Validation of the Hepatoma Arterial Embolization Prognostic Score in European and Asian Populations and Proposed Modification.

Trans-arterial chemoembolization (TACE) is used to treat hepatocellular carcinoma (HCC), but it is a challenge to predict patient survival. The hepatic arterial embolization prognostic (HAP) score has been shown to predict which patients will have shorter survival times and should not undergo TACE. We aimed to validate this scoring system in a prospective study of patients in Europe and Asia.We evaluated the prognostic accuracy of the HAP score in estimating overall survival (OS) of 126 patients with HCC who received TACE in the UK or Italy (training set) from 2001 through 2013. We also analyzed data from 723 patients treated in Korea and Japan (validation set), including 79 with newly diagnosed HCC, who underwent TACE in Korea or Japan from 2004 through 2013. Response to TACE was determined based on computed tomography analysis. OS was calculated from the time of the first TACE until death or the last follow-up evaluation.OS was associated with hypoalbuminaemia, alfa-fetoprotein (AFP) >400 ng/ml, and tumor size >7 cm at diagnosis (P<.01), but not bilirubin>17 umol/L (P>.05), in both datasets. The lack association between OS and bilirubin level was confirmed using receiver operating characteristic analysis. We developed a modified version of the HAP score (mHAP), based on level of albumin and AFP and tumor size, which predicted OS with increased accuracy in the training and validation cohorts.In a multi-center validation study, we developed an mHAP that predicts survival of patients with HCC treated with TACE in Europe and Asia. This system might be used to identify patients with HCC most likely to benefit from TACE in clinical practice.