BACKGROUND: Metabolic disorders are well known risk factors for HCC. Conversely, their impact on the natural history of HCC is not established. This study aimed at evaluating the impact of metabolic disorders on clinical features, treatment and survival of HCC patients regardless of its etiology. METHODS: We analyzed the ITA.LI.CA database regarding 839 HCC patients prospectively collected. The following metabolic features were analyzed: BMI, diabetes, arterial hypertension, hypercholesterolemia and hypertriglyceridemia. According to these features, patients were divided into 3 groups: 0hyphen1, 2 and 3hyphen5 metabolic features. RESULTS: As compared with patients with 0hyphen1 metabolic features, patients with 3hyphen5 features showed lower percentage of HCC diagnosis on surveillance (pequal0.021), larger tumors (pequal0.038), better liver function (higher percentage of ChildhyphenPugh class A [pequal0.007] and MELDlt10 [pequal0.003]), higher percentage of metastasis (pequal0.024), and lower percentage of portal vein thrombosis (pequal0.010). The BCLC stage and treatment options were similar among the 3 groups, with the exception of a less frequent access to locohyphenregional therapies for BCLC stage B patients with 3hyphen5 features (pequal0.012). Overall survival and survival according to BCLC stage andsolor treatment did not significantly differ among the 3 groups. Only using a probabilistic sensitivity analysis, diabetic patients showed a lower survival (pequal0.046). MELD score, HCC morphology, nodule size, BCLC stage, portal vein thrombosis and metastasis were independent predictors of leadhyphentime adjusted survival. CONCLUSIONS: Our "real world" study suggests that metabolic disorders shapes the clinical presentation of HCC but do not seem to play a major role in setting patient survival. This article is protected by copyright. All rights reserved.