Background: To evaluate the pattern and outcomes of sorafenib use in unresectable/advanced HCC in a real life setting in a tertiary Hong Kong liver cancer centre. Methods: A retrospective review of unresectable or advanced HCC patients treated with sorafenib at Queen Mary Hospital, Hong Kong from 2010-2015 was conducted. The objectives were to evaluate the sorafenib efficacy in overall treated population as well as different subgroups; and also reviewed the tolerability of sorafenib, especially its impact on liver function. Results: During the study period, 504 consecutive cases were identified and 493 cases with sufficient clinical data were analyzed. Consistent with Asia-Pacific etiologies, 79.3% patients had chronic hepatitis B. Sorafenib was mainly used in patients with high tumor burden (75.1% BCLC-C, 68.6% MVI or/and EHS). Two-third patients (68.2%) were pretreated, mostly with loco-regional therapies. While 70.2% patients had good baseline PS 0, one-quarter (26.6%) had Child-Pugh B/C cirrhosis state. The overall survival (OS) was 8.15 months, with no difference between HBV and non-HBV subgroups. Patients had Child-Pugh A(CP-A) had significantly better OS compared with those at CP-B/C (11.1m vs 3.29m vs 3.34m). About 36.1% patients received subsequent therapies. Safety profile was essentially consistent with literature with hand-foot-skin reaction (HFSR) being the most common AE (30.7% all-grade). Interestingly, the onset of HFSR was associated with significantly better OS (median: 14.59 vs 5.59 months, p <0.001). Notably, there was no significant change in the on-treatment levels of liver function in terms of bilirubin and plasma albumin level. Conclusions: Our study confirms the efficacy and safety in using sorafenib to treat unresectable or advanced HCC patients in the real life setting. Our results are s comparable with those reported in literature. In addition, we found that 1) similar efficacy in treating HCC regardless of HBV status, 2) positive association of OS with HFSR onset, and 3) no compromised liver function during sorafenib therapy.