Hepatocellular carcinoma (Hcc) is the fourth leading cause of cancer-related death worldwide, but its current status is unclear. We aimed to investigate the evolution of etiology, presentation, management and prognostic tool in HCC over the past 12 years. A total of 3349 newly diagnosed HCC patients were enrolled and retrospectively analyzed. the comparison of survival was performed by the Kaplan-Meier method with the log-rank test. Hepatitis B and c virus infection in Hcc were continuously declining over the three time periods (-2015; p < 0.001). At diagnosis, single tumor detection rate increased to 73% (p < 0.001), whereas vascular invasion gradually decreased to 20% in 2012-2015 (p < 0.001). Early stage HCC gradually increased from 2004-2007 to 2012-2015 (p < 0.001). The probability of patients receiving curative treatment and long-term survival increased from 2004-2007 to 2012-2015 (p < 0.001). The Cancer of Liver Italian Program (CLIP) and Taipei integrated Scoring (tiS) system were two more accurate staging systems among all. in conclusion, the clinical presentations of HCC have significantly changed over the past 12 years. Hepatitis B and C virusassociated Hcc became less common, and more patients were diagnosed at early cancer stage. patient survival increased due to early cancer detection that results in increased probability to undergo curative therapies.Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the fourth leading cause of cancer-associated mortality in 2018 globally 1 . The incidence of HCC is high in East Asia with male prediomance 2-4 . Also, HCC is the second most common reason for cancer-related mortality in Taiwan 5 , an endemic area for hepatitis B virus (HBV).HBV infection in Taiwan in mainly due to perinatal mother-to-infant transmission of the virus. The carrier rate of hepatitis B surface antigen (HBsAg) in general population was as high as 15-20% 6 . Prospective cohort and meta-analyses studies showed a 10-to 100-fold increase in the risk of HCC development among subjects chronically infected with HBV 2,7 . In Taiwan, the vaccination program against HBV was initiated in July 1984, and has reduced the incidence of HCC in children and adolescent successfully 8,9 . In addition to HBsAg, positive serum HBV e antigen and HBV DNA level were also associated with increased cancer risk 10 . Cumulative evidence showed that antiviral therapy might suppress HBV replication and lead to reduced risk of HCC formation [11][12][13] . HCV infection is another risk factor for HCC. The risk for HCC development in patients with serologically confirmed HCV infection was estimated to be 17-fold 2 . Notably, in recent years, nonalcoholic fatty liver disease (NAFLD), which is often associated with obesity and diabetes mellitus, emerged as potentially new risk factor for HCC 3,14,15 .For patients with early stage HCC, surgical resection, liver transplantation or local ablation therapy are usually indicated, with 5-year survival rate up to 75% 14,16 . Transarterial chemoembolization i...