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Objective: A prospective randomized control study investigated the feasibility and efficacy of adjuvant radiotherapy on patients with central hepatocellular carcinoma (HCC) after narrow-margin hepatectomy (＜1 cm).This study presents an updated 10-year real-world evidence to further characterize the role of adjuvant radiotherapy.Methods: Patients with central HCC after narrow-margin hepatectomy (＜1 cm) were prospectively assigned to adjuvant radiotherapy group and control group.Patients' outcome,adverse events,long-term recurrence and survival rates were investigated.Results: The 1-,5-,and 10-year recurrence-free survival (RFS) rates were 81.0％,43.9％,and 38.7％,respectively in adjuvant radiotherapy group and 71.7％,35.8％,and 24.2％,respectively in control group (log-rank test,P=0.09).The 1-,5-,and 10-year overall survival (OS) rates were 96.6％,54.7％,and 42.8％,respectively in adjuvant radiotherapy group and 90.2％,55.1％,and 30.0％,respectively in control group (log-rank test,P=0.20).The 1-,5-,and 10-year RFS rates for patients with small HCC (≤5 cm) were 91.1％,51.6％,and 48.4％,respectively in adjuvant radiotherapy group and 80.0％,36.6％,and 26.6％,respectively in control group (log-rank test,P=0.03).Landmark analysis demonstrated that patients with small HCC in adjuvant radiotherapy group had a significantly improved OS in second five years after treatnent in comparison to patients in control group (log-rank test,P=0.05).Conclusions: Our updated results showed a sustained clinical benefit on reducing recurrence,improving longterm survival for small central HCC by adjuvant radiotherapy after narrow-margin hepatectomy.Long-term survival data also indicated that hepatectomy is an optimal treatnent for selected patients with central HCC.