Radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) are used to treat hepatocellular carcinoma (HCC). This study was designed to compare the long-term survival of HCC patients within the Milan criteria who underwent RFA or TACE. In all, 315 RFA patients and 215 TACE patients with HCC within the Milan criteria were analyzed. Propensity scores were generated to select matched patients. For the propensity model, 101 patients were selected from each arm of the study. Independent prognostic predictors were determined with the Cox proportional hazards model. The long-term survival was significantly better for the RFA group in the univariate survival analysis (P = 0.048). In the Cox model, the following were identified as independent predictors of poor prognosis (TACE was not): age > 69 years (P = 0.026), serum α-fetoprotein level > 20 ng/mL (P = 0.003), ascites (P < 0.001), Eastern Cooperative Oncology Group performance status ≥ 1 (P = 0.004), total tumor volume (TTV) > 8.2 cm3 (P = 0.020), and vascular invasion (P = 0.023). With similar baseline patient characteristics generated in the propensity score model, there was no significant difference in the long-term survival rates of the 2 groups of patients. A subgroup analysis showed that among patients with a TTV < 11 cm3, the RFA group had significantly better long-term survival than the TACE group (P = 0.032). In conclusion, TACE and RFA lead to comparable long-term survival rates for HCC patients within the Milan criteria. Patients with a smaller TTV (<11 cm3) are likely to benefit more from RFA treatment. Further studies are needed to compare RFA and TACE in patients with early-stage cancers. Liver Transpl 17:556–566, 2011. © 2011 AASLD.