Abstract
BackgroundThis study was performed to identify risk factors associated with recurrence of hepatoblastoma.MethodsA retrospective study was conducted on 56 patients with hepatoblastoma from 2012 to 2015 in Beijing Children’s Hospital. Pretreatment extension stage (PRETEXT), serum alpha fetoprotein (AFP) value, change trend of tumors after treatment and some other clinical characteristics were collected and analyzed. The comparison of independent variables that were not distributed normally was performed with the log-rank test.ResultsTwenty-eight patients with tumour recurrence and 28 patients without recurrence were included in this study, and the median age at presentation was 46.5 (26, 71.5) months. There was a significant difference in the 3-year recurrence-free survival (RFS) probability between patients aged over 54 months and those younger than 54 months (p = 0.007). After neoadjuvant chemotherapy, the chance of recurrence in partial response (PR) patients was significantly lower than that in stable disease (SD) patients (p = 0.004). The 3-year RFS rate of patients with a reduction in AFP of more than 60% after neoadjuvant chemotherapy was significantly higher than that of patients with a reduction of less than 60% (p = 0.005). The postoperative follow-up revealed that patients whose postoperative AFP fell to normal levels within 6 months of the start of treatment had a 3-year RFS rate of 68.6%, which is higher than that of patients whose AFP fell below the normal range after 6 months (p = 0.0005). Finally, the multivariate analysis by Cox regression showed that AFP decreased by less than 60% and tumour size decreased by less than 50% after neoadjuvant chemotherapy were significant independent prognostic risk factors for the 3-year RFS rate. The other clinical features were not significantly associated with tumour recurrence in this study.ConclusionsThrough this study, we concluded that the prognosis of childhood HB is related to the age at presentation and the response of chemotherapy. The results of the multivariate analysis showed that AFP decreased by less than 60% and tumour size decreased by less than 50% after neoadjuvant chemotherapy were significant independent prognostic risk factors. These findings can be helpful to evaluate therapeutic effects and predict prognosis.
Highlights
This study was performed to identify risk factors associated with recurrence of hepatoblastoma
The results showed that alpha fetoprotein (AFP) that decreased by less than 60% and tumour size that decreased by less than 50% after neoadjuvant chemotherapy were significant independent prognostic risk factors for 3-year recurrence-free survival (RFS)
This study focused on the factors related to HB recurrence and found the following risk factors in this study: patient age older than 54 months, AFP that decreased by less than 60% after the patient received neoadjuvant chemotherapy, tumour size that failed to achieve partial remission after neoadjuvant chemotherapy, and AFP that failed to return to a normal range within 6 months after receiving treatment
Summary
This study was performed to identify risk factors associated with recurrence of hepatoblastoma. Hepatoblastoma (HB) is a rare type of primary malignant liver tumour that mostly occurs in infants and children under 3 years of age [1]. The pathological features of HB consist of tissues resembling foetal liver cells, mature hepatocytes or biliary cells [2]. The most common symptom is abdominal mass [3]. Surgical tumour resection, chemotherapy and orthotopic liver transplantation are used for the treatment of HB [7, 8]. The survival of patients with HB relies largely on surgical resection [9, 10].
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