Shruthi H S Reddy1, Neil Mehta2, Jennifer L Dodge3, Abdul R Hakeem4, Shirin E Khorsandi5, Wayel Jassem1, Hector Vilca-Melendez1, Miriam Cortes-Cerisuelo1, Parthi Srinivasan1, Andreas Prachalias1, Michael A Heneghan6, Varuna Aluvihare6, Abid Suddle6, Rosa Miquel7, Mohamed Rela8, Nigel D Heaton1, Krishna V Menon9. 1. Liver Transplant Surgery, Institute of Liver Studies, King's College Hospital, London, SE5 9RS, United Kingdom. 2. Hepatology, Department of Medicine, University of California, San Francisco, United States. 3. Biostatistics, Department of Medicine and Preventive Medicine, University of Southern California, Los Angeles, United States. 4. Hepatobiliary and Liver Transplant Surgery, St James's University Hospital, Leeds, LS97TF, United Kingdom. 5. Liver Transplant Surgery, Institute of Liver Studies, King's College Hospital, London, SE5 9RS, United Kingdom; Institute of Hepatology, Foundation for Liver Research, London, United Kingdom. 6. Hepatology, Institute of Liver Studies, King's College Hospital, London, United Kingdom. 7. Liver Histopathology, Department of Histopathology, Institute of Liver Studies, King's College Hospital, London, United Kingdom. 8. Liver Transplant and HPB Surgery, Dr Rela Institute & Medical Center, Chennai, India. 9. Liver Transplant Surgery, Institute of Liver Studies, King's College Hospital, London, SE5 9RS, United Kingdom. Electronic address: krishna.menon@nhs.net.
Abstract
BACKGROUND: The Risk Estimation of Tumor Recurrence After Transplant (RETREAT) score as a prognostic index for recurrence has been reported previously and has not been validated outside the USA. Our study has validated the score in a single center UK cohort of patients being transplanted for HCC. METHODS: LT for HCC between 2008 and 2018 at our center were analyzed. Recurrence-free survival (RFS) was compared by the RETREAT score and validated using Net Reclassification Improvement (NRI) by comparing it to Milan criteria. RESULTS: 346 adult HCC patients were transplanted of whom 313 were included. 28 (8.9%) had a recurrence. Summation of largest diameter and total number of viable tumors (HR = 1.19, p < 0.001), micro-/macro-vascular invasion (HR = 3.74, p = 0.002) and AFP>20 ng/ml (HR = 3.03, p = 0.005) were associated with recurrence on multivariate analysis. RFS decreased with increasing RETREAT score (log-rank p = 0.016). RETREAT performed better than Milan with significant NRI at 1- and 2-years post-transplant (0.43 (p = 0.004) and 0.38 (p = 0.03) respectively). CONCLUSION: LT outcomes using the revised UK criteria are equivalent to Milan criteria. Further, RETREAT score was validated as a prognostic index for the first time in a UK cohort and may assist risk stratification, selection for adjuvant therapies and guide surveillance. Crown
BACKGROUND: The Risk Estimation of Tumor Recurrence After Transplant (RETREAT) score as a prognostic index for recurrence has been reported previously and has not been validated outside the USA. Our study has validated the score in a single center UK cohort of patients being transplanted for HCC. METHODS: LT for HCC between 2008 and 2018 at our center were analyzed. Recurrence-free survival (RFS) was compared by the RETREAT score and validated using Net Reclassification Improvement (NRI) by comparing it to Milan criteria. RESULTS: 346 adult HCC patients were transplanted of whom 313 were included. 28 (8.9%) had a recurrence. Summation of largest diameter and total number of viable tumors (HR = 1.19, p < 0.001), micro-/macro-vascular invasion (HR = 3.74, p = 0.002) and AFP>20 ng/ml (HR = 3.03, p = 0.005) were associated with recurrence on multivariate analysis. RFS decreased with increasing RETREAT score (log-rank p = 0.016). RETREAT performed better than Milan with significant NRI at 1- and 2-years post-transplant (0.43 (p = 0.004) and 0.38 (p = 0.03) respectively). CONCLUSION: LT outcomes using the revised UK criteria are equivalent to Milan criteria. Further, RETREAT score was validated as a prognostic index for the first time in a UK cohort and may assist risk stratification, selection for adjuvant therapies and guide surveillance. Crown
Authors: Maria C van Hooff; Milan J Sonneveld; Jan N Ijzermans; Michail Doukas; Dave Sprengers; Herold J Metselaar; Caroline M den Hoed; Robert A de Man Journal: Cancers (Basel) Date: 2022-01-27 Impact factor: 6.639