449 Background: Recent advances in systemic therapies have revolutionized the management of HCC. However, there is limited real-world data on treatment patterns and survival outcomes in pts with uHCC. OREIOS (NCT05239507) study determined the clinical characteristics, management patterns and survival outcomes in pts with uHCC from 12 countries across Asia, Latin America, and Middle East and Africa. Methods: This non-interventional, retrospective study included pts with Barcelona Clinic Liver Cancer (BCLC) stage B or C unresectable or advanced/metastatic HCC at index date (date of diagnosis), diagnosed between January 2017 and December 2019. We present the clinicodemographic characteristics, treatment patterns, median overall survival (mOS), landmark survival (12 and 24 months), and median progression-free survival (mPFS). Results: A total of 1115 pts (median [range] age: 63 [18.0-97.0] yrs) were assessed; 83.2% (928/1115) were males, 49.1% (422/859) were current or ex-smokers, 21.4% (122/571) consumed alcohol. Most common etiologies were hepatitis B (48.9% [529/1082]), hepatitis C (23.1% [250/1082]) and alcoholic liver disease (6.6% [72/1082]). At index date, 22.3% (249/1115) and 77.7% (866/1115) presented with BCLC stage B and C, respectively with main portal vein invasion in 23.5% (262/1114), >50% liver involvement in 23.1% (250/1081) and extrahepatic metastases in 48.5% (541/1115). After index date, treatment modalities included systemic therapy (88.2% [992/1112] (including sorafenib [77.5%], nivolumab [21.3%], lenvatinib [19.8%], regorafenib [15.6%]), transarterial chemoembolization (TACE) (20.8% [232/1115]), and surgery (2.6% [29/1115]). The mPFS was 6.6 (95% CI 6.0, 7.2) months and mOS was 13.1 (95% CI 11.6, 14.2) months. Conclusions: Our study provides real-world data on treatment patterns and reports poor prognosis with pts reaching a mOS of ∼13 months. With novel agents and combination therapies being approved for uHCC, integrating them in routine care is important to improve survival. Alongside, further real-world studies are warranted for evaluating the change in treatment patterns and prognosis. Clinical trial information: NCT05239507 . [Table: see text]