":"2019","journal-title":"Nat Med"},{"key":"2026081701213436600_zrag113-B67","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1038\/s41575-024-00919-y","article-title":"Artificial intelligence in liver cancer\u2014new tools for research and patient management","volume":"21","author":"Calderaro","year":"2024","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"2026081701213436600_zrag113-B68","doi-asserted-by":"crossref","first-page":"1716","DOI":"10.1038\/s41591-018-0213-5","article-title":"The artificial intelligence clinician learns optimal treatment strategies for sepsis in intensive care","volume":"24","author":"Komorowski","year":"2018","journal-title":"Nat Med"}],"container-title":["BJS Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/4\/zrag113\/70608942\/zrag113.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjsopen\/article-pdf\/10\/4\/zrag113\/70608942\/zrag113.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:21:49Z","timestamp":1786944109000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjsopen\/article\/doi\/10.1093\/bjsopen\/zrag113\/8758838"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":68,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,7,3]]}},"URL":"https:\/\/doi.org\/10.1093\/bjsopen\/zrag113","relation":{},"ISSN":["2474-9842"],"issn-type":[{"value":"2474-9842","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,8]]},"published":{"date-parts":[[2026,7,3]]},"article-number":"zrag113"}}