Aim: Survival in patients with hepatocellular carcinoma (HCC) is impacted by stage of liver disease, tumor characteristics, and HCC surveillance in high-risk individuals. Factors associated with HCC tumor growth rate (TGR) and its influence on recurrence-free survival after treatment was investigated. Methods: TGR was calculated in 164 HCC patients with chronic viral hepatitis who had two consecutive magnetic resonance imaging or computed tomography scans ≥ 30 days apart prior to treatment and who were followed prospectively to determine the rates of recurrence-free survival. Results: The median TGR in 164 patients was 17.8％ per month (mean 33.3％ per month). Regression tree analysis indicated that the top three predictors of TGR were alpha-fetoprotein (AFP) levels (≥ 16.7 ng/mL), platelet counts (≥ 140,000 mm3), and serum albumin level ( 56 years (HR = 1.08, P = 0.072), hepatitis C virus (HR = 1.44, P = 0.091), macrovascular invasion (HR = 1.94, P = 0.092), and the most definitive treatments (orthotopic liver transplantation, HR 0.14, P < 0.001; surgical resection, HR = 0.54, P = 0.072; radiofrequency ablation, HR = 0.58, P = 0.060) as independent predictors of recurrence-free survival. For all treatment modalities, slowTGR was significant for prolonged survival (P = 0.029). The poorest survival rates were observed in patients with fast TGRs treated by transarterial chemoembolization.Conclusion: The TGR correlated with AFP, platelet count, and albumin level. Patients with fast TGRs had shorter recurrence-free survival after HCC treatments. TGR is a potential imaging biomarker to predict clinical outcomes in HCC.