Comparison of RETREAT and CCFSS Scoring Systems for Risk Estimation of Hepatocellular Carcinoma Recurrence After Radical Resection.

ABSTRACT

Objective: RETREAT and CCFSS are two scoring systems specifically designed to predict postoperative recurrence in hepatocellular carcinoma (HCC). RETREAT and CCFSS are scoring systems designed to predict postoperative recurrence in hepatocellular carcinoma (HCC). This study aims to evaluate and compare the prognostic performance of two scoring systems, RETREAT and CCFSS, for predicting tumor recurrence after radical resection in patients with hepatocellular carcinoma (HCC). Methods: In this retrospective study, we analyzed the clinical data of 124 patients with HCC who underwent radical resection at our hospital between March 2017 and February 2020. The patients were categorized into a recurrence group (n = 41) and a non-recurrence group (n = 83) based on whether they experienced recurrence within 3 years of follow-up. Logistic regression analysis was conducted to compare the clinical characteristics between the two groups and identify factors associated with HCC recurrence. Additionally, we generated receiver operating characteristic (ROC) curves to evaluate the predictive value of the RETREAT and CCFSS scoring systems for predicting HCC recurrence after surgery. Results: Significant differences (P < .05) were found in the postoperative relapse-free survival time, HBsAg positivity, preoperative ALT≥ 40 U/L, preoperative Alb < 40 g/L, pericardial invasion, RETREAT score, and CCFSS score between the two groups. A multi-factor logistic regression analysis was performed between postoperative relapse in HCC patients and HBsAg positivity, preoperative ALT ≥ 40U/L, preoperative Alb<40g/L, pericardial invasion, RETREAT score, and CCFSS score grading as independent variables. The analysis revealed that HBsAg positivity (OR = 6.039, 95%CI 2.994~12.182), preoperative ALT ≥ 40 U/L (OR = 3.738, 95%CI 2.016-6.931), preoperative Alb< 40g/L (OR = 3.655, 95%CI 2.083-6.415), envelope invasion (OR = 3.119, 95%CI 1.922-5.061), RETREAT score (OR = 6.867, 95%CI 3.204-14.719), and CCFSS score (OR = 3.228, 95%CI 1.951-5.342) were significant factors influencing postoperative recurrence in HCC patients (P < .05). The RETREAT score had an area under the curve (AUC) of 0.853, with a sensitivity of 89.23% and a specificity of 93.87% (95%CI 0.7567-0.950), while the AUC of the CCFSS score for predicting postoperative recurrence in HCC patients was 0.741, with a sensitivity of 78.57% and a specificity of 60.71% (95%CI 0.609-0.873). Among the factors analyzed, including postoperative relapse-free survival time, HBsAg positivity, preoperative ALT≥ 40 U/L, preoperative Alb < 40 g/L, pericardial invasion, RETREAT score, and CCFSS score, statistically significant differences were observed between the recurrence and non-recurrence groups (P < .05). Conclusion: The RETREAT score demonstrates higher efficacy compared to the CCFSS score in predicting postoperative recurrence in hepatocellular carcinoma (HCC) patients and can serve as a valuable tool for the prognostic evaluation of HCC patients who undergo radical resection. The RETREAT score's superiority can be attributed to its higher area under the curve (AUC) and improved sensitivity and specificity, which allow for better discrimination between positive and negative cases. This enhanced accuracy enables clinicians to make more informed decisions towards post-surgical management and treatment strategies, ultimately improving patient outcomes. Thus, the RETREAT score serves as a vital tool for personalized and targeted care towards HCC patients undergoing radical resection.