Abstract: Objective: Many studies have shown that introperative blood transfusion may predispose patients to an increased risk of tumor recurrence after surgery. The study was to explore the significance of introperative blood transfusion for patients with large hepatocarcinoma treated with hepatectomy. Methods:The clinicopathologic and survival data of166 consecutive patients with large hepatocarcinoma who underwent hepatectomy between 2002 and 2005 were retrospectively analyzed. Eighty-seven patients who received blood transfusion were enrolled into group A and 79patients who didn’t receive blood transfusion were enrolled into group B. The overall survival and tumor-free survival rates of the two groups were evaluated and compared with univariate log-rank test. The multivariate analysis was performed by Cox proportional hazards model. Results: The 1-, 3-, and 5- year overall survival rates and tumor-free survival rates of all patients were73.2% ,31.5% , and26.2% , and27.0% ,20.1% , and18.0% , respectively. The1-, 3-, and 5-year overall survival rates and tumor-free survival rates of patients in group A were 71.6%,20.2%, and12.7%, and22.6%,13.6%, and 11.3%, respectively. The1-, 3-, and 5-year overall survival rates and tumor-free survival rates of patients in group B were 75.0%,45.2%, and45.2%, and32.1%,27.6%, and27.6%, respectively, with significant differences between the two groups (P<0.05). Multivariate analysis revealed that portal vein tumor thrombus, pathological grade and transfusion were independent risk factors for long-term survival of patients with large hepatocarcinoma. Conclusion:Introperative blood transfusion is one of the predictive factors for the prognosis of patients with large hapetocarcinoma who underwent hepatectomy and may promote tumor recurrence and reduce over all survival rate.