Objective: To assess the efficacy of radiofrequency ablation (RFA) in the treatment of small hepatocellular carcinoma (HCC) and analyze the prognostic factors. Methods: The clinical data of 98 patients with small HCC undergoing RFA from January 2006 to June 2013 in Xiangya Hospital of Central South University were reviewed. The rate of local tumor progression, recurrence, and survival, as well as the factors affecting prognosis were analyzed. Results: The 98 patients were followed-up for 2 to 29 months, and their 1-, 3- and 5-year cumulative local tumor progression rate was 17.3%, 27.4% and 30.9%, 1-, 3- and 5-year cumulative intrahepatic distant recurrence rate was 25.7%, 62.1% and 77.3%, 1-, 2-, 3-, 4- and 5-year cumulative survival rate was 95.4%, 85.4%, 65.9%, 54.7% and 39.9%, and 1-, 2-, 3-, 4- and 5-year cumulative tumor-free survival rate was 74.0%, 52.7%, 45.0%, 37.0% and 25.3%, respectively. Multivariate analysis revealed that serum albumin≤35 g/L (P=0.001), time to first recurrence ≤1 year (P=0.002), and the first recurrence located in a different distant hepatic segment (P=0.004) were risk factors for the overall survival of the patients. Conclusion: RFA is safe and effective in treatment of small HCC, and is of high repeatability for early intrahepatic HCC recurrence. Low preoperative serum albumin level, short time interval to first recurrence, and first recurrence located in a different distant hepatic segment are important factors affecting the prognosis of the patients.