Tsilimigras DI, Moris D, Hyer JM, et al. - Despite the wide adoption of the Barcelona Clinic Liver Cancer (BCLC) staging system in clinical practice, recent studies have highlighted the necessity for further refinement and subclassification of this system. Researchers here calculated the tumor burden score (TBS), and examined overall survival (OS) in relation to TBS and BCLC stage in patients who underwent hepatectomy with curative intent for BCLC-0, -A or -B hepatocellular carcinoma (HCC) between 2000 and 2017. Using a multi-institutional database, they identified 1,053 patients; of these, 63 (6·0%) had BCLC-0, 826 (78·4%) BCLC-A and 164 (15·6%) had BCLC-B HCC. Variation in the prognosis of patients with HCC was observed according to the BCLC stage but this was largely dependent on the TBS. An incremental worseming was observed in OS with higher TBS (5-year OS 77·9%, 61% and 39% for low, medium and high TBS, respectively).