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

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As progression and outcome of relapsed hepatocellular carcinoma (HCC) are distinct from those of a second primary tumor, clonal analyses of initial and recurrent HCCs are thus clinically useful. Although several studies in Japan and Taiwan had shown that the multicentric origin (MO) recurrences were more common than intrahepatic metastases (IM), a recent report from China indicated that IM cases outnumber MO recurrences. In managing HCC cases, both tumor malignancy and background liver function are important 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, we explain why the report had shown such a different conclusion. We also discuss current management of HCC.