Early-stage hepatocellular carcinoma (HCC) represents a critical window for curative treatment. However, treatment selection is complicated by significant heterogeneity in tumor biology, liver function, and patient performance status. This review provides a comprehensive overview of current curative-intent strategies for early-stage HCC, including liver transplantation, surgical resection, and local ablative therapies. We emphasize the importance of integrating tumor-specific characteristics-such as microvascular invasion, size, and anatomical location-with liver reserve metrics, including portal hypertension, Child-Pugh classification, and novel indices like albumin-bilirubin and albumin-indocyanine green evaluation grades. Furthermore, we discuss recent advances in non-thermal ablation techniques (eg, high-intensity focused ultrasound and irreversible electroporation), and technical innovations in radiofrequency ablation and cryoablation that are expanding the therapeutic landscape. By combining macro-level functional assessments with micro-level biological indicators, this review advocates for a personalized, evidence-based framework to optimize long-term outcomes in early HCC. The future of HCC management lies in standardizing individualized therapy.