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Effect of Tumor Size on Cancer-Specific Survival in Small Hepatocellular Carcinoma. OBJECTIVE: To further clarify the prognosis of small hepatocellular carcinoma (HCC) in different subgroups and to assess the connection between the tumor cutoff point and its impact on prognostic significance. PATIENTS AND METHODS: In this study, Surveillance, Epidemiology, and End Results Program-registered patients with small HCC and patients from the Liver Transplantation Center of Nanjing Medical University (LTCNJMU) were combined and analyzed. The optimal cutoff point of the tumor size was determined by using the "X-tile" program. The 60-month, cancer-specific survival data were obtained. Kaplan-Meier methods and multivariable Cox regression models were used to analyze long-term hepatocellular carcinoma-specific survival (HCSS) outcomes and risk factors. RESULTS: There were significant differences among these different tumor size subgroups with regard to 60-month HCSS rates (P<.001). The X-tile program indicated that the difference in survival was most significant (maximum of χ(2) log-rank values) (P<.001) for the tumor size 35 mm. A stratified analysis of the effect of tumor size on 60-month HCSS rate found that only localized and regional stages could be validated as independent predictors, but not advanced stages. CONCLUSION: These results confirmed that patients with small HCC are essentially a heterogeneous group. Tumor size is still an independent prognostic factor for resected small HCC, and patients with tumors of 0- to 35-mm diameter have a better 60-month HCSS rate than do those with larger tumors (36-50 mm).