The Tokyo score, introduced by Tateishi et al. in 2005, enhances prognostic accuracy for early-stage HCC patients. Derived from a cohort of 403 patients who underwent percutaneous ablation, it identifies four independent predictors: serum albumin (3.5 g/dL and 2.8 g/dL), serum bilirubin (1 mg/dL and 2 mg/dL), tumor size (2 cm and 5 cm), and tumor number (1-3 vs. >3). Scores, based on regression coefficients, yield a total score. Survival curves show clear distinctions among Tokyo score groups, with five-year survival rates of 78.7%, 62.1%, 40%, 27.7%, and 14.3% for scores 0, 1, 2, 3, and 4-6, respectively. Validation against AIC and Harrell’s C index supports its predictive capability comparable to CLIP and superior to BCLC for patients eligible for curative treatments. However, its suitability is limited for advanced disease stages, as acknowledged by the authors.