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to international guidelines. Moreover the effectiveness of AASLD guidelines application has never been prospectively addressed. This is a prospective survey on a large cohort of newly diagnosed HCC observed in the last 2 years. Material and methods: From September 2008 to September 2010, 710 consecutive patients with HCC referring to 30 non-tertiary referral Hospitals were included. Inclusion criteria were newly detected HCC and cirrhosis. Patients were classified according to Child-Pugh and Meld score and BCLC stage. No prefixed protocols on diagnosis and treatment of HCC were operative. Statistical analysis is based on the first 536 cases. Results: Mean age was 70±4.7 yrs (71% M). Comorbidities were present in 322 patients (76%). Prevalent etiology was HCV (56%). Cirrhosis was Child A in 266 (63%), B in 125 (29%) and mean MELD score was 9.5±5.3. The mean size of nodules was 3.8±2.3 cm, monofocal in 57% and paucifocal in 23% cases. Age > 70 yrs and moderate/severe comorbidities were equally distributed among different BCLC stages. Regular follow-up was recorded in 289 cases (54%). Early HCC was more frequently observed in patients on regular follow-up (71% vs 39%). The most frequently employed imaging technique for diagnosis of HCC was TC (93%) followed by CEUS (62%); MRI was utilized in 17% of cases. Adherence to the non-invasive diagnostic criteria was 59% in nodules = 2 cm and 97% in larger nodules. The overall adherence to BCLC treatment algorithm was 52%. Ratio between ideal and real treatment offered was: OLT 42/9, resection 78/36, ablation 160/152, TACE 129/159, Sorafenib 67/21, palliative 60/134. In 25 cases combination therapy was performed. In particular 119 (40%) patients in BCLC stage A did not receive curative therapies. Conclusions: This translational study showed that adherence to either diagnostic and therapeutic AASLD 2005 algorithms was low particularly in early HCC stages. These discrepancies are mainly due to: 1) the difficulty in applying the algorithms in routine clinical practice and 2) the high prevalence of patients > 70 yrs with relevant comorbidities. The effectiveness of AASLD guidelines application remains to be verified.