Background and aim: Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world. Many staging systems for the survival prognosis of patients with HCC have been proposed but the validity of these staging systems is still controversial. The study objectives were to determine the mortality rate, to identify the risk factors and to compare the value of four different staging systems: Child-Pugh, Meld, Okuda, and Barcelona Clinic Liver Caner (BCLC) for predicting survival in patients with HCC. Patients and methods: A retrospective study was carried out on 397 patients with HCC inCho Ray Hospital from 01102/2009 to 30/09/2009. The follow-up time was 24 weeks. The risk factors were identified by univariate and multivariate Cox model analyses. The value of Child-Pugh, Meld, Okuda, and BCLC scores was compared by using LRc2, Akaike information criterion, Harrell's C statistics and area under the ROC curve. Results: The median survival was 18.2 + or - 7.3 weeks. The mortality rate was 40.6 percent. Six factors were independently associated with survival, including jaundice (Hazard ratio [HR] = 2.07, 95 percent confidence interval [CI] 1.26-3.39), ascites (HR = 2.19, 95 percent Cl1.453.29), portal vein thrombosis (HR = 2.34, 95 percent CI 1.60-3.29), tumor size 6.5 cm (HR=2.32, 95 percent CI 1.67-3.22), AFP level 200ng/ml (HR= 1.47, 95 percent CI 1.06-2.04) and serum albumin level or
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