Radiofrequency ablation (RFA) has been used as a curative therapy for small hepatocellular carcinoma (HCC). However, relatively little is known about the long-term outcome of RFA for small HCC in a background of hepatitis B infection, which is common among the Chinese population. Between May 2001 and May 2012, 837 patients with HCC nodules ≤3 cm treated with RFA were enrolled in this study. We evaluated long-term survival rates, local tumor progression rates, complications and the prognostic factors. Among 1020 tumor nodules in 837 patients, complete ablation was achieved in 98.8% (1008/1020) and the 1-, 3-,5-, and 10-year overall survival rates were 91, 71, 54, and 33%, respectively. Multivariate analysis revealed that tumor number [P = 0.003, hazard ratio (HR) 1.523, 95% confidence interval (CI) 1.158-2.004], Child-Pugh grade (P = 0.001, HR 3.089, 95% CI 2.238-4.266), and serum-glutamyltranspeptidase level (P = 0.002, HR 1.576, 95% CI 1.251-1.985) were independent predictors of overall survival. The 1-, 3-, 5-, and 10-year recurrence-free survival rates were 74, 44, 30, and 15%, respectively. Multivariate analysis revealed that serum α-fetoprotein level (P = 0.041, HR 1.249, 95% CI 1.028-1.517) and tumor number (P = 0002, HR 1.449, 95% CI 1.143-1.836) were independent predictors of recurrence-free survival. There were no procedure-related patient deaths and major complications occurred in 0.59% (5/837) of patients. RFA achieved comparable long-term overall survival rates to those of surgical resection with fewer major complications and could therefore be considered as an alternative option for curative treatment of patients with small liver cancer.