Can The Retreat Score Predict Hcc Recurrence After Surgical Resection?

INTRODUCTION: Recurrent HCC following surgical resection is a major complication. Reliable predictors of HCC recurrence are lacking. Degree of tumor differentiation, the presence of vascular invasion and satellite lesions are often utilized. Alternatively, the risk of recurrent HCC after liver transplantation can be predicted by use of the RETREAT score, which utilizes tumor burden (largest visible tumor + number of visible tumors), presence of microvascular invasion, and plasma α-fetoprotein (AFP) level. We aimed to determine if the RETREAT score can predict the risk of HCC recurrence when applied to patients who have undergone surgical resection for HCC. METHODS: Surgical databases at our center were queried to identify 58 patients with cirrhosis who had undergone resection for HCC between 2000 and 2016. Resection pathology was reviewed to determine the number/size of tumors, and degree of histologic differentiation. Post-resection imaging was reviewed to determine post-operative tumor-free survival by the Kaplan-Meier method. Multivariable proportional hazards regression was used to identify if components the RETREAT score had predictive value for recurrence at P < 0.05. RESULTS: The average age of the cohort was 61 ± 10 yrs; 69% (40/58) were male. The most common etiology of cirrhosis was HCV (55%; 32/58). NAFLD accounted for 12% (7/58). AFP was > 200 ng/mL in 24% (14/58). The 5-year recurrence rate was 65% (38/58). There were no significant differences between the tumor-free group and the HCC recurrence group in gender or racial distribution, liver disease etiology, degree of tumor differentiation, or RETREAT score (all P-values NS). Largest tumor diameter (HR 1.49, 95% CI 1.03–2.16 per SD increase of 4 cm) (Figure 2) and the presence of micro or macrovascular invasion (HR 2.10, 95% CI 1.02–4.32) were significant predictors of HCC recurrence risk. AFP was not predictive. CONCLUSION: The RETREAT score did not accurately predict the risk of HCC recurrence in patients undergoing surgical resection. However, contrary to previous studies, these data suggest that the largest tumor size is predictive of recurrence. This is likely because tumor size (in conjunction with number) comprise overall tumor burden, a robust predictor of recurrence. These data confirm the role of vascular invasion in predicting post-resection recurrence. These results are congruent with published data from a large multinational registry.Figure 1.: Predicted post-surgical recurrence-free survival for largest tumor diameters of 2.7 cm (25th %-tile) and 8.2 cm (75th %-tile) [P = 0.04].