Hepatocellular carcinoma (HCC) is the fifth most common malignancy, accounting for the third leading cause of death from tumors, with a 5-year natural mortality rate of over 95%. Globally, more than 500,000 people suffer from HCC each year, more than half of which are in China. Currently, chronic hepatitis B infection remains the leading cause of HCC in China, with more than 10% being carriers of the hepatitis B virus. In addition, hepatitis C infection, aflatoxin consumption, alcohol abuse, and smoking are also important causes of HCC in China. With the widespread use of hepatitis B vaccine in the Chinese population in 1992 and the announcement of free vaccination for newborns by the Chinese government, the incidence of hepatitis B-associated HCC in China is expected to decrease significantly in 20 years. However, although the current prevalence of hepatitis C infection in China is low, the increasing incidence of hepatitis C due to social issues such as the proliferation of HIV and drug injection, poorly controlled blood collection systems, and lack of safer sex education among the homosexual population will likely lead to higher rates of hepatitis C-associated HCC in China in the future. In addition, the incidence of diabetes and obesity, which are high-risk factors for HCC, has gradually increased in China in recent years, which is also not to be ignored. Therefore, the situation of HCC in China will not be optimistic in the future. With the improvement of economic level and health awareness of the people, as well as the expansion of the scope and intensity of screening for high-risk groups, a proportion of HCC patients in China have been cured due to early detection and early treatment. However, due to objective factors such as the large proportion of poor people in rural China and the fact that the social problem of “difficult and expensive to see a doctor” has not been completely solved, more than half of the HCC patients still seek treatment only after symptoms appear and are diagnosed as advanced at the first diagnosis, losing the best time for treatment and having a rather poor prognosis. Despite the proliferation of advanced surgical instruments and anti-cancer drugs, they have not necessarily had a significant impact or change on the current overall status of HCC treatment in China, as their introduction has meant increasing treatment costs. “The wool comes off the sheep’s back”, and the increased cost of treatment ultimately needs to be paid by the patients themselves. For example, in most hepatobiliary surgery centers in China, the technique used today for liver resection is still the finger pinch + clamp method (a method that does not require additional surgical instruments). If so-called “advanced instruments” such as waterjet and ultrasonic knife are used, intraoperative bleeding can be reduced and surgical safety can be improved, but the cost of treatment will be greatly increased, requiring patients to spend more money for hepatectomy. This additional cost is contradictory to the current situation in China, not to mention that the government’s current “universal health insurance” program requires cutting costs and controlling overall treatment costs. At the author’s largest hepatobiliary surgery center in China, the average hospitalization cost for a liver resection is less than 20,000 RMB, which is simply not possible in the western developed world. It is this low cost that has allowed a wider range of HCC patients to be treated effectively in China, expanding the coverage of HCC treatment. However, treatment for HCC is long-term, ongoing, and comprehensive, and cannot be completely resolved with a single hospitalization or surgery. There are many HCC patients in China who are forced to discontinue the next step of treatment not because the disease is terminal, but because of financial conditions. It is worth pointing out that until now, the majority of the population is aware that if there is a chance of surgery for HCC, it means that there is hope for long-term survival, otherwise there is no choice but to face death. When told by doctors that surgery is not possible, they usually do not choose adjuvant or palliative treatments such as TACE, systemic chemotherapy, etc., but choose to take traditional Chinese medicine in the hope that a miracle will happen. We cannot deny that some Chinese herbal medicines have really produced good efficacy or even achieved the ultimate cure for individual HCC patients. However, more Chinese HCC patients can only go to the end of their lives with the bitter taste of herbal medicine. Nowadays, the introduction of sorafenib (Sorafenib) undoubtedly means hope for patients with advanced HCC or an effective way to prolong their lives [17]. However, the high price of Sorafenib is prohibitive to the majority of the Chinese general population. In response to this paradox, although the drug development companies, together with the China Charity Federation, have developed some incentives to support the poor in China, the eligibility criteria for this group of patients are still demanding – patients are required to pay for the first 3 months of the drug at their own expense before they are eligible to apply, and they must provide many The patient must provide a lot of relevant documentation and must promise to receive regular or unscheduled follow-up visits. It should also be noted that the retail price of sorafenib in China ($7,300 per month) is one of the highest in the world. Here, we may suggest that drug development companies, based on the fact that China has more than half of the world’s HCC population, may be able to win a larger market and more significant benefits by lowering their sales price in China. Wouldn’t such a move be a win-win situation for individual HCC patients in China? Until today, there are some differences in the treatment paradigm and concepts of HCC in China and internationally, especially in most Western countries, but it is inconclusive whether these differences are right or wrong. For example, when HCC is combined with portal vein carcinoma thrombosis, it is considered advanced HCC and most doctors abroad do not recommend surgery, while in China, as long as liver function allows and tumor resection is feasible, surgical treatment is still advocated, even if it is palliative resection or tumor reduction surgery. With further research, it is believed that there will be more consensus and standards for the diagnosis and treatment of HCC in the East and West. However, this approach of “seeking common ground while reserving differences” is actually encouraged, as it is more conducive to the advancement of science and beyond. Because of the high prevalence of HCC in China, medical research on HCC is now flourishing in China. A search of Medline using “hepatocellular carcinoma” as the subject term revealed that there were only 980 articles (12.1%, 980/8097) published in the five-year period from 1999 to 2003 in which Chinese scholars conducted or participated in the research. 8097) in the five-year period from 1999 to 2003, while the number increased to 2294 (20.6%, 2294/11109) in the five-year period from 2004 to 2008. We also note that the number of RCT-related papers published therein similarly increased from 16.8% (15/89) in the previous period to 40.2% (60/149) in the latter period. This indicates that the share of HCC-related research from China is considerable and important. However, we must also acknowledge that, although adequate in terms of the number of publications, most of these papers are not of high quality, most are repetitive or retrospective studies, the number of publications in high-end medical journals is limited, the assessment of RCT papers is of low quality, and there are various flaws in trial design and statistical methods. Furthermore, it is quite unfortunate that some large global multicenter RCT studies on HCC lack case enrollment from mainland China. In the case of the authors’ Shanghai Oriental Hepatobiliary Surgery Hospital, nearly 3500 HCC patients are treated surgically each year and no less than 20,000 HCC patients are seen in the outpatient clinic, which is a tremendous and valuable resource for HCC research and unmatched by any other liver cancer research center internationally. In 2008, the Chinese Ministry of Health has officially launched a major national project involving viral hepatitis and HCC with hundreds of millions of RMB, and the Chinese Academy of Sciences will also establish a national oncology research center including HCC in Shanghai this year, which will facilitate the integration of resources and further deepen clinical and basic research on HCC. Here, we hope to draw the attention of international counterparts and look forward to more international exchanges and collaborations, which will help improve the capability of Chinese scientific research on the one hand, and make significant development and progress in the diagnosis and treatment of HCC on the other.