Analyses of risk factors affecting the prognosis of hepatoblastoma

Abstract

Objective To analyze the prognostic factors of hepatoblastoma （HB） after comprehensive treatment. Methods Between May 1,2001 and January 30,2012, retrospective analyses were conducted for 136 cases of pediatric hepatoblastoma. Their clinicopathologieal data and follow-up information were collected and analyzed. The treatment regimen was composed mostly of surgery plus chemotherapy. And chemotherapy was divided into preoperative and postoperative chemotherapies. For 112 cases, the follow-up period was 35.6 （3-144） months. Kaplan-Meier curve and Log-rank test were employed for survival analysis. Cox proportional hazard regression model was used for univariate and multivariate analyses. Statistical analysis was performed with SPSS 19. 0 software. Results The median diameter of HB was 8. 4 ± 3.1 （2. 9-19. 0） cm and the median AFP level 6 453. 8 ± 47 699. 2 （12. 9-484000. 0） μg/L. The PRETEXT stages were I （n = 3,2. 7%）, II （n = 16, 14. 3%）, III （n = 42,37. 5%） and IV （n = 51,45.5%）. There were single tumor （n = 96,85.7%） ,multiple tumors （n = 16, 14.3%）, with distant metastasis （n = 27, 24. 1%） and without distant metastases （n = 85,75.9 % ）. Vascular invasion occurred in 25 cases, including portal vein invasion （n = 17,68 % ） and vena cava infringement （n = 8,32%）. K-M survival curve showed that prognostic factors of HB included level of AFP, PRETEXT staging, multiple single tumor, metastasis and vascular invasion. Serum alphafetoprotein （AFP）〈100 μg/L or AFP〉10 000μg/L （28/61,47%） had lower 5-year survival rate than 100μg/L 〈AFP〈10,000μg/L group （36/51,71.3%）. And multiple tumors group （4/16, 25.9%） had a lower 5-year survival rate than single tumor group （66/96,68. 8%）. As compared to PRETEXT stages I , II , III group（44/61,71.7%）, PRETEXT IV stage group（21/51,41.8%）had a lower 5-year survival rate. The 5-year survival rate of metastasis group （6/27,24. 3%） was lower than that of metastasis group （57/85,67. 9%） and the 5-year survival rate of vascular invasion group （9/ 25,35 %） lower than that of without vascular invasion group （56/87,64. 3 %）. Cox proportional hazard regression multivariate analysis showed that AFP 〈100 μg/L or〉 10 000 μg/L （HR 2. 454,95% CI 1. 207-4. 987, P = 0. 013） ; PRETEXT IV （ HR 2. 817, 95 % CI 1. 373-5. 783, P = 0. 005） ; multiple tumors （HR 2. 852,95%CI 1. 256-6. 475,P = 0. 012） ; distant metastasis （HR 2. 654,95% CI 1. 342- 5. 267,P = 0. 005） and vascular invasion （HR 2. 272, 95%CI 1. 102-4. 687, P = 0. 026） were risk factors. Conclusions The prognosis of HB children is associated with AFP level, single tumor, PRETEXT stage, metastasis and vascular invasion. And prognosis may vary for different risk factors of HB. Key words: Carcinoma, Hepatocellular; Prognosis; Risk factors