title: Addition of tumor multiplicity improves the prognostic performance of the hepatoma arterial-embolization prognostic score.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Yehyun
authors.initials: Y
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.|Liver Cirrhosis Clinical Research Center, Seoul, South Korea.
authors.forename: Seung Up
authors.initials: SU
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.|Liver Cirrhosis Clinical Research Center, Seoul, South Korea.
authors.forename: Beom Kyung
authors.initials: BK
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.|Liver Cirrhosis Clinical Research Center, Seoul, South Korea.
authors.forename: Jun Yong
authors.initials: JY
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.|Liver Cirrhosis Clinical Research Center, Seoul, South Korea.
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.|Liver Cirrhosis Clinical Research Center, Seoul, South Korea.
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Ahn
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Yong Eun
authors.initials: YE
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Yong Il
authors.initials: YI
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Hae Ryong
authors.initials: HR
authors.lastname: Yun
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, South Korea.|Liver Cirrhosis Clinical Research Center, Seoul, South Korea.
authors.forename: Kwang-Hyub
authors.initials: KH
authors.lastname: Han
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012107:Research Design / Q000592:standards; D018570:Risk Assessment / Q000379:methods*; D016019:Survival Analysis; D047368:Tumor Burden; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins
keywords: hepatocellular carcinoma; model; overall survival; prediction; prognosis; trans-arterial chemoembolization