Sorafenib is the only systemic drug approved for advanced hepatocellular carcinoma (HCC), recommended for patients under Child-Pugh (CP) class-A and Barcelona Clinic Liver Cancer (BCLC) stage-C. However, these groups are heterogeneous and sorafenib high cost and modest activity represent a major challenge to the health care budget. We recently reported a novel validated IGF score by replacing ascites and encephalopathy in CP with plasma IGF-1. A significant number of original CP-A patients were reclassified as IGF-score class B and C and had significantly poorer survival. However, we never assessed the predictive ability of the IGF score in patients receiving sorafenib, or incorporated the IGF score into HCC staging. We plan to accrue 300 patients with HCC who will be prospectively treated with sorafenib and are classified under CP-A, BCLC-C, from MD Anderson, and 4 international institutions through our newly established international HCC consortium.