Hepatocellular carcinoma (HCC) represents ～90% of the pri-mary liver cancer cases, and 90% of HCC cases occur in pa-tients with chronic liver disease.1 It also represents the sixth most common cancer (4.7%) and the third leading cause of cancer-related death globally (8.3%).2 More troubling, the global incidence and mortality rates have been increasing since 1990.3 In the United States, the highest average an-nual percentage change (known as AAPC) reported between 2000 and 2012 involved individuals between 55 and 59 years of age (AAPC: 8.9%; 95% confidence interval: 7.1–10.7%).4 The current European Association for the Study of the Liver (commonly known as EASL) guidelines advise treat-ment assignment according to tumor stages following the Barcelona Clinic Liver Cancer (BCLC) staging system.5 The concept of very-early or stage 0 classification was not intro-duced until the 2003 BCLC modification.