Background: Hepatocellular carcinoma is a common malignancy in Asia and is related to the high prevalence of chronic viral hepatitis. We examined the clinical features, treatments and survival rates in Asian Americans with HCC. Methods: Retrospective cohort study of 278 HCC patients who presented to the UCLA Liver Cancer Center in Los Angeles, California, USA from September 2000 to December 2007. Results: Two hundred and seventeen of 278 (78%) HCC patients were male, 58% and 30% had HBV and HCV infection respectively, and 73% had cirrhosis. HCC patients detected by surveillance had smaller tumor sizes, more within the Milan and UCSF criteria, lower HCC Tokyo system scores and had improved 1,3,5 year overall patient and disease free survival rates compared to HCC patients who presented with symptoms (p<0.01 to p<0.0001). By multivariate analysis, independent predictors of patient survival were tumor volumes greater than 5cm (HR1.48, p=0.04), AFP per unit log10 increase (HR 1.12, p=0.02), HCC Tokyo score per unit increase (HR 1.3, p<0.0001), liver transplantation (HR 0.14, p<0.0001), hepatic resection (HR 0.18, p<0.0001), RFA (HR 0.17, p<0.0001), TACE (HR 0.44, p=0.0006), and Hepatitis B infection (HR 0.71, p=0.03). Factors associated with disease free survival were age per year increase (HR 1.01, p=0.03), MELD per unit increase (HR 0.97, p=0.0049), liver transplantation (HR 0.23, p<0.0001), and hepatic resection (HR 0.39, p<0.0001). Conclusion: HBV and HCV infection accounts for the majority of HCC in Asian Americans. HCC detected by surveillance resulted in treatments which improved overall patient and disease free survival.