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Validation of the prognostic power of the RETREAT score for hepatocellular carcinoma recurrence using the UNOS database
Author(s) -
Mehta Neil,
Dodge Jennifer L.,
Roberts John P.,
Yao Francis Y.
Publication year - 2018
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.14549
Subject(s) - medicine , milan criteria , hepatocellular carcinoma , liver transplantation , risk stratification , oncology , carcinoma , database , transplantation , surgery , computer science
Researchers in a recent multicenter study developed and validated a novel prognostic index, Risk Estimation of Tumor Recurrence After Transplant ( RETREAT ), which incorporates α‐fetoprotein ( AFP ) at liver transplantation ( LT ), microvascular invasion, and the sum of the largest viable tumor and number of tumors on explant. We now aim to evaluate RETREAT in the United Network for Organ Sharing ( UNOS ) database in patients with hepatocellular carcinoma ( HCC ) who meet Milan criteria by imaging and underwent LT between 2012 and ‐2014. On explantation (n = 3276), 13% had microvascular invasion, 30% had no viable tumor, and 15% exceeded Milan criteria. Post‐ LT survival at 3 years decreased with increasing RETREAT score: 91% for a score of 0, 80% for a score of 3, and 58% for a score ≥5 ( P < .001). Post‐ LT HCC recurrence probability within 3 years increased from 1.6% with RETREAT score of 0% to 29% for a score ≥5 ( P < .001). Increasing RETREAT score was also associated with a shorter time to HCC recurrence. RETREAT was superior to Milan criteria (explant) in predicting HCC recurrence by the net reclassification index ( P < .001). This study validates the prognostic power of RETREAT , which may help standardize post‐ LT surveillance, provide a framework for tumor staging and risk stratification, and select candidates for adjuvant therapies.