The management of hepatocellular carcinoma (HCC) has become increasingly complex due to advancements in surgical and systemic therapies. Traditional staging-based algorithms are no longer sufficient, and treatment allocation now requires consideration of factors like patient frailty, comorbidities, tumor location, liver function, and technical contraindications. In this Policy Review, the shift towards a more personalized treatment approach is critically examined. Expert tumor boards play a central role in this approach, and an evidence-based framework called multiparametric therapeutic hierarchy is proposed. This framework prioritizes treatment options based on their survival benefit, with surgery being the top choice followed by systemic therapy. Additionally, the concept of converse therapeutic hierarchy is introduced, which orders therapies based on their conversion or adjuvant abilities, with systemic therapy preceding surgery. These innovative approaches provide a more tailored and individualized treatment strategy for HCC patients.

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