From a series of 452 consecutive patients with hepatocellular carcinoma (HCC) admitted to the department of Medicine III, Kyushu University Hospital between January 1988 and December 2002, patients were evaluated, who met the following criteria: (a) the patients had not been diagnosed with HCC previously, (b) they had a solitary HCC less than 4 cm in diameter, or had fewer than three tumors with diameters less than 3 cm, and (c) patients with extrahepatic metastasis or vessel invasion were excluded. Five-year survival was more than 60%, and there were no significant differences in survival among the periods of 1988 - 1989, 1990 - 1994, and 1995 - 2002. There were significant differences in survival among patients with tumors of diameters < 2 cm (80%), 2 - 3 cm (60%), 3 < (40%) cm, and among those with tumor numbers of 1 (70%), 2 (50 %), 3 - 4 tumors (30%). The study also analyzed variables that could influence prognosis or recurrence of HCC, including tumor size and number, parameters of hepatic function, combined therapy with transcatheter arterial chemoembolization and local recurrence. Multivariate regression analysis showed that indocyanine green retention at 15 min serum albumin level, and local recurrence were significant independent predictors of survival, and that serum albumin and alanine aminotransferase levels were significant independent predictors of recurrence. In conclusion, achieving complete necrosis of HCC at first treatment to prevent local recurrence is important for improving the prognosis of patients with HCC. In addition, ameliorating hepatitis, by antiviral treatment for example, to maintain hepatic function is also important for improving both the prognosis and the prevention of the recurrence.