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. 2022 Jan 27;14(3):630.
doi: 10.3390/cancers14030630.

External Validation of the RETREAT Score for Prediction of Hepatocellular Carcinoma Recurrence after Liver Transplantation

Maria C van Hooff  1 , Milan J Sonneveld  1 , Jan N Ijzermans  2 , Michail Doukas  3 , Dave Sprengers  1 , Herold J Metselaar  1 , Caroline M den Hoed  1 , Robert A de Man  1
Affiliations

External Validation of the RETREAT Score for Prediction of Hepatocellular Carcinoma Recurrence after Liver Transplantation

Maria C van Hooff et al. Cancers (Basel). .

Abstract

Background: We aimed to externally validate the performance of the RETREAT score in a European population.

Methods: This single center retrospective cohort study enrolled all consecutive patients with HCC who underwent LT between 1989 and 2019. The performance of RETREAT was assessed in the overall population and after stratification between being within or beyond the Milan criteria based on the explant pathology report. Recurrence probabilities were estimated by using the Kaplan-Meier method and compared by log-rank test.

Results: We studied 203 patients; 42 patients were beyond the Milan criteria based on explant pathology. The median follow-up was 26.8 months (IQR 7.2-60.7). Overall cumulative HCC recurrence rates were 10.6%, 21.3%, and 23.0% at 2, 5, and 10 years, with the majority of recurrences extrahepatic and at multiple sites. Higher RETREAT scores were associated with higher recurrence rates, with a 10-year recurrence rate of 60.5% in patients with RETREAT ≥ 3 (n = 65), compared to 6.2% in those with RETREAT ≤2 (n = 138; p < 0.001). HCC recurrence rates were even lower in patients within the Milan criteria who also had a low RETREAT score (n = 122; 2.7% at 10 years).

Conclusion: Low RETREAT scores identify patients at low risk of HCC recurrence after LT in patients within the Milan criteria based on explant pathology.

Keywords: Milan criteria; hepatocellular carcinoma; liver neoplasms; liver transplantation; recurrence; risk score.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Overall hepatocellular carcinoma recurrence risk in study cohort.
Figure 2
Figure 2
Higher hepatocellular carcinoma recurrence risk in patients beyond the Milan criteria a based on explant pathology. a Milan criteria (MC): one tumor ≤ 5 cm, or three tumors ≤ 3 cm each.
Figure 3
Figure 3
RETREAT a score predicts HCC recurrence risk after LT. Panel (A): Risk of HCC recurrence according to RETREAT score. Panel (B): Risk of HCC recurrence in patients with low versus high RETREAT scores. a RETREAT score: α-fetoprotein at LT, microvascular invasion, and sum of largest viable tumor diameter and number of tumors. Abbreviations: AFP, α-fetoprotein; HCC, hepatocellular carcinoma; LT, liver transplantation.
Figure 4
Figure 4
Low RETREAT scores a identify patients at low risk of HCC recurrence in patients within the Milan criteria b (panel (A)), but not in those beyond the Milan criteria (panel (B)). a RETREAT score: α-fetoprotein at LT, microvascular invasion, and sum of largest viable tumor diameter and number of tumors. b Milan criteria (MC): one tumor ≤5 cm, or three tumors ≤3 cm each. Abbreviations: HCC, hepatocellular carcinoma.
Figure 5
Figure 5
Overall survival in patients with low (≤2) versus high (≥3) RETREAT scores a. a RETREAT score: α-fetoprotein at LT, microvascular invasion, and sum of largest viable tumor diameter and number of tumors.
See this image and copyright information in PMC

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