101
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Zheng J, Guo X, Shioya A, Yoshioka T, Matsumoto K, Hiraki T, Kusano H, Oyama T, Kurose N, Yamaguchi R, Uramoto H, Ieiri S, Okajima H, Kohno M, Yamada S. Peroxiredoxin 4 promotes embryonal hepatoblastoma cell migration but induces fetal cell differentiation. Am J Transl Res 2020; 12:2726-2737. [PMID: 32655804 PMCID: PMC7344098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/28/2020] [Indexed: 06/11/2023]
Abstract
Hepatoblastoma (HB) is the leading primary hepatic malignancy in children and likely emerges due to failure of hepatic progenitor cells to properly differentiate. The peroxiredoxin (PRDX) family is frequently linked to cancer. In our previous study, we demonstrated that expression of the only secreted family member, PRDX4, was correlated with hepatocellular carcinoma. The aim of this new study was to investigate PRDX4's role in HB. We collected 87 HB specimens and performed PRDX4 immunohistochemistry staining. Clinical analysis was conducted and the effect of PRDX4 overexpression on two HB cell lines (Huh6 and HepG2) was also examined. Clinical data revealed elevated PRDX4 expression in embryonal component was correlated with advanced stage (IV) and metastasis. In comparison, increased PRDX4 expression in fetal component was associated with well differentiation. In vitro experiments showed PRDX4 overexpression enhanced migration in embryonal-like HB cells (Huh6), which was accompanied by epithelial-mesenchymal transition (EMT). By contrast, PRDX4 overexpression inhibited proliferation, decreased stemness markers, and increased hepatic markers in fetal-like HB cells (HepG2), which indicated induction of tumor cell differentiation. In conclusion, PRDX4 promotes embryonal hepatoblastoma cell migration but induces fetal cell differentiation. It can be adopted as an important marker for HB prognosis and a potential treatment target.
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Affiliation(s)
- Jianbo Zheng
- Department of Pathology and Laboratory Medicine, Kanazawa Medical UniversityIshikawa 920-0293, Japan
- Department of Pediatrics, Wuhan Union Hospital, Tongji Medical College of Huazhong University of Science and TechnologyWuhan 430022, Hubei, China
| | - Xin Guo
- Department of Pathology and Laboratory Medicine, Kanazawa Medical UniversityIshikawa 920-0293, Japan
- Department of Pathology, Kanazawa Medical University HospitalIshikawa 920-0293, Japan
| | - Akihiro Shioya
- Department of Pathology and Laboratory Medicine, Kanazawa Medical UniversityIshikawa 920-0293, Japan
- Department of Pathology, Kanazawa Medical University HospitalIshikawa 920-0293, Japan
| | - Takako Yoshioka
- Department of Pathology, National Center for Child Health and DevelopmentTokyo 157-8535, Japan
| | - Kimikazu Matsumoto
- Department of Pediatric Hematology and Oncology Research, National Center for Child Health and DevelopmentTokyo 157-8535, Japan
| | - Tsubasa Hiraki
- Department of Pathology, Kagoshima University Graduate School of Medical and Dental SciencesKagoshima 890-8544, Japan
| | - Hironori Kusano
- Department of Pathology, School of Medicine, Kurume UniversityKurume 830-0011, Japan
| | - Takeru Oyama
- Department of Molecular and Cellular Pathology, Graduate School of Medical Science, Kanazawa UniversityKanazawa 920-0293, Japan
| | - Nozomu Kurose
- Department of Pathology and Laboratory Medicine, Kanazawa Medical UniversityIshikawa 920-0293, Japan
- Department of Pathology, Kanazawa Medical University HospitalIshikawa 920-0293, Japan
| | - Reimon Yamaguchi
- Department of Dermatology, Kanazawa Medical UniversityIshikawa 920-0293, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical UniversityIshikawa 920-0293, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Research Field in Medical and Health Sciences, Medical and Dental Area, Research and Education Assembly, Kagoshima UniversityKagoshima 890-8544, Japan
| | - Hideaki Okajima
- Department of Pediatric Surgery, Kanazawa Medical UniversityIshikawa 920-0293, Japan
| | - Miyuki Kohno
- Department of Pediatric Surgery, Kanazawa Medical UniversityIshikawa 920-0293, Japan
| | - Sohsuke Yamada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical UniversityIshikawa 920-0293, Japan
- Department of Pathology, Kanazawa Medical University HospitalIshikawa 920-0293, Japan
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102
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Gattuso G, Casanova M, Biassoni V, Terenziani M, Schiavello E, Sironi G, Collini P, Pallotti F, Morosi C, Massimino M. Precocious pseudopuberty, a paraneoplastic manifestation: a report of 2 cases. TUMORI JOURNAL 2020; 106:NP14-NP17. [PMID: 32462993 DOI: 10.1177/0300891620925532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Peripheral precocious puberty (PPP) may be a paraneoplastic manifestation, associated with beta human chorionic gonadotropin (β-hCG)-secreting tumors. We describe 2 young children with β-hCG-secreting tumors presenting with signs of pubertal activation. In the first patient, a 16-month-old boy with hepatoblastoma, only initial signs of PPP at presentation were identifiable, with concomitant high levels of β-hCG. Although the tumor had good response to therapy, β-hCG levels were fluctuant until the tumor was resected surgically. The second patient, an 18-month-old boy with intracranial germ cell tumor, presented with clear signs of pubertal activation and genitalia enlargement with no initial alteration of sex hormones. In both cases, the oncologic response to therapy was good. In the first case, full remission of the pubertal signs was observed; in the second, pubertal signs were still visible 20 months after the end of treatment.
