title: A simple prognostic scoring system for patients receiving transarterial embolisation for hepatocellular cancer.
abstract: 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.
authors.affiliation: Cancer Research UK & UCL Cancer Trials Centre, London.
authors.forename: L
authors.initials: L
authors.lastname: Kadalayil
authors.affiliation: Department of Oncology, UCL Medical School, Royal Free Campus, London.
authors.forename: R
authors.initials: R
authors.lastname: Benini
authors.affiliation: Cancer Research UK Institute for Cancer Studies, University of Birmingham.
authors.forename: L
authors.initials: L
authors.lastname: Pallan
authors.affiliation: The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, London.
authors.forename: J
authors.initials: J
authors.lastname: O'Beirne
authors.affiliation: The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, London.
authors.forename: L
authors.initials: L
authors.lastname: Marelli
authors.affiliation: Department of Radiology, Royal Free Hospital, London.
authors.forename: D
authors.initials: D
authors.lastname: Yu
authors.affiliation: Cancer Research UK & UCL Cancer Trials Centre, London.
authors.forename: A
authors.initials: A
authors.lastname: Hackshaw
authors.affiliation: Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham.
authors.forename: R
authors.initials: R
authors.lastname: Fox
authors.affiliation: Cancer Research UK Institute for Cancer Studies, University of Birmingham.
authors.forename: P
authors.initials: P
authors.lastname: Johnson
authors.affiliation: The Royal Free Sheila Sherlock Liver Centre, Royal Free Hospital, London.
authors.forename: A K
authors.initials: AK
authors.lastname: Burroughs
authors.affiliation: Cancer Research UK Institute for Cancer Studies, University of Birmingham.
authors.forename: D H
authors.initials: DH
authors.lastname: Palmer
authors.affiliation: Department of Oncology, UCL Medical School, Royal Free Campus, London; UCL Cancer Institute, London, UK. Electronic address: t.meyer@ucl.ac.uk.
authors.forename: T
authors.initials: T
authors.lastname: Meyer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000378:metabolism; D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D001663:Bilirubin / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy*; D004317:Doxorubicin / Q000627:therapeutic use; D004621:Embolization, Therapeutic; D004998:Ethiodized Oil / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012709:Serum Albumin / Q000378:metabolism; D016896:Treatment Outcome; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: D000418:Albumins; D000903:Antibiotics, Antineoplastic; D014408:Biomarkers, Tumor; D012709:Serum Albumin; D000509:alpha-Fetoproteins; D004998:Ethiodized Oil; D004317:Doxorubicin; D001663:Bilirubin
keywords: embolization; hepatocellular; prognosis