Background & Aims: There are a number of prognostic scores in hepatocellular carcinoma (HCC), none of which is optimalin predicting overall survival (OS) in the individual patient, particularly in intermediate stage disease, where patients are notsurgically treatable but may qualify for a wide range of palliative interventions. We evaluated the prognostic role of a bio-chemical algorithm, the Kings Score (KS), in the palliative setting of care.Methods: We used the algorithm [age x AST xINR]/platelet count to derive the KS. Full clinical data including Barcelona Clinic Liver Cancer (BCLC) stage were studied in atraining set of 97 patients from the UK. Independent predictors of survival identified in multivariate analysis were validatedin an independent cohort of 766 patients from Japan and Italy.Results: In both training and validation sets, KS was con-firmed as an independent predictor of OS (P < 0.01). Ad-hoc subgroup analysis revealed the KS to be prognostic in the palli-ative setting, being able to subclassify patients presenting with intermediate and advanced disease according to BCLCcriteria (P < 0.001).Conclusion: The KS integrates into the BCLC system to improve prognostic substratification in the palli-ative setting of care. The KS may help reducing disease heterogeneity and refine treatment allocation in intermediate-advanced HCC.