Background and aim: Hepatocellular carcinoma from HBV and HCV is increasing. Results after curative liver resection are unsatisfactory due to high postoperative intrahepatic recurrence and liver failure, the latter often merely the result of postoperative therapies. Specific predictors to facilitate decision for use and choice of postoperative adjuvant therapy may improve patient survival. This study evaluates telomerase activity in tumor and non-tumor liver, and an array of clinicopathological factors as predictors for recurrence, survival and optimal postoperative therapeutic regimens. Material and Methods: Liver tissue from 53 hepatocellular carcinoma patients receiving curative resection during the period of 1998 to 2000 was analyzed for telomerase activity within tumor and non-tumor liver. Clinical and pathological data were collected during regular follow-up including recurrence rates, types of recurrence, mortality rates and adjuvant therapy types. The collected data were analyzed to identify risk factors for recurrence and survival. Results: Telomerase activity was detected in 98% of tumor and 70% of non-tumor liver tissue. Telomerase activity in cancerous liver correlated significantly with HCV infection and cirrhotic change of liver parenchyma, and correlated marginally with HBV infection. Telomerase activity in non-cancerous liver correlated with high serum AFP level. During 60 months (median) follow-up, the 1-, 3- and 5-year survival rates were respectively 88%, 64% and 57% in all patients, 100%, 94% and 88% in non-recurrence patients and 76%, 51% and 44% in recurrence patients. Recurrence could be predicted by abnormally high tumor telomerase activity or by advanced TMN stage. TMN stage or high serum ALT level could predict multi-nodular intrahepatic recurrence, and TMN stage also could predict single nodular intrahepatic recurrence. High serum AFP (>400ng/ml) combined with high telomerase activity in non-tumor liver had significant predictive ability for poor survival. Conclusion: Tumor telomerase is a useful independent predictor of recurrence. Simultaneous high remnant liver telomerase and high serum AFP is a strong negative predictor for survival. Because adjuvant therapies have severe side effects, patient survival can be optimized by using indicators such as tumor telomerase to limit adjuvant treatment only to patients with high risk of recurrence.