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Affiliation(s)
- Giovanna Gattuso
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Michela Casanova
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Veronica Biassoni
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elisabetta Schiavello
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sironi
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Collini
- Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Pallotti
- Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Carlo Morosi
- Radiology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maura Massimino
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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103
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Hiyama E, Hishiki T, Watanabe K, Ida K, Ueda Y, Kurihara S, Yano M, Hoshino K, Yokoi A, Takama Y, Nogami Y, Taguchi T, Mori M, Kihira K, Miyazaki O, Fuji H, Honda S, Iehara T, Kazama T, Fujimura J, Tanaka Y, Inoue T, Tajiri T, Kondo S, Oue T, Yoshimura K. Outcome and Late Complications of Hepatoblastomas Treated Using the Japanese Study Group for Pediatric Liver Tumor 2 Protocol. J Clin Oncol 2020; 38:2488-2498. [PMID: 32421442 DOI: 10.1200/jco.19.01067] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We report here the outcomes and late effects of the Japanese Study Group for Pediatric Liver Tumors (JPLT)-2 protocol, on the basis of cisplatin-tetrahydropyranyl-adriamycin (CITA) with risk stratification according to the pretreatment extent of disease (PRETEXT) classification for hepatoblastoma (HB). PATIENTS AND METHODS From 1999 to 2012, 361 patients with untreated HB were enrolled. PRETEXT I/II patients were treated with up-front resection, followed by low-dose CITA (stratum 1) or received low-dose CITA, followed by surgery and postoperative chemotherapy (stratum 2). In the remaining patients, after 2 cycles of CITA, responders received the CITA regimen before resection (stratum 3), and nonresponders were switched to ifosfamide, pirarubicin, etoposide, and carboplatin (ITEC; stratum 4). Intensified chemotherapeutic regimens with autologous hematopoietic stem-cell transplantation (SCT) after resection were an optional treatment for patients with refractory/metastatic disease. RESULTS The 5-year event-free and overall survival rates of HB patients were 74.2% and 89.9%, respectively, for stratum 1, 84.8% and 90.8%%, respectively, for stratum 2, 71.6% and 85.9%%, respectively, for stratum 3, and 59.1% and 67.3%%, respectively, for stratum 4. The outcomes for CITA responders were significantly better than those for nonresponders, whose outcomes remained poor despite salvage therapy with a second-line ITEC regimen or SCT. The late effects, ototoxicity, cardiotoxicity, and delayed growth, occurred in 61, 18, and 47 patients, respectively. Thirteen secondary malignant neoplasms (SMNs), including 10 leukemia, occurred, correlating with higher exposure to pirarubicin and younger age at diagnosis. CONCLUSION The JPLT-2 protocol achieved up-front resectability in PRETEXT I/II patients with no annotation factors, and satisfactory survival in patients who were CITA responders in the remaining patients. However, outcomes for CITA nonresponders were unsatisfactory, despite therapy intensification with ITEC regimens and SCT. JPLT-2 had a relatively low incidence of cardiotoxicity but high rates of SMNs.
