Mehta et al reported the Risk Estimation of Tumor Recurrence After Transplant (RETREAT) score for evaluating a patient who has undergone liver transplant for hepatocellular carcinoma. This can help to identify a patient who may benefit from more aggressive management. The authors are from the University of California at San Francisco, Mayo Clinic, and the University of Toronto.
Patient selection: status post liver transplant for hepatocellular carcinoma
Outcome: recurrence of the carcinoma and overall post-transplant survival
Parameters:
(1) serum AFP in ng/mL at the time of liver transplant
(2) microvascular invasion
(3) largest viable tumor diameter in cm plus number of tumor masses
Parameter
Finding
Points
serum AFP
<= 20 ng/mL
0
21 to 99 ng/mL
1
100 to 999 ng/mL
2
>= 1,000 ng/mL
3
microvascular invasion
no
0
yes
2
largest viable tumor diameter plus number of metastases
no viable tumor identified at transplant
0
1 to 4.9
1
5.0 to 9.99
2
>= 10
3
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 8
• The higher the score the worse the survival and the greater the risk of recurrence.
Parameter
3-Year Post-Transplant Survival
Percent Tumor Recurrence
0
91%
1.6%
1
85%
5.0%
2
85%
5.6%
3
80%
8.4%
4
71%
20.3%
>=5
58%
29%
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