Validation of the MAAPE Score for Predicting Clinical Outcomes in Hepatocellular Carcinoma Treated With Selective Internal Radiation Therapy

BACKGROUND: Selective internal radiation therapy (SIRT) is an established treatment option for hepatocellular carcinoma (HCC); however, patient selection remains challenging. The MAAPE score (MELD, Albumin, AFP, PVTT, ECOG) was recently developed as a prognostic tool. This study aimed to provide an independent, single-centre external validation of the MAAPE score in predicting clinical outcomes for patients treated with Yttrium-90 SIRT. METHODS: A retrospective analysis of patients with HCC treated with SIRT at a tertiary centre in Australia between 2012 and 2024 was performed. All patients received SIRT as first-line treatment. Patients were stratified into Good, Average, and Poor prognosis groups based on their pre-treatment MAAPE score. Tumour response and survival outcomes at 12 months were assessed as endpoints. Statistical analysis was performed using Kendall's rank correlation, Mann-Whitney tests, and Fisher's exact tests. RESULTS: A total of 64 patients were included, of whom 62 were evaluable for 12-month survival. Patients were stratified into Good (n = 18; 28.1%), Average (n = 29; 45.3%), and Poor (n = 17; 26.6%) prognosis groups. The MAAPE score demonstrated a significant correlation with 12-month survival (p = 0.008) and tumour response (p = 0.030). Patients in the Good prognosis group achieved an 88.2% survival rate at 12 months, compared to 62.1% and 43.8% for the Average and Poor groups respectively. While correlations were statistically significant, pairwise comparisons between prognosis groups were only significant when comparing Good and Poor (p = 0.010 for 12-month survival and p = 0.046 for tumour response). CONCLUSION: In this small single-centre cohort, the MAAPE score identified patients with the most and least favourable 12-month outcomes. It did not separate the adjacent prognosis groups from each other. These findings support the score at the extremes of risk, but they are preliminary. Larger prospective multicentre studies are required to assess the value of this score in personalised patient management.