Gender, Male: Female Age (years) HBsAg positive HCVAb positive ALB (g/L) TBIL (μmol/L) PT (s) ICGR15 (%) AFP (μg/L) median (range) † Child-Pugh A MELD score median (range) Cirrhosis Tumor size (cm) Tumor encapsulation Microvascular invasion‡ Resection margin > 0 mm Major hepatic resection Blood loss, liters Blood transfusion Previous TACE Postoperative adjuvant TACE 48.0 ± 10.7 257 (86.2%) 18 (6.0%) 42.7 ± 5.4 17.0 ± 9.5 13.6 ± 1.8 11.1 ± 6.4 488 (1-332318) 260 (87.6%) 7 (6-14) 241 (80.9%) 9.7 ± 3.8 87 (29.2%) 187 (62.8%) 110 (36.9%) 217 (72.8%) 0.8 ± 0.5 157 (52.7%) 16 (5.4%) 76 (25.5%) 48.4 ± 12.5 17(81.0%) 1(4.8%) 40.0 ± 4.8 18.0 ± 10.9 13.9 ± 2.5 12.9 ± 6.8 2839(76-46135) 19(90.5%) 7(6-9) 17(80.9%) 8.6 ± 2.70 5(23.8%) 21(100%) 6(28.6%) 16(76.2%) 0.9 ± 0.4 14(66.7%) 1(3.1%) 6(28.6%) 46.1 ± 10.6 85(78.7%) 3(2.8%) 43.1 ± 5.1 16.4 ± 9.6 13.6 ± 1.9 10.0 ± 5.6 487(1-332318) 97(89.8%) 7(6-14) 89(82.4%) 9.1 ± 3.0 36(33.3%) 51(47.2%) 39(36.1%) 81(75%) 0.8 ± 0.6 57(53.3%) 5(4.6%) 32(33.3%) 49.0 ± 8.2 26(81.3%) 2(6.3%) 39.7 ± 5.7 17.6 ± 10.1 14.2 ± 2.1 10.3 ± 4.3 151.5(2-32318) 27(84.4%) 7(6-11) 26(81.3%) 10.9 ± 3.5 8(25.0%) 20(62.5%) 12(37.5%) 21(65.6%) 0.7 ± 0.4 22(68.7%) 2(6.3%) 7(21.9%) 45.6 ± 10.1 51(89.5%) 3(5.3%) 43.4 ± 5.2 16.6 ± 5.9 13.0 ± 1.9 8.2 ± 2.8 817(2-266360) 48(84.2%) 7(6-10) 45(78.9%) 8.8 ± 2.8 14(24.6%) 32(56.1%) 19(33.3%) 38(66.7%) 0.8 ± 0.7 36(63.2%) 2(3.5%) 9(15.8%) Li et al. BMC Cancer 2010, 10:535 http://www.biomedcentral.com/1471-2407/10/535 Page 4 of 9 Table 1 Clinicopathological characteristics of the whole cohort and four subgroups of patients with pT3/4N0M0 HCC * Characteristics Whole cohort Major vascular Multiple tumors more than Invasion of adjacent Perforation of visceral (n = 298) invasion (n = 21) 5 cm (n = 108) organs (n = 32) peritoneum (n = 57) 276:22 20:1 100:8 30:2 51:6 Unless otherwise stated, continuous data are expressed as mean ± SD; other figures indicate number of patients. HBsAg, hepatitis B surface antigen; HCVAb, hepatitis C virus antibody; ALB, albumin; TBIL, total bilirubin; PT, prothrombin time; ICGR15, indocyanine green retention rate at 15 minutes; AFP, a-fetoprotein; MELD, model for end-stage liver disease; TACE, transarterial chemoembolization. * The four subgroups were selected patients in whom the four pathologic features present singularly. † Serum AFP levels of patients with major vascular invasion were significantly higher than those of the other three subgroups (P < 0.05). ‡ The proportion of patients with microvascular invasion was significantly higher in patients with major vascular invasion than in the other three subgroups (P < 0.05). There were no significant differences between any groups in any other parameters. Recurrence Type in Four Groups of Locally Advanced HCC Since recurrence is the main cause of death after cura- tive partial hepatectomy for HCC, we evaluated the dif- ference in recurrence type for the four categories of locally advanced HCC (Gp1-4). We classified tumor recurrence into early or late with 12 months as the cut- off point, [13,14] and the number of recurrent nodules into single or multiple recurrence. As shown in Table 4, early recurrence occurred in 90.5% of Gp1, which was significant higher than Gp2, Gp3 and Gp4 (P = 0.006, 0.041 and 0.024, respectively). Multiple recurrence was observed in 85.7% of Gp1, which was also significantly higher than Gp3 and Gp4 (P = 0.039 and 0.036, respectively). Discussion To provide a better prognostic prediction for cancer patients, the AJCC/UICC TNM staging system has been updated periodically based on new evidence from clinical studies [15]. In 2002, the TNM staging system for HCC was revised and it put more emphasis on vascular inva- sion. However, patients with major vascular invasion are still classified as pT3 after this revision. Many studies have shown HCC with major vascular invasion had extre- mely poor outcomes, [6,7] but HCC with invasion of adjacent organs or perforation of visceral peritoneum were not definitely associated with such a poor prognosis [10,11]. Thus, there is a need to reassess the accuracy of the current TNM classification for pT3-4 tumors.