The recommended treatment for hepatocellular carcinoma (HCC) according to the Milan criteria (Barcelona clinic liver cancer stage A: three or fewer tumors with a maximum diameter of ≤3 cm or a single tumor with a maximum diameter of ≤5 cm) is hepatic resection and radiofrequency ablation (RFA), with the addition of liver transplantation in the United States and Europe [1,2]. Since the degree of invasiveness of these three treatments differs greatly, careful selection is necessary based on the prediction of post-treatment recurrence of HCC, in addition to the liver reserve capacity [3]. Liver resection and RFA have comparable outcomes in HCC with three or fewer tumors with a maximum diameter of ≤3 cm each [4]; Japanese guidelines are also in line with this report [5]. Therefore, it would be beneficial to determine whether surgical treatment or RFA would improve the prognosis of patients with HCC. Recently, various parameters, other than age, have been devised as prognostic factors for postoperative outcomes. Sarcopenia (SP) is characterized by age-related progressive and generalized loss of muscle mass and strength. It is a multifactorial syndrome caused by inflammatory and metabolic disorders [6]. SP is a poor prognostic factor in the treatment of digestive cancer, including pancreatic and liver cancer [[7], [8], [9], [10], [11]]. Osteopenia (OP) is a condition in which bone mineral density (BMD) is lower than normal. Several studies have suggested a correlation between OP and prognosis of breast [12,13] and pancreatic cancer [14]. Physiologically, the development and maintenance of bone and muscle are largely parallel [15]. SP and OP often coexist, and this condition is termed “osteosarcopenia” (OSP) [16]. OP is independently associated with early markers of deconditioning that precedes SP in patients with HCC [17]. Recently, preoperative OSP has been shown to be a poor prognostic factor in patients undergoing hepatic resection for colorectal liver metastases [18] and intrahepatic cholangiocarcinoma [19]. However, it is not known how OSP affects prognosis when HCC is treated with hepatic resection or RFA. Therefore, in this study, we performed a retrospective analysis to identify factors that influence the prognosis of patients who underwent surgery or RFA treatment for Barcelona Cancer Liver Classification stage A hepatocellular carcinoma (BCLC A HCC) with three or fewer tumors with a maximum diameter of ≤3 cm.