Purpose To compare the outcome of transarterial chemoembolization(TACE)in combination with percutaneous computed tomography(CT)-guided radiofrequency ablation(RFA)with surgical resection(SR)in the treatment of hepatocellular carcinoma(HCC)within up-to-7 criteria(HCCs with seven as the sum of the size of the largest tumor [in cm] and the number of tumors). Methods We conducted a retrospective study on 420 treatment naive patients with HCC up-to-7 criteria who had received either TACE+RFA(214 patients)or curative SR(206 patients).A matched cohort composed of 130 patients from each group was selected during propensity score matching.All patients were regularly followed up after treatment at our department with blood and radiologic tests. The main endpoint was overall survival(OS). Results The median follow-up period was 63.8 months in the TACE+RFA group(range: 11.3-120.0 months)and 60.0 months(range: 8.4-142.0 months)in the SR group.There were no significant differences in the baselines characteristics between these two groups after the propensity score-matched adjustment.In the propensity score-matched cohort,the SR group showed no significant difference in the OS compared to the TACE-RFA group(P =.530).The median OS and 1-,3-,and 5-year survival rates were 59.3 months,98.8%,91.9%and 50.9%in the SR group and 57.8 months,98.8%,87.6%and 46.0%in the TACE-RFA group,respectively.In the subgroup analysis,TACE+RFA showed higher OS rates in comparison with SR for patients beyond Milan criteria and within up-to-7 criteria(P = 0.010). Conclusion TACE in combined with RFA is safe and may confer a comparable OS rate with that of SR within up-to-7 criteria.In patients with HCC between Milan and the up-to-7 criteria,TACE+RFA might be superior to SR.