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Background: Hepatocarcinoma is the sixth most common cancer worldwide, but it is considered the second most lethal cancer; only supplanted by lung cancer. The most used prognostic tool in hepatocarcinoma is the Barcelona Clinic Liver Cancer (BCLC) which divides patients considering the tumor size, liver function, performance status, and venous involvement. BCLC A and B patients could be submitted to transarterial chemoembolization (TACE) but the number of procedures acceptable is not known.Methods: We studied 76 patients treated in an oncologic center from January 1993 until December 2019, with the diagnosis of hepatocarcinoma, who had at least 1 treatment with TACE. The evaluation of the response was made by RECIST 1.1. Patients were divided into low ART Score (between 0-1.5) and high ART Score (higher than 2.5). The objective was to evaluate the applicability of Assessment for Retreatment with TACE (ART Score) to determine the number of procedures acceptable for a patient with hepatocarcinoma.Results: A total of 76 patients were included: 92.1% were males, with a median age at diagnosis of 70 years old (min 39, max 88). The main etiologic factor was alcohol. The tumor was unifocal in 58% of the patients; 82% of the patients were Child-Pugh A and 18% were Child-Pugh B. After the first TACE, 72% of the patients had a low ART Score and 28% had a high ART Score. The patients with lower scores who performed a second TACE obtained better PFS and OS compared to patients that did not perform TACE and patients with a higher score. The patients with lower scores who performed a third TACE obtained, once more, better PFS and OS. However, in this instance, patients with a high score who performed a TACE obtained a superior OS than patients who did not. When we analyzed the Art Score as survival predictor, we concluded that there is a tendency for statistical significance for lower scores being associated with a longer survival rate (HR: 0,6; IC 95% 0.3 e 1.0, p¼0,06). Conclusion:Low Art Score is associated with longer OS. A second TACE is beneficial in patients with low Art Score, and a third TACE is beneficial in all patients.Legal entity responsible for the study: The authors.

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