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Validation of a Risk Estimation of Tumor Recurrence After Transplant (RETREAT) Score for Hepatocellular Carcinoma Recurrence After Liver Transplant.
- Source :
-
JAMA oncology [JAMA Oncol] 2017 Apr 01; Vol. 3 (4), pp. 493-500. - Publication Year :
- 2017
-
Abstract
- Importance: Several factors are associated with increased hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT), but no reliable risk score has been established to determine the individual risk for HCC recurrence.<br />Objective: We aimed to develop and validate a Risk Estimation of Tumor Recurrence After Transplant (RETREAT) score for patients with HCC meeting Milan criteria by imaging.<br />Design, Setting, and Participants: Predictors of recurrence were tested in a development cohort of 721 patients who underwent LT between 2002 and 2012 at 3 academic transplant centers (University of California-San Francisco; Mayo Clinic, Rochester; and Mayo Clinic, Jacksonville) to create the RETREAT score. This was subsequently validated in a cohort of 341 patients also meeting Milan criteria by imaging who underwent LT at the University of Toronto transplant center using the C concordance statistic and net reclassification index.<br />Main Outcomes and Measures: Characteristics associated with post-LT HCC recurrence.<br />Results: A total of 1061 patients participated in the study; 77.8% (825) were men, and the median (IQR) age was 58.2 (53.3-63.9) years in the development cohort and 56.4 (51.7-61.0) years in the validation cohort (P < .001). In the development cohort of 721 patients (542 men), median α-fetoprotein (AFP) level at the time of LT was 8.3 ng/mL; 9.4% had microvascular invasion (n = 68), and 22.1% were beyond Milan criteria on explant (n = 159) owing to understaging by pretransplantation imaging. Cumulative probabilities of HCC recurrence at 1 and 5 years were 5.7% and 12.8%, respectively. On multivariable Cox proportional hazards regression, 3 variables were independently associated with HCC recurrence: microvascular invasion, AFP at time of LT, and the sum of the largest viable tumor diameter and number of viable tumors on explant. The RETREAT score was created using these 3 variables, with scores ranging from 0 to 5 or higher that were highly predictive of HCC recurrence (C statistic, 0.77). RETREAT was able to stratify 5-year post-LT recurrence risk ranging from less than 3% with a score of 0 to greater than 75% with a score of 5 or higher. The validation cohort (n = 340; 283 men) had significantly higher microvascular invasion (23.8% [n = 81], P < .001), explant beyond Milan criteria (37.3% [n = 159], P < .001), and HCC recurrence at 5 years (17.9% [n = 159], P = .03). RETREAT showed good model discrimination (C statistic, 0.82; 95% CI, 0.77-0.86) and superior recurrence risk classification compared with explant Milan criteria (net reclassification index, 0.40; P = .001) in the validation cohort.<br />Conclusions and Relevance: We have developed and validated a simple and novel prognostic score that may improve post-LT HCC surveillance strategies and help identify patients who may benefit from future adjuvant therapies.
- Subjects :
- Adult
Aged
Carcinoma, Hepatocellular pathology
Cohort Studies
Female
Humans
Liver Neoplasms pathology
Male
Middle Aged
Neoplasm Recurrence, Local pathology
Prognosis
Proportional Hazards Models
Retrospective Studies
Risk
Risk Factors
alpha-Fetoproteins analysis
Carcinoma, Hepatocellular epidemiology
Liver Neoplasms epidemiology
Liver Transplantation
Neoplasm Recurrence, Local epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 2374-2445
- Volume :
- 3
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- JAMA oncology
- Publication Type :
- Academic Journal
- Accession number :
- 27838698
- Full Text :
- https://doi.org/10.1001/jamaoncol.2016.5116