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BACKGROUND:A simplified American Joint Committee on Cancer (AJCC) TNM staging system forhepatocellular carcinoma (HCC) (the 6th edition) was proposed in 2002. In this study, wevalidated the prognostic value of the staging system in a patient cohortundergoing hepatic resection with longterm followup. STUDY DESIGN: From aprospective database, the study cohort consisted of 440 patients who underwentcurative hepatic resection for HCC between July 1991 and January 1999. Medianfollowup time was 66 months. Multivariate analysis was performed to identifythe independent prognostic factors related to postoperative survival. Patientswere staged according to both the 5th edition (TNM-5) and 6th edition (TNM-6)AJCC TNM staging criteria. RESULTS: The independent prognostic factors includedmajor vascular invasion, microvascular invasion, surgical margin < 1 cm, indocyanine greenretention rate at 15 minutes > 10%, multiple tumors, tumor rupture, male,and serum aspartate aminotransferase > 90 U/L. The breakdown by TNM-5staging: I, 27 (6.1%); II, 108 (24.5%); III, 218 (49.5%); and IVA, 87 (19.8%)and by TNM-6 staging: I, 120 (27.3%); II, 170 (38.6%); and III, 150 (34.1%).When stratified according to the TNM-5 system, difference in survival wasnotable between stages II and IIIA (p < 0.001), between stages IIIA and IVA(p < 0.001), but not between stages I and II (p > 0.05). When stratifiedaccording to the TNM-6 system, difference in survival was considerable betweenstages I and II (p < 0.01), stages II and III (p < 0.001), and stages Iand III (p < 0.001). CONCLUSIONS: Overall, the TNM-6 staging system appearsto provide a reliable prognostic classification of HCC patients and is simplerto use than the TNM-5 staging system. Leggil'articolo