Comment on staging hepatocellular carcinoma involving a single large tumor

Many patients with primary hepatocellular carcinoma (HCC) have a single large tumor (>5 cm). Official guidelines (1,2) and large retrospective studies (3,4) assign these patients to different Barcelona Clinic Liver Cancer (BCLC) stages, leading to different treatment recommendations. Current BCLC guidelines recommend transarterial chemoembolization (TACE) for BCLC stage B patients (1,2). However, improvements in surgical technique and perioperative care at several large liver centers have made hepatic resection (HR) a first-line therapy for many patients in stage B as well as earlier and advanced stages (5-7).