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Affiliation(s)
- Eiso Hiyama
- Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima, Japan.,Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomoro Hishiki
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan.,National Cancer Center Hospital, Tokyo, Japan
| | | | - Kohmei Ida
- Department of Pediatrics, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Yuka Ueda
- Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Sho Kurihara
- Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Michihiro Yano
- Department of Pediatrics, Akita University School of Medicine, Akita, Japan
| | - Ken Hoshino
- School of Medicine, Keio University, Tokyo, Japan
| | - Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Yuichi Takama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Nogami
- National Cancer Center Hospital, Tokyo, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Makiko Mori
- Departments of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Kentaro Kihira
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Osamu Miyazaki
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Fuji
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Shohei Honda
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tomoko Iehara
- Department of Pediatrics, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takuro Kazama
- Department of Pediatric Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Junya Fujimura
- Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan
| | - Yukichi Tanaka
- Department of Pathology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Satoshi Kondo
- Division of Pediatric Surgery and Transplant Surgery, Nagoya City University Medical School, Nagoya, Japan
| | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Kenichi Yoshimura
- Center for Integrated Medical Research, Hiroshima University Hospital, Hiroshima, Japan
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104
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Rammohan A, Rela M, Kumar GV, Scott JX, Shanmugam N, Reddy MS, Ramachandran P. Outcomes for high-risk hepatoblastoma in a resource-challenged setting. BJS Open 2020; 4:630-636. [PMID: 32379933 PMCID: PMC7397353 DOI: 10.1002/bjs5.50297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/09/2020] [Indexed: 11/30/2022] Open
Abstract
Background Outcomes of high‐risk hepatoblastoma have been dismal, especially in resource‐challenged countries where access to chemotherapy and paediatric liver transplantation is limited for the underprivileged. This study aimed to assess the results of treatment of high‐risk hepatoblastoma in a tertiary centre, including patients who had non‐transplant surgical procedures in the form of extended resection. Methods A review of patients with high‐risk hepatoblastoma treated between January 2012 and May 2018 was carried out. Perioperative data and long‐term outcomes were analysed. Results Of 52 children with hepatoblastoma, 22 were considered to have high‐risk hepatoblastoma (8 girls and 14 boys). The mean(s.d.) age at diagnosis was 35(20) months. Of these 22 children, five died without surgery. Of the remaining 17 who underwent surgery, six had a resection (4 right and 2 left trisectionectomies) and 11 underwent living‐donor liver transplantation. Median follow‐up was 48 (range 12–90) months. Thirteen of the 17 children were alive at last follow‐up and four developed disseminated disease (3 had undergone liver transplantation and 1 liver resection). The overall survival rate at 1, 3 and 5 years was 77, 64 and 62 per cent for the whole cohort with high‐risk hepatoblastoma. In children who had surgery, 1‐, 3‐ and 5‐year survival rates were 91, 82 and 73 per cent for transplantation and 100, 83 and 83 per cent for resection. There was no difference in survival between the two surgical groups. Conclusion Excellent results in the treatment of high‐risk hepatoblastoma are possible, even in resource‐challenged countries.
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Affiliation(s)
- A Rammohan
- Institute of Liver Disease and Transplantation, Sree Balaji Medical College Hospital, Bharat Institute of Higher Education and Research, Chennai, India
| | - M Rela
- Ray of Light Foundation, Kanchi Kamakoti Children's Health Institute Laboratory and Diagnostic Services (CHILDS) Trust Hospital, CHILDS Trust Medical Research Foundation, Chennai, India
| | - G V Kumar
- Institute of Liver Disease and Transplantation, Sree Balaji Medical College Hospital, Bharat Institute of Higher Education and Research, Chennai, India
| | - J X Scott
- Institute of Liver Disease and Transplantation, Sree Balaji Medical College Hospital, Bharat Institute of Higher Education and Research, Chennai, India
| | - N Shanmugam
- Institute of Liver Disease and Transplantation, Sree Balaji Medical College Hospital, Bharat Institute of Higher Education and Research, Chennai, India
| | - M S Reddy
- Institute of Liver Disease and Transplantation, Sree Balaji Medical College Hospital, Bharat Institute of Higher Education and Research, Chennai, India
| | - P Ramachandran
- Institute of Liver Disease and Transplantation, Sree Balaji Medical College Hospital, Bharat Institute of Higher Education and Research, Chennai, India.,Ray of Light Foundation, Kanchi Kamakoti Children's Health Institute Laboratory and Diagnostic Services (CHILDS) Trust Hospital, CHILDS Trust Medical Research Foundation, Chennai, India
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105
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Suh JK, Kang S, Kim H, Koh KN, Im HJ. Management of Hepatoblastoma in the Modern Era and Future Perspectives. CLINICAL PEDIATRIC HEMATOLOGY-ONCOLOGY 2020. [DOI: 10.15264/cpho.2020.27.1.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Jin Kyung Suh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Sunghan Kang
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyery Kim
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Nam Koh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Joon Im
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center Children’s Hospital, University of Ulsan College of Medicine, Seoul, Korea
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106
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Zou H, Wang F, Zhou JJ, Liu X, He Q, Wang C, Zheng YW, Wen Y, Xiong L. Application of photodynamic therapy for liver malignancies. J Gastrointest Oncol 2020; 11:431-442. [PMID: 32399283 DOI: 10.21037/jgo.2020.02.10] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Liver malignancies include primary and metastatic tumors. Limited progress has been achieved in improving the survival rate of patients with advanced stage liver cancer and who are unsuitable for surgery. Apart from surgery, chemoradiotherapy, trans-arterial chemoembolization and radiofrequency ablation, a novel therapeutic modality is needed for the clinical treatment of liver cancer. Photodynamic therapy (PDT) is a novel strategy for treating patients with advanced cancers; it uses a light-triggered cytotoxic photosensitizer and a laser light. PDT provides patients with a potential treatment approach with minimal invasion and low toxicity, that is, the whole course of treatment is painless, harmless, and repeatable. Therefore, PDT has been considered an effective palliative treatment for advanced liver cancers. To date, PDT has been used to treat hepatocellular carcinoma, cholangiocarcinoma, hepatoblastoma and liver metastases. Clinical outcomes reveal that PDT can be considered a promising treatment modality for all liver cancers to improve the quality and quantity of life of patients. Despite the advances achieved with this approach, several challenges still impede the application of PDT to liver malignancies. In this review, we focus on the recent advancements and discuss the future prospects of PDT in treating liver malignancies.
