Criteria for switching from transcatheter arterial chemo-embolization (TACE) to sorafenib or other chemotherapy in patients with hepatocellular carcinoma (HCC) resistant to repeated TACE have not been established. Herein, we propose an easy to implement method for such determination. One hundred six patients with advanced HCC (beyond Milan criteria) without venous invasion by the tumor or extra-hepatic metastasis and with good liver function (Child-Pugh A class) who were treated by repeated TACE from 2000 to 2011 were analyzed. We combined the scores for the tumor markers alpha-fetoprotein (AFP, ≥100 ng/mL), fucosylated AFP (AFP-L3, ≥10%), and protein induced by vitamin K absence-II (PIVKA-II, ≥100 mAU/mL) into a single prognostic marker, then added up the positive factors in each case. In patients with a score under 2, TACE could control HCC. When HCC is not controlled by TACE after the patient has a score of 2 or more points, switching to the next therapy should be considered.
