A simple prognostic scoring system for patients receiving transarterial embolisation for hepatocellular cancer

Ann Oncol. 2013 Oct;24(10):2565-2570. doi: 10.1093/annonc/mdt247. Epub 2013 Jul 14.


Background: The prognosis for patients with hepatocellular cancer (HCC) undergoing transarterial therapy (TACE/TAE) is variable.

Methods: We carried out Cox regression analysis of prognostic factors using a training dataset of 114 patients treated with TACE/TAE. A simple prognostic score (PS) was developed, validated using an independent dataset of 167 patients and compared with Child-Pugh, CLIP, Okuda, Barcelona Clinic Liver Cancer (BCLC) and MELD.

Results: Low albumin, high bilirubin or α-fetoprotein (AFP) and large tumour size were associated with a two- to threefold increase in the risk of death. Patients were assigned one point if albumin <36 g/dl, bilirubin >17 μmol/l, AFP >400 ng/ml or size of dominant tumour >7 cm. The Hepatoma arterial-embolisation prognostic (HAP) score was calculated by summing these points. Patients were divided into four risk groups based on their HAP scores; HAP A, B, C and D (scores 0, 1, 2 and >2, respectively). The median survival for the groups A, B, C and D was 27.6, 18.5, 9.0 and 3.6 months, respectively. The HAP score validated well with the independent dataset and performed better than other scoring systems in differentiating high- and low-risk groups.

Conclusions: The HAP score predicts outcomes in patients with HCC undergoing TACE/TAE and may help guide treatment selection, allow stratification in clinical trials and facilitate meaningful comparisons across reported series.

Keywords: embolization; hepatocellular; prognosis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Albumins / metabolism
  • Antibiotics, Antineoplastic / therapeutic use
  • Bilirubin / blood
  • Biomarkers, Tumor / blood
  • Carcinoma, Hepatocellular / mortality*
  • Carcinoma, Hepatocellular / therapy*
  • Doxorubicin / therapeutic use
  • Embolization, Therapeutic*
  • Ethiodized Oil / therapeutic use
  • Female
  • Humans
  • Liver Neoplasms / mortality*
  • Liver Neoplasms / therapy*
  • Male
  • Middle Aged
  • Prognosis
  • Serum Albumin / metabolism
  • Treatment Outcome
  • Young Adult
  • alpha-Fetoproteins / metabolism


  • Albumins
  • Antibiotics, Antineoplastic
  • Biomarkers, Tumor
  • Serum Albumin
  • alpha-Fetoproteins
  • Ethiodized Oil
  • Doxorubicin
  • Bilirubin