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Affiliation(s)
- Heng Zou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Fusheng Wang
- Department of General Surgery, Fuyang People's Hospital, Fuyang 236000, China
| | - Jiang-Jiao Zhou
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Xi Liu
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Qing He
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Cong Wang
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Yan-Wen Zheng
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Yu Wen
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
| | - Li Xiong
- Department of General Surgery, The Second Xiangya Hospital, Central South University, Changsha 410011, China
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107
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Sindhi R, Rohan V, Bukowinski A, Tadros S, de Ville de Goyet J, Rapkin L, Ranganathan S. Liver Transplantation for Pediatric Liver Cancer. Cancers (Basel) 2020; 12:cancers12030720. [PMID: 32204368 PMCID: PMC7140094 DOI: 10.3390/cancers12030720] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/10/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023] Open
Abstract
Unresectable hepatocellular carcinoma (HCC) was first removed successfully with total hepatectomy and liver transplantation (LT) in a child over five decades ago. Since then, children with unresectable liver cancer have benefitted greatly from LT and a confluence of several equally important endeavors. Regional and trans-continental collaborations have accelerated the development and standardization of chemotherapy regimens, which provide disease control to enable LT, and also serve as a test of unresectability. In the process, tumor histology, imaging protocols, and tumor staging have also matured to better assess response and LT candidacy. Significant trends include a steady increase in the incidence of and use of LT for hepatoblastoma, and a significant improvement in survival after LT for HCC with each decade. Although LT is curative for most unresectable primary liver sarcomas, such as embryonal sarcoma, the malignant rhabdoid tumor appears relapse-prone despite chemotherapy and LT. Pediatric liver tumors remain rare, and diagnostic uncertainty in some settings can potentially delay treatment or lead to the selection of less effective chemotherapy. We review the current knowledge relevant to diagnosis, LT candidacy, and post-transplant outcomes for these tumors, emphasizing recent observations made from large registries or larger series.
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Affiliation(s)
- Rakesh Sindhi
- Hillman Center for Pediatric Transplantation, UPMC-Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA; (A.B.); (S.T.)
- Correspondence: ; Tel.: +1-412-692-7123
| | - Vinayak Rohan
- Medical University of South Carolina, Charleston, SC 29403, USA;
| | - Andrew Bukowinski
- Hillman Center for Pediatric Transplantation, UPMC-Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA; (A.B.); (S.T.)
| | - Sameh Tadros
- Hillman Center for Pediatric Transplantation, UPMC-Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA; (A.B.); (S.T.)
| | - Jean de Ville de Goyet
- Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), 90127 Palermo, Italy;
| | - Louis Rapkin
- Department of Hematology/Oncology, UPMC-Children’s Hospital of Pittsburgh, Pittsburgh, PA 15224, USA;
| | - Sarangarajan Ranganathan
- Department of Pathology, Children’s Hospital Medical Center of Cincinnati, Cincinnati, OH 45229, USA;
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108
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Zhang YT, Chang J, Yao YM, Li YN, Zhong XD, Liu ZL. Novel treatment of refractory / recurrent pulmonary hepatoblastoma. Pediatr Int 2020; 62:324-329. [PMID: 31885124 DOI: 10.1111/ped.14134] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/25/2019] [Accepted: 12/23/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND There is no consensus about how to manage pulmonary metastasis in patients with hepatoblastoma. We reviewed a treatment with a combination of oxaliplatin, vincristine, and topotecan (OVT) paired with radiofrequency ablation (RFA) of 12 patients with multiple refractory / recurrent pulmonary hepatoblastoma. METHODS The medical records from patients with ≤21 years of age presenting with multiple deposits (≥2) of refractory / recurrent pulmonary hepatoblastoma were reviewed. The following data were extracted from each patient: age, gender, histological subtyping, cycles of OVT, tumor size, biomarkers, chemotherapy regimen and dosage, RFA details, treatment response, follow up, and patient outcomes. The primary outcome measure was the complete response (CR) of pulmonary diseases, and secondary outcomes were event-free survival rate and overall survival rate. RESULTS Of 12 assessable patients, three (25%) (95% CI, 46.3-104) patients achieved PR (partial resopnse) after they finished OVT. After RFA, five (41.7%) (95% CI, 8.95-74.4) patients achieved CR (complete response). The 2 year event-free survival rate was 33% (95% CI, 20.5-64.6). The 2 year overall survival for the study group was 41.7% (95% CI, 8.9-74.4). All toxicity events were handled satisfactorily and no toxic related deaths were observed. CONCLUSIONS Our review report shows that OVT combined with RFA can be a successful treatment modality for previously heavily treated refractory / recurrent pulmonary metastatic lesions from hepatoblastoma.
