Objective To explore the efficacy and safty of sorafenib in Child-Pugh class B to class C hepatocellular carcinoma(HCC).Methods In this three-center open-label study from November 2011 to May 2013,we randomly assigned 189 patients with advanced Child-Pugh class B or C HCC patients into two groups,one group with 95 patient to receive sorafenib(400 mg a time,twice a day) and the other group with 94 patients to receive best supportive care.The primary end points were progression-free survival and overall survival.Results The median progression-free survival was 2.2 months and 1.9 months in the sorafenib group and best supportive care group respectively(Hazard ratio in the sorafenib group,0.55;95% confidence interval,0.40-0.75;P=0.002).The median overall survival was 4.0 months and 3.5 months in the sorafenib group and best supportive care group respectively(Hazard ratio in the sorafenib group,0.48;95% confidence interval,0.35-0.68;P<0.001).The main adverse effect of sorafenib was rash and acne of the skin(in 51.7% patients).The incidences of severe rash,diarrhea,and dry skin were 5.6%,5.6%,and 2.2% in the sorafenib group.One patient reached partial response in the sorafenib group.Conclusions Sorafenib is safe in patients with liver function impaired advanced HCC.It is effective in terms of progression-free survival and overall survival compared with best supportive care.Liver functions are the important predictive factors. Objective To explore the efficacy and safty of sorafenib in Child-Pugh class B to class C hepatocellular carcinoma (HCC). Methods In this three-center open-label study from November 2011 to May 2013, we randomly assigned 189 patients with advanced Child- Pugh class B or C HCC patients into two groups, one group with 95 patient to receive sorafenib (400 mg a time, twice a day) and the other group with 94 patients to receive best supportive care. The primary end points were progression-free survival and overall survival. Results of the median progression-free survival was 2.2 months and 1.9 months in the sorafenib group and best supportive care group respectively (Hazard ratio in the sorafenib group, 0.55; 95% confidence interval, 0.40-0.75; P = 0.002 ). The median overall survival was 4.0 months and 3.5 months in the sorafenib group and best supportive care group respectively (Hazard ratio in the sorafenib group, 0.48; 95% confidence interval, 0.35-0.68; P <0.001) of sorafenib was rash and acne of the skin (in 51.7% patients) .The incidences of severe rash, diarrhea, and dry skin were 5.6%, 5.6%, and 2.2% in the sorafenib group. One patient reached partial response in the sorafenib group. Confclusions Sorafenib is safe in patients with liver function impaired advanced HCC. It is effective in terms of progression-free survival and overall survival compared with best supportive care. Liver functions are the important predictive factors.