Li et al. BMC Cancer 2010, 10:535 http://www.biomedcentral.com/1471-2407/10/535 efficacy of Sorafenib in patients with advanced HCC has been evaluated in a randomized, double-blind, multicen- tre, phase III trials: the SHARP (Sorafenib Hepatocellu- lar Carcinoma Assessment Randomized Protocol) trial [35]. However, the placebo group of the SHARP study with similar baseline characteristics as in this study had a median survival of 7.9 months. It seems that these patients may not benefit from resection or even suffer detrimental effects. Since there are no head-to-head stu- dies comparing resection and nonsurgical treatment or sorafenib in this category of patients, future studies will need to investigate more thoroughly which modality should be used as first line treatment. There are several limitations of our study. Our study is retrospective and it is based on a single-institutional experience. The sample size of some of the subgroups is relatively small. A larger scale, multi-center study is needed to confirm our results. Conclusion In conclusion, our study suggested that the current 2002 TNM staging system failed to stratify patients with differ- ent categories of locally advanced HCC according to the outcomes after hepatic resection. The current pT3 sub- group of major vascular invasion exhibited poor surgical outcomes when compared with the other pT3 subgroups with multiple tumors more than 5 cm, and the pT4 group with invasion of adjacent organs or perforation of visceral peritoneum. These data, in addition to the pub- lished data, challenge the value of the current 2002 TNM staging classification in locally advanced HCC. Acknowledgements This work was supported by grants from National Natural Science Foundation of China (30872489 and 30972916). We are grateful to Professor Qing Liu (Dept. of GCP, Sun Yat-sen University Cancer Center, Guangzhou, China) for supporting the statistical analysis. Author details 1State Key Laboratory of Oncology in South China, Guangzhou, China. 2Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China. 3Department of Surgery, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. 4Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China. 5Faculty of Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong SAR, China. Authors’ contributions BKL, YFY, JQL, and GHL have made substantial contributions to conception and design of the study. BKL, GHC, and YQZ carried out acquisition of data. BKL, GHC, and LRH carried out analysis and interpretation of data. BKL, YFY, LRH and WYL have been involved in drafting the manuscript. All authors read and approved the final manuscript. Competing interests The authors declare that they have no competing interests. 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