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Addition of tumor multiplicity improves the prognostic performance of the hepatoma arterial‐embolization prognostic score
Author(s) -
Park Yehyun,
Kim Seung Up,
Kim Beom Kyung,
Park Jun Yong,
Kim Do Young,
Ahn Sang Hoon,
Park Yong Eun,
Park Ji Hye,
Lee Yong Il,
Yun Hae Ryong,
Han KwangHyub
Publication year - 2016
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12878
Subject(s) - medicine , arterial embolization , embolization , oncology , cardiology , radiology
Background & Aims The hepatoma arterial‐embolization prognostic ( HAP ) score predicts survival outcome in patients with hepatocellular carcinoma ( HCC ) treated with trans‐arterial chemoembolization ( TACE ). We validated the HAP score in Korean subjects with HCC and investigated whether its prognostic performance is improved with additional parameters. Methods A total of 280 patients with HCC treated with TACE between 2003 and 2009 were included. Validation and modification of HAP score were performed based on multivariate Cox regression models. Results The median age of the study population (211 men, 69 women) was 60 years. Viral etiology of HCC accounted for 80.4% ( n = 181 for hepatitis B, 44 for hepatitis C). The median overall survival ( OS ) was 40.5 months. On multivariate analysis, together with the original components of the HAP score (serum albumin <3.6 g/ dl , total bilirubin >0.9 mg/dl, alpha‐foetoprotein >400 ng/ ml , and tumor size >7 cm), tumor number ≥2 was selected as an independent unfavorable prognostic factor for OS (hazard ratio 2.3; P < 0.001). Accordingly, a modified HAP ‐ II ( mHAP ‐ II ) score was established by adding tumor number ≥2. Although both HAP and mHAP ‐ II scores discriminated the four different risk groups (log‐rank test, all P < 0.001), the mHAP ‐ II score performed significantly better than the HAP score, as per the areas under receiver‐operating curves predicting OS at 3 years (0.717 vs. 0.658) and 5 years (0.728 vs. 0.645), respectively (all P < 0.05). Conclusions Although the HAP score predicted OS for Korean subjects with HCC undergoing TACE , the addition of tumor number significantly improved the prognostic performance. The mHAP ‐ II score can be used for accurate prognostication and selection of optimal candidates for TACE .