The Risk Estimation of Tumor Recurrence After Transplant (RETREAT) score was highly predictive of hepatocellular carcinoma (HCC) recurrence risk following liver transplantation, according to a study published in JAMA Oncology.1

Although various factors are associated with increased risk of HCC recurrence after liver transplantation, no reliable risk score has been established to determine the individual risk for HCC recurrence.

Researchers therefore developed and attempted to validate a prognostic tool for estimating tumor recurrence after transplantation for patients with HCC meeting Milan criteria (1 lesion of at least 5 cm, 2-3 lesions of at least 3 cm) by imaging.

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In the development cohort of 721 patients, investigators found that microvascular invasion, α-fetoprotein (AFP) level at the time of liver transplantation, and the sum of the largest viable tumor diameter with the number of viable tumors on explant were independently associated with HCC recurrence. Using these 3 variables, the researchers created the RETREAT score, with scores ranging from 0 to 5 or higher that were highly predictive of HCC recurrence.

The study showed that the RETREAT prognostic score could stratify 5-year post-liver transplantation 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, which included 340 patients, had significantly higher microvascular invasion (P < .001), explant beyond Milan criteria (P < .001), and HCC recurrence at 5 years (P = .03).

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RETREAT showed good model discrimination and superior recurrence risk classification compared with explant Milan criteria (P = .001).

The findings suggest that the RETREAT score is useful for identifying patients with HCC who may derive benefit from future adjuvant therapy and for aiding in clinical decision-making of post-transplant surveillance strategies.


  1. Mehta N, Heimbach J, Harnois DM, et al. Validation of a risk estimation of tumor recurrence after transplant (RETREAT) score for hepatocellular carcinoma recurrence after liver transplant. JAMA Oncol. 2016 Nov 13. doi: 10.1001/jamaoncol.2016.5116 [Epub ahead of print]