In patients with tumor size ≤ 3 cm, multivariate Cox analysis revealed that age > 67 years (HR: 1.657, 95% CI: 1.374–1.998, p < 0.001), positive HBsAg (HR: 1.298, 95% CI: 1.076–1.565, p = 0.006), serum AFP > 20 ng/mL (HR: 1.378, 95% CI: 1.144–1.661, p < 0.001), performance status 1–2 (HR: 1.668, 95% CI: 1.347–2.065, p < 0.001), medium-high TBS (HR: 1.319, 95% CI: 1.098–1.584, p = 0.003), ALBI grade 2 (HR: 1.738, 95% CI: 1.419–2.128, p < 0.001) and grade 3 (HR: 3.455, 95% CI: 2.204–5.416, p < 0.001) were independent predictors linked with poor survival. Here, AFP is linked to neoplasm.