ReviewBJS open2026
Personalised decision-making in hepatocellular carcinoma: conceptual evolution over two decades.
Review in BJS open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEvidence-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.
methodsThis 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.
resultsHCC 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.
conclusionHCC 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.