Background: Hepatocellular carcinoma (HCC) is a common cancer worldwide causing substantial mortality. Although surgical resection is a form of curative treatment in HCC, only a minority of patients is suitable for this treatment and the postoperative recurrence remains high. Transarterial chemoembolization (TACE) is a treatment option for inoperable HCC and it was proven by randomized control trials that TACE can prolong survival in selected patients. The aim of this study is to evaluate the survival and the prognostic factors in patients with advanced HCC treated by TACE. Methods: Seventy four patients with inoperable HCC diagnosed from January 1998 to December 2003 were analyzed retrospectively in this study. Only patients with unresectable HCC or who refused operation were included. Patients with advanced cirrhosis, extrahepatic metastasis or previously treated HCC were excluded. Multiple host, tumor and treatment variables were analyzed in order to evaluate the predictive factors of favorable response to treatment and better survival. Results: The median survival of the study patients was 213.5 days. The cumulative survival rates at 1 year, 2 year and 3 year were 28.4%, 12.2% and 6.8% respectively. By multivariate analysis, superselective cannulation performed in TACE (hazard ratio: 0.47, 95% CI: 0.23-0.95, p=0.034), embolization with gelfoam (hazard ratio: 0.30, 95% CI: 0.11-0.80, p=0.017), treatment interval more than 45days (hazard ratio: 0.33, 95% CI: 0.15-0.72, p=0.006), Child-Pugh grade B (hazard ratio: 5.62, 95% CI: 2.11-14.97, p=0.001), and pre-treatment serum FP level (hazard ratio: 2.93, 95% CI: 1.50-5.73, p=0.002) were independent predictors of survival. Conclusions: Survival of patients with inoperable HCC is still grave despite treatment. This study provided information in predicting the survival of patients with inoperable hepatocellular carcinoma treated by transarterial chemoembolization. Result: Age <65, total bilirubin (TB) <2.0mg/dl, albumin (Alb) 3.5g/dl, prothrombin time (PT) 70%, platelet counts (Plt) 10.0 10 4 /mm 3 , single nodule, and type of treatment (surgery or local ablation therapy) were linked to increased survival at univariate analysis of CLIP 0-1 HCC patients. Of CLIP 2-6 HCC patients, TB <2.0mg/dl, Alb 3.5g/dl, des-gamma-carboxy prothrombin (DCP) <100mAU/ml, absence of vascular invasion, and type of treatment were correlated with survival. The following factors were related to survival by multivariate analysis: CLIP 0-1 HCC patients; age, Alb, single nodule, and absence of vascular invasion, CLIP 2-6 HCC patients; age, TB, Alb, alpha-fetoprotein (AFP) <100ng/ml, DCP, absence of vascular invasion, and type of treatment. Conclusion: Age, albumin, vascular invasion were significant predictors of survival both CLIP 0-1 and CLIP 2-6 HCC patients. CLIP 0-1 HCC patients: single nodule; CLIP 2-6 HCC patients: lower levels of tumor markers and patients receiving promising treatment had a better chance of prolonged survival.