Management of hepatocellular carcinoma should consider both tumor factors and background liver factors

As progression and outcome of relapsed hepatocellular carcinoma (HCC) are distinct from thoseof a second primary tumor, clonal analyses of initial and recurrent HCCs are thus clinically useful. Althoughseveral studies in Japan and Taiwan had shown that the multicentric origin (MO) recurrences were morecommon than intrahepatic metastases (IM), a recent report from China indicated that IM cases outnumberMO recurrences. In managing HCC cases, both tumor malignancy and background liver function areimportant considerations (and which we characterize as tumor factors and background liver factors,respectively); they indicate both appropriate treatment, and likely post-surgical outcome. In this editorial, weexplain why the report had shown such a different conclusion. We also discuss current management of HCC.