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Affiliation(s)
- Yu-Tong Zhang
- Department of Pediatric Oncology, The First Hospital of Jilin University, Changchun, China
| | - Jian Chang
- Department of Pediatric Oncology, The First Hospital of Jilin University, Changchun, China
| | - Yun-Ming Yao
- Department of Ultrasound, The First Hospital of Jilin University, Changchun, China
| | - Ya-Nan Li
- Department of Pediatric Respiratory, The First Hospital of Jilin University, Changchun, China
| | - Xiao-Dan Zhong
- Department of Pediatric Oncology, The First Hospital of Jilin University, Changchun, China
| | - Zi-Ling Liu
- Department of Oncology, The First Hospital of Jilin University, Changchun, China
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109
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Hafberg E, Borinstein SC, Alexopoulos SP. Contemporary management of hepatoblastoma. Curr Opin Organ Transplant 2020; 24:113-117. [PMID: 30762666 DOI: 10.1097/mot.0000000000000618] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Hepatoblastoma is the most common primary pediatric liver malignancy. The goal of treatment in hepatoblastoma is complete surgical resection. Recently published multinational collaborative studies are better defining risk factors for disease recurrence and guide optimal treatment strategy. RECENT FINDINGS Successful margin-negative resection of hepatoblastoma is dependent on the location and extent of disease as defined by the PRETEXT classification. Liver transplantation is an appropriate treatment modality when complete oncological resection requires total hepatectomy. In general, advanced PRETEXT class as well as histologic features, age at presentation, tumoral production of α-feto protein and the presence of metastatic disease adversely affect outcome. Hepatoblastoma is chemosensitive and significant downstaging can occur with the use of neoadjuvant chemotherapy allowing for less extensive hepatectomy. In addition, patients at moderate-to-high risk of postresection recurrence should receive neoadjuvant chemotherapy. Cisplatin-based chemotherapy can allow for resection of transplantation of patients with metastatic disease when complete metasatectomy can be achieved albeit with inferior results. SUMMARY Treatment of hepatoblastoma with surgical resection or liver transplantation is associated with excellent long-term results in the setting of modern chemotherapy.
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Affiliation(s)
- Einar Hafberg
- Division of Gastroenterology, Department of Pediatrics, Vanderbilt University Medical Center
| | - Scott C Borinstein
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center
| | - Sophoclis P Alexopoulos
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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110
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Tiusanen T, Hukkinen M, Leskinen O, Soini T, Kanerva JA, Jahnukainen T, Mäkisalo H, Heikinheimo M, Pakarinen MP. Incidence and long-term outcomes of surgically treated childhood hepatic malignancies in Finland. Acta Paediatr 2020; 109:404-414. [PMID: 31350767 DOI: 10.1111/apa.14952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/06/2019] [Accepted: 07/24/2019] [Indexed: 12/12/2022]
Abstract
AIM To analyse incidence, treatment and outcomes of paediatric liver malignancies in Finland during 1987-2017. METHODS Medical records and national cancer registry data of 47 children with liver malignancies were reviewed. Survival was calculated with the Kaplan-Meier method. RESULTS During follow-up, liver malignancy incidence remained stable at 1.1:106 . Altogether, 42 patients with hepatoblastoma (n = 24), hepatocellular carcinoma (n = 11) and undifferentiated embryonal sarcoma (n = 7) underwent surgery at median age 4.6 (interquartile range, 2.0-9.6) years and were followed up for 13 (7.0-19) years. Cumulative 5-year survival was 86% for hepatoblastoma, 41% for hepatocellular carcinoma and 67% for undifferentiated embryonal sarcoma. Five-year survival was decreased among hepatoblastoma patients aged ≥ 2.4 years (73% versus 100%, P = .040), with PRETreatment EXTent of disease IV (PRETEXT, 60% vs 100%, P = .004), and with recurrent disease (67% vs 88%, P = .029). Recurrent/residual disease associated with decreased 5-year survival in hepatocellular carcinoma (0% vs 83%, P = .028). Survival was similar among 19 transplanted and 23 resected patients. In total, 14 deaths occurred either for the underlying malignancy (n = 8), adverse effects of chemotherapy (n = 5) or unrelated reasons (n = 1). CONCLUSION Outcomes for PRETEXT I-III hepatoblastoma and un-metastasized hepatocellular carcinoma were encouraging. Adverse effects of chemotherapy significantly contributed to mortality.
