Addition of tumor multiplicity improves the prognostic performance of the hepatoma arterial-embolization prognostic score

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 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