The Okuda system, introduced in 1985, is a prognostic score for hepatocellular carcinoma (HCC) that considers tumor features and the extent of underlying cirrhosis. It was developed using a cohort of 850 HCC patients between 1975-1983 and incorporates four factors indicating advanced disease: tumor occupying >50% of the liver, presence of ascites, and serum albumin and bilirubin levels. Although the Okuda system is still in use, its main limitation is the crude classification of early-stage patients. Newer staging systems have attempted to better characterize Okuda Stage I patients by incorporating liver-specific variables and sometimes incorporating the Okuda score itself. Nevertheless, the Okuda system remains the benchmark for comparing newer scoring systems. ¹