Recently, the International Cooperative Study Group for hepatocellular carcinoma (HCC) proposed a new staging based on data from multiple centers across the world. The new TNM staging has been shown to be more accurate in the prognostic classification of patients after resection for HCC. This staging is the basis for the new TNM for HCC approved by the AJCC (American Joint Committee on Cancer) and UICC (Union Internationale Contre le Cancer). Although the general applicability of the new staging system has been confirmed, there still remains a marked geographic variation in the clinicopathologic factors of HCC patients based on their country of origin. Tumor size, rates of hepatitis, and degree of underlying liver damage all vary significantly among countries. Despite these geographic variations, recent data reveal similar long-term survival in Western and Eastern centers when these clinicopathologic factors are accounted for. Uniform criteria that account for these clinicopathologic differences need to be developed to assist in stratifying patients across hepatobiliary centers.
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