The incidence of hepatocellular carcinoma (HCC) is relatively high in Southeast Asia. Globally, HCC hasa high fatality rate and short survival. The objectives of this retrospective cohort study were to review theepidemiology and survival of HCC patients at a tertiary centre in north-east of Peninsular Malaysia. Subjectswere adult HCC patients diagnosed by histopathology or radio-imaging. Secondary liver carcinoma was excluded.Kaplan Meier and multiple Cox proportional hazard survival analyses were used. Only 210 HCC cases fromyears 1987-2008, were included in the final analysis. The number of cases was increasing annually. The mean agewas 55.0 (SD 13.9) years with male:female ratio of 3.7:1. Approximately 57.6% had positive hepatitis B virus,2.4% hepatitis C virus, 20% liver cirrhosis and 8.1% chronic liver disease. Only 2.9% had family history and9.0% had frequently consumed alcohol. Most patients presented with abdominal pain or discomfort and hadhepatomegaly, 47.9% had an elevated α-fetoprotein level of 800 IU/ml or more, 51.9% had multiple tumors and44.8% involved multiple liver lobes. Approximately 63.3% were in stage 3 and 23.4% in stage 4, and 82.9%did not receive any treatment. The overall median survival time was 1.9 months (95% confidence interval(CI): 1.5, 2.3). The 1-month, 6-month, 1-year and 2-year survival rates were 71.8%, 23.3%, 13.0% and 7.3%respectively. Significant prognostic factors were Malay ethnicity [Adjusted hazard ratio (AHR) 1.6; 95%CI: 1.0,2.5; p=0.030], no chemotherapy [AHR 1.7; 95%CI: 1.1, 2.5; p=0.017] and Child-Pugh class C [AHR 2.6; 95%CI:1.4, 4.9; p=0.002]. HCC in our study affected a wide age range, mostly male, in advanced stage of disease, withno treatment and very low survival rates. Primary prevention should be advocated in view of late presentationand difficulty of treatment. Vaccination of hepatitis virus and avoidance of liver toxins are to be encouraged.