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Performance analysis of the mHAP-II score was based on Mann-Whitney<jats:italic>U<\/jats:italic>tests, the Kaplan-Meier method, log-rank tests, receiver operating characteristics, Akaike\u2019s information criterion and Cox regression models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In this population, HCC risk factors were mainly alcohol abuse (31%) and hepatitis C (28%). The median survival of the entire cohort was 29.4\u00a0months. mHAP-II classification of the cohort was mHAP-II B (30%), C (41%) and D (23%) respectively. Survival of all subgroups differed significantly from each other (each<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). Area under the curve for receiver operating characteristic was 0.60 and Akaike\u2019s information criterion was 21.8 (<jats:italic>p\u2009=<\/jats:italic>\u00a00.03), indicating a superior performance of mHAP-II score compared with HAP score and BCLC. Tumour number \u2265\u2009two (HR 1.54), alpha-fetoprotein &gt;\u2009400\u00a0\u03bcg\/l (HR 1.14), serum albumin &lt;\u20093.6\u00a0g\/dl (HR 1.63) and total bilirubin &gt;\u20090.9\u00a0mg\/dl (HR 1.58) contributed significantly in Cox proportional hazards regression (each<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The mHAP-II score can predict survival outcomes of western HCC patients undergoing DEB-TACE and further subdivide this heterogeneous group; however, certain limitations concerning the predictive power of mHAP-II score must be taken into account.<\/jats:p><\/jats:sec><jats:sec><jats:title>Key Points<\/jats:title><jats:p><jats:italic>\u2022 This retrospective study evaluated the predictive performance of the modified hepatoma arterial embolisation prognostic II (mHAP-II) score in a real-life western HCC cohort treated with drug-eluting bead-TACE.<\/jats:italic><\/jats:p><jats:p><jats:italic>\u2022 Survival of all mHAP-II subgroups differed significantly, area under the curve for mHAP-II was 0.60 and Akaike\u2019s information criterion was 21.8.<\/jats:italic><\/jats:p><jats:p><jats:italic>\u2022 The mHAP-II score can predict survival outcomes of western HCC patients undergoing DEB-TACE and further subdivide this heterogeneous group. 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