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Affiliation(s)
- Toivo Tiusanen
- Pediatric Liver and Gut Research Group Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
- Pediatric Research Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Maria Hukkinen
- Pediatric Liver and Gut Research Group Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
- Pediatric Research Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
- Section of Pediatric Surgery Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Outi Leskinen
- HUS Medical Imaging Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Tea Soini
- Pediatric Research Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Jukka A. Kanerva
- Pediatric Research Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Timo Jahnukainen
- Pediatric Research Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
- Department of Pediatric Nephrology and Transplantation Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
| | - Heikki Mäkisalo
- Department of Liver and Transplantation Surgery University Hospital University of Helsinki Helsinki Finland
| | - Markku Heikinheimo
- Pediatric Research Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
- Department of Pediatrics Washington University St. Louis MO USA
| | - Mikko P. Pakarinen
- Pediatric Liver and Gut Research Group Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
- Pediatric Research Center Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
- Section of Pediatric Surgery Children's Hospital Helsinki University Hospital University of Helsinki Helsinki Finland
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Whitlock RS, Yang T, Vasudevan SA, Woodfield SE. Animal Modeling of Pediatric Liver Cancer. Cancers (Basel) 2020; 12:cancers12020273. [PMID: 31979130 PMCID: PMC7072332 DOI: 10.3390/cancers12020273] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/19/2020] [Accepted: 01/19/2020] [Indexed: 01/09/2023] Open
Abstract
Hepatoblastoma (HB) is the most common pediatric liver malignancy. Management of HB requires multidisciplinary efforts. The 5-year overall survival of this disease is about 80% in developed countries. Despite advances in the care of these patients, survival in recurrent or treatment-refractory disease is lower than 50%. This is due to more complex tumor biology, including hepatocellular carcinoma (HCC)-like mutations and expression of aggressive gene signatures leading to chemoresistance, vascular invasion, and metastatic spread. The current treatment protocols for pediatric liver cancer do not incorporate targeted therapies, and the ability to test these therapies is limited due to the inaccessibility of cell lines and mouse models. In this review, we discuss the current status of preclinical animal modeling in pediatric liver cancer, primarily HB. Although HB is a rare cancer, the research community has worked together to develop a range of interesting and relevant mouse models for diverse preclinical studies.
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Affiliation(s)
- Richard S. Whitlock
- Divisions of Pediatric Surgery and Surgical Research, Michael E. DeBakey Department of Surgery, Pediatric Surgical Oncology Laboratory, Texas Children’s Surgical Oncology Program, Texas Children’s Liver Tumor Program, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA; (R.S.W.); (S.A.V.)
| | - Tianyou Yang
- Department of Pediatric Surgery, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Sanjeev A. Vasudevan
- Divisions of Pediatric Surgery and Surgical Research, Michael E. DeBakey Department of Surgery, Pediatric Surgical Oncology Laboratory, Texas Children’s Surgical Oncology Program, Texas Children’s Liver Tumor Program, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA; (R.S.W.); (S.A.V.)
| | - Sarah E. Woodfield
- Divisions of Pediatric Surgery and Surgical Research, Michael E. DeBakey Department of Surgery, Pediatric Surgical Oncology Laboratory, Texas Children’s Surgical Oncology Program, Texas Children’s Liver Tumor Program, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX 77030, USA; (R.S.W.); (S.A.V.)
- Correspondence: ; Tel.: +1-832-824-4591
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Murase N, Kaneko K, Hama A, Yoshida N, Sakaguchi H, Chiba K, Oshiro M. Hepatoblastoma associated with trisomy 18. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2019.101342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Kachanov DY, Aliev TZ, Moiseenko RA, Roschin VY, Metelin AV, Uskova NG, Shamanskaya TV, Filin AV, Varfolomeeva SR. Hepatoblastoma relapses with a normal level of alpha-fetoprotein: report of two cases. ACTA ACUST UNITED AC 2019. [DOI: 10.24287/1726-1708-2019-18-4-58-65] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Hepatoblastoma (HB) is the most common malignant liver tumor in children. The level of alpha-fetoprotein (AFP) is used for monitoring the response to antitumor therapy and for diagnosing relapses. The occurrence of HB relapses with normal AFP levels in patients who had elevated levels of this tumor marker at disease onset is considered to be an uncommon situation. The aim of this study was to describe cases in which AFP-negative hepatoblastoma relapses developed. The study participants included two HB patients who were initially stratified into high-risk and standard-risk groups and who received treatment at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology and the Petrovsky National Research Center of Surgery inMoscow. At the moment of relapse acknowledgement these patients had normal AFP levels, which was confirmed by serial measurements. Immunohistochemistry (IHC) tests were performed on paired samples of the tumor at disease onset and at disease relapse respectively to evaluate AFP expression. The presented clinical cases demonstrate that normal AFP levels, when accompanied by suspicious clinical symptoms, do not allow to exclude an HB relapse. The possibility of relapse with a normal AFP level reinforces the importance of following the current plan of screening tests, which includes not only an evaluation of AFP levels, but also other tests such as a chest X-ray and an abdominal ultrasound. Parents gave their consent to use information about the child in the article.
