Evaluating the utility of hepatoma arterial-embolization prognostic (HAP) score in clinical practice to provide prognosis of hepatocellular carcinoma (HCC) irrespective of treatment modalities


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Nor Farzana Abdul Aziz1,Andrew Yeoman2,Marek Czajkowski2
1Cardiff University School of Medicine,2Royal Gwent Hospital, Newport



Hepatocellular carcinoma (HCC) remains to be one of the most devastating cancers with increasing incidence worldwide. The hepatoma arterial-embolization prognostic (HAP) score is a more recent prognostic tool developed to assist decision-making on treatment options and to predict patient survival specifically for patients undergoing transarterial chemoembolization (TACE). Factors considered in the HAP score include size of tumour, AFP, bilirubin and albumin levels which are common parameters of liver disease. The objective of this study was to assess the utility of the HAP score in clinical practice to provide prognosis to patients diagnosed with HCC irrespective of treatment modalities received by analysing patient survival.


This retrospective study were carried out on 200 patients diagnosed with HCC from Aneurin Bevan Health Board (ABHB) from the year 2007 to 2017. HAP score at diagnosis and length of survival for each patient were calculated and analysed using the SPSS software to produce Kaplan-Meier survival curves. The Mantle-Cox regression was then used to validate the significance of the results. 


The overall median survival (OS) for patients with HAP A, B, C and D were found to be 987 days (95% CI 636-1337), 794 days (95% CI 365-1223), 248 days (95% CI 148-347) and 71 days (95% CI 52-89) respectively (p<0.0001). HAP A and HAP B patients clearly survived longer when compared to HAP C and HAP D patients allowing them more invasive and aggressive treatment options to manage the disease. HAP D patients had the lowest survival hence validating decisions of many clinicians to focus on palliative treatment to improve their quality of life.


The role of prognostic scores in HCC is very important in clinical practice as it helps inform both clinicians and patients when discussing treatment options as well as providing a time frame for patient survival.