[11] Qi Q, Chu AY, Kang JH, et al. Sugar-sweetened beverages and genetic risk of obesity. N Engl J Med 2012;367:1387–1396. [12] Abdelmalek MF, Suzuki A, Guy C, Unalp-Arida A, Colvin R, Johnson RJ, et al. Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease. Hepatology 2010;51: 1961–1971. Salvatore Petta ⇑ Sezione di Gastroenterologia, Di.Bi.M.I.S, Università di Palermo, Italy ⇑ Corresponding author. E-mail address: petsa@inwind.it Giulio Marchesini Dipartimento di Medicina e Gastroenterologia, ‘‘Alma Mater Studiorum’’, Università di Bologna, Italy Antonio Craxì Sezione di Gastroenterologia, Di.Bi.M.I.S, Università di Palermo, Italy The ART strategy: Sequential assessment of the ART score predicts outcome of patients with hepatocellular carcinoma re-treated with TACE To the Editor: Hucke and colleagues are to be congratulated on their work pre- dicting likely response to multiple cycles of transarterial chemo- embolization (TACE) [1]. However, there are some issues that need addressing. Firstly, the authors assert that the ART score is derived from 3 variables. This is not true. The Child-Pugh score itself consists of 5 variables thus, it actually consists of 7 variables. In addition, the greatest weighting for the ART score is not placed on evidence of radiological response but on evidence of progressive cirrhosis and worsening liver synthetic function. A rising aspartate amino- transferase (AST) is well documented in advanced disease as a marker of more severe cirrhosis [2,3]. It would have been useful to have seen the individual biochemical constituents of the Child- Pugh score and assessed their impact on predicting outcome. An alternative score for predicting patient outcome after TACE is available. The hepatoma arterial-embolization prognostic score (HAP) was derived to assess likely response to TACE [4]. The score was derived from a training set of 114 patients from which the score was developed, and then validated in an independent sam- ple of 167 patients. Patients were assigned 1 point for albumin <36 g/dl, bilirubin >17 lmol/l, AFP >400 ng/ml, or size of domi- nant lesion >7 cm, and has the advantage of not relying on assess- ment of response to previous TACE. The score was calculated by adding up their respective points. Patients were then divided into four groups: HAP score 0 = A, HAP 1 = B, HAP 2 = C, HAP >2 = D. The median survival for the respective groups was 27.6 months, 18.5 months, 9 months, and 3.6 months. Future studies in this field should compare the performance of both the ART strategy and the HAP score to determine their applicability and how they could best be used to help our patients. Conflict of interest The authors declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript. References [1] Hucke F, Sieghart W, Pinter M, Graziadei I, Vogel W, Muller W, et al. The ART strategy: sequential assessment of the ART score predicts outcome of patients with hepatocellular carcinoma re-treated with TACE. J Hepatol 2014;60:118–126. [2] Cross TJS, Rizzi P, Berry PA, Bruce M, Portmann B, Harrison PM. King’s score: an accurate marker of cirrhosis in chronic hepatitis C. Eur J Gastroenterol Hepatol 2008:1–9. [3] Kamimoto Y, Horiuchi S, Tanase S, Morino Y. Plasma clearance of intrave- nously injected aspartate aminotransferase isozymes: evidence for preferen- tial uptake by sinusoidal liver cells. Hepatology 1985;5:367–375. [4] Kadalayil L, Benini R, Pallan L, O’Beirne J, Marelli L, Yu D, et al. A simple prognostic scoring system for patients receiving transarterial embolization for hepatocellular cancer. Ann Oncol 2013:1–6. F. Yousuf ⇑ T.J.S. Cross Department of Gastroenterology and Hepatology, The Royal Liverpool Hospital, Prescot Street, Liverpool L7 8XP, United Kingdom ⇑ Corresponding author. E-mail address: Fidan.Yousuf@doctors.org.uk D. Palmer Department of Academic Medical Oncology, The University of Liverpool, Liverpool, United Kingdom JOURNAL OF HEPATOLOGY Journal of Hepatology 2014 vol. 61 j 169–182 175