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Affiliation(s)
- D. Yu. Kachanov
- Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian Federation
| | - T. Z. Aliev
- Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian Federation
| | - R. A. Moiseenko
- Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian Federation
| | - V. Yu. Roschin
- Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian Federation
| | - A. V. Metelin
- B.V. Petrovsky Russian National Center of Surgery Russian Academy of Science
| | - N. G. Uskova
- Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian Federation
| | - T. V. Shamanskaya
- Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian Federation
| | - A. V. Filin
- B.V. Petrovsky Russian National Center of Surgery Russian Academy of Science
| | - S. R. Varfolomeeva
- Dmitriy Rogachev National Medical Research Center of Pediatric Hematology, Oncology, Immunology Ministry of Healthcare of Russian Federation
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Yang W, Chen Y, Huang Y, Wang H. Analysis of factors related to recurrence of paediatric hepatoblastoma - a single Centre retrospective study. BMC Pediatr 2019; 19:485. [PMID: 31822277 PMCID: PMC6902323 DOI: 10.1186/s12887-019-1870-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/03/2019] [Indexed: 01/10/2023] Open
Abstract
Background This study was performed to identify risk factors associated with recurrence of hepatoblastoma. Methods A 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. Results Twenty-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. Conclusions Through 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.
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Affiliation(s)
- Wei Yang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, No.56 Nanlishi road, Beijing, China
| | - Yiwei Chen
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, No.56 Nanlishi road, Beijing, China
| | - Yijin Huang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, No.56 Nanlishi road, Beijing, China
| | - Huanmin Wang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, No.56 Nanlishi road, Beijing, China.
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Abstract
Advanced stage hepatoblastoma, including both locally advanced primary tumors as well as metastatic disease, poses unique clinical challenges. Despite substantial advances in chemotherapeutics, surgical extirpation remains the mainstay of cure for this tumor. Locally advanced tumors that involve multiple hepatic lobes and/or invade significant vascular structures can be managed either by complex hepatic resections or liver transplantation. We review the indications, roles, and outcomes of these surgical approaches as well as those for the resection of pulmonary metastases.
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Kobayashi T, Kubota M, Kinoshita Y, Arai Y, Oyama T, Yokota N, Saito K, Matsuda Y, Osawa M. Epidermal growth factor receptor/heme oxygenase-1 axis is involved in chemoresistance to cisplatin and pirarubicin in HepG2 cell lines and hepatoblastoma specimens. Pediatr Surg Int 2019; 35:1369-1378. [PMID: 31559456 DOI: 10.1007/s00383-019-04563-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the possibility that the antioxidant stress protein Heme oxygenase-1 (HO-1) is involved in the acquisition of chemoresistance in cisplatin and pirarubicin (CITA) therapy. METHODS Human hepatoblastoma-derived cell line (HepG2) was used to generate a knockdown cell line of HO-1 by small interfering RNA (siRNA). Expression of HO-1, epidermal growth factor receptor (EGFR), Akt, and extracellular signal-regulated kinase1/2 (ERK1/2) was examined by Western blot. The cytotoxic effect of cisplatin, pirarubicin, and EGFR inhibitor was examined by trypan blue staining. In human hepatoblastoma specimens (n = 5), changes of HO-1 expression were examined immunohistochemically before and after CITA therapy. RESULTS HO-1 expression in HepG2 cells was increased by the treatment of cisplatin (CDDP) and pirarubicin (THP) dose-dependently. In HO-1 knockdown HepG2 cells, the HO-1 was not expressed and the percentage of trypan blue-positive cells (dead cells) was significantly increased after treatment of CDDP and THP. The EGFR inhibitor decreased the levels of HO-1, phospho-Akt and phospho-ERK1/2 in HepG2 cells. Combination treatment of EGFR inhibitor with CDDP and THP increased the cytotoxic effect in HepG2 cells. In human hepatoblastoma specimens, 4 of the 5 patients (80%) showed HO-1 expression changed much stronger in the viable tumor cells after CITA therapy. CONCLUSION The cytotoxic effects of CDDP and THP were both enhanced under HO-1 knockdown conditions as well as under conditions that inhibit the activation pathway of HO-1 by EGFR inhibitors. EGFR/HO-1 axis may be involved in acquiring chemoresistance in HepG2 cell lines as well as in human hepatoblastoma.
