ABSTRACT: Clinical staging systems for hepatocellular carcinoma (HCC) provide guides to patient assessment and therapeutic decision making. The most commonly used staging systems for HCC internationally are the Okuda classification and the pathologic tumor node metastasis (TNM) classification. But each has its own limitations. New staging systems for HCC have recently been reported from Italy, France, Spain and China. In this review, we evaluated the staging systems of HCC and discussed the natural history and prognosis of tumors of different stages. We believe that a reliable new staging system of HCC patients will be established in the near future.