Validation of Hepatoma Arterial Embolization Prognostic (HAP) Score in Egyptian Patients with Hepatocellular Carcinoma

Background: Hepatoma Arterial Embolization prognostic (HAP) score has recently emerged as an overall survival predictor for hepatocellular carcinoma (HCC) patients after treatment with transarterial chemoembolisation (TACE). It depends on serum bilirubin, albumin, alpha-fetoprotein (AFP) and tumor size. We evaluated the utility and validity of HAP score in a cohort of Egyptian patients with HCC who underwent TACE. Methods: Our study included 416 Egyptian patients with HCC who underwent TACE at National Liver institute, Menoufia University, Egypt from January 2013 to May 2015. Child-Turcotte-Pugh (CTP), BCLC Staging as well as HAP score were calculated. Overall survival was assessed with a minimum follow up period of 12 months. Results: Patients were mainly males (83.7 %) with a mean age of 58 ± 8.1 years, 267 (64.9%) patients had Child A cirrhosis, 143 (34.7%) had Child B cirrhosis and only one (0.2%) patient had Child C cirrhosis. Ten patients (2.4%) were in BCLC stage 0, 63 patients (15.1%) were in BCLC stage A, 335 patients (80.5%) were in BCLB stage B, 7 patients (1.7%) were in BCLC stage C and only one patient (0.2%) was in BCLC stage D. Fifty-one patients (12.3%) had a HAP score of 0, 129 (31%) had a score of 1, 164 (39.4%) had a HAP score of 2 and 72 (17.3%) had a HAP score of >2. Patients with HAP 0, HAP 1, HAP 2 and HAP >2 had a median survival of 53, 23, 22, 14 months respectively, showing a significantly shorter survival with more advanced score. Survival probability was 37.2%, 26.1%, 9.2% and 7.3% for patients with HAP score 0, 1, 2 and >2 respectively, with a P value 0.001. Conclusion: HAP score is useful in survival prediction after TACE in HCC patients and can be used for proper patient selection to improve outcome after TACE.