Background: Hepatocellular carcinoma (HCC) remains one of the leading causes of cancer-related mortality worldwide and in Mongolia. Alcohol-related liver disease (ALD) and metabolic dysfunction-associated steatohepatitis (MASH) are two major etiological factors contributing to the rising burden of HCC, each presenting distinct clinical and pathological characteristics. Aim: To compare the clinical, pathological, and survival characteristics of patients with ALD-related HCC and MASH-related HCC who underwent liver resection. Material and Methods: A retrospective cohort study was conducted using clinical and pathological data from 980 patients who underwent liver resection between 2010 and 2024. Among them, 191 were categorized into the ALD group and 789 into the MASH group. Clinical parameters, laboratory findings, tumor pathology (size, grade, fibrosis stage, vascular invasion), recurrence, and overall survival (OS) were analyzed. A simulated Kaplan–Meier survival curve was generated based on group-level survival estimates. Results: Patients with ALD were significantly younger and predominantly male compared with those in the MASH group (p=0.0014; p<0.0001). The MASH group demonstrated more aggressive pathological features, including larger tumors (>5 cm), poorer differentiation (G3–4), advanced T4 stage, and a higher rate of large-vessel invasion (all p<0.05). Despite these findings, the MASH group showed a longer mean overall survival (92.6 months) than the ALD group (82.0 months; p=0.0206). Conclusion Although MASH exhibits more aggressive pathological features compared with ALD, patients in the MASH group demonstrated better overall survival. These findings underscore the importance of incorporating etiological differences into the diagnostic, therapeutic, and postoperative management strategies for HCC.