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Affiliation(s)
- Takashi Kobayashi
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata, 951-8510, Japan.
| | - Masayuki Kubota
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata, 951-8510, Japan.,Kokuraminami Medical Care Hospital, 2-14-2 Kuzuharahigashi, Kokuraminami-ku, Kitakyu-syu, 800-0206, Japan
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Yuki Arai
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Toshiyuki Oyama
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Naoki Yokota
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Koichi Saito
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata, 951-8510, Japan
| | - Yasunobu Matsuda
- Department of Medical Technology, Niigata University Graduate School of Health Sciences, 2-746 Asahimachi-Dori, Chuo-ku, Niigata, 951-8518, Japan
| | - Mami Osawa
- Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-Dori, Chuo-ku, Niigata, 951-8510, Japan
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Lauferman L, Halac E, Aredes D, Cañon Reyes I, Cervio G, Dip M, Minetto J, Reijenstein H, Meza V, Gole M, Jacobo Dillon A, Rose A, Imventarza O. Prognostic factors for event-free survival in liver transplantation for hepatoblastoma: A single-center experience. Pediatr Transplant 2019; 23:e13581. [PMID: 31531932 DOI: 10.1111/petr.13581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/07/2019] [Accepted: 08/22/2019] [Indexed: 10/26/2022]
Abstract
Hepatoblastoma (HB) is the most common malignant liver tumor in children. Twenty percent of the cases may remain unresectable after neoadjuvant chemotherapy and, for these patients, liver transplant (LT) is an accepted therapeutic option. To analyze the risk factors to event-free survival (EFS) that influence the clinical outcome of patients with HB receiving LT, we retrospectively analyzed 21 patients with HB who underwent LT between January 1, 2005, and May 1, 2018. Overall survival (OS) was 90%. The univariate analysis shows that the AFP level at the time of LT was associated with a higher risk of EFS. With a ROC curve analysis, we established a cutoff point value of AFP levels at 16 000 ng/dL, with a sensitivity of 71.43% and a specificity of 85.71%. Multivariate analysis showed that patients with higher values of pretransplant AFP (>16 000 ng/dL) had a significantly higher risk of EFS than those transplanted with lower levels (HR: 10.180; 95% CI: 1.54-66.97; P = .02). Efforts should be made to improve the selection of candidates for LT for unresectable HB, aiming at a better definition of chemoresistance as a risk factor of poor outcomes.
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Affiliation(s)
- Leandro Lauferman
- Department of Pediatric Liver Transplantation, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Esteban Halac
- Department of Pediatric Liver Transplantation, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Diego Aredes
- Department of Pediatric Liver Transplantation, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Isabel Cañon Reyes
- Department of Pediatric Liver Transplantation, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Guillermo Cervio
- Department of Pediatric Liver Transplantation, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Marcelo Dip
- Department of Pediatric Liver Transplantation, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Julia Minetto
- Department of Pediatric Liver Transplantation, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Hayellen Reijenstein
- Department of Pediatric Liver Transplantation, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Veronica Meza
- Department of Pediatric Liver Transplantation, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Maria Gole
- Department of Pediatric Liver Transplantation, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Agustina Jacobo Dillon
- Department of Pediatric Liver Transplantation, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Adriana Rose
- Department of Pediatric Hematology-Oncology, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Oscar Imventarza
- Department of Pediatric Liver Transplantation, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
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Impact of microscopically margin-positive resection on survival in children with hepatoblastoma after hepatectomy: a retrospective cohort study. Int J Clin Oncol 2019; 25:765-773. [PMID: 31701290 DOI: 10.1007/s10147-019-01573-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/01/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Impact of R1 (microscopically margin-positive) resection on survival of patients with hepatoblastoma (HB) remains debatable. This study aimed to compare the long-term outcomes of R0 (microscopically margin-negative) and R1 resection for HB in children after hepatectomy. METHODS We retrospectively reviewed files of children with HB who underwent resection at our institution between September 1, 2005, and November 30, 2017. Survival analyses and prognostic factors were evaluated using Kaplan-Meier curves and Cox regression models. RESULTS Of 259 patients, 218 (84.2%) underwent R0 and 41 (15.8%) R1 resection. After adjusting for confounding factors, R1 resection demonstrated non-significantly lower overall survival (OS: hazard ratio [HR] = 0.75; 95% CI 0.34-1.64) and shorter event-free survival (EFS: HR = 0.97; 95% CI 0.53-1.78) rates than R0 resection. However, stratified analysis showed significantly increased risk of poor OS and EFS in patients with metastasis and mixed epithelial/mesenchymal pathologic subtype in R1 compared with R0 resection (P values for interactions < 0.05). There was no significant difference between R0 resection with metastasis and R1 resection with metastasis in the incidence of local recurrence (P = 0.494); however, a significant difference in the incidence of local recurrence was seen between R0 and R1 resection for subgroups with mixed pathologic subtypes (P = 0.035). CONCLUSIONS With effective chemotherapy, microscopic margin status may not be associated with survival outcome in children with HB undergoing hepatectomy. However, stratified analysis showed that R1 resection might be associated with decreased survival in children with mixed epithelial/mesenchymal HB, compared with R0 resection, and not affect survival outcomes in those with an epithelial subtype and without metastasis.
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Angelico R, Grimaldi C, Gazia C, Saffioti MC, Manzia TM, Castellano A, Spada M. How Do Synchronous Lung Metastases Influence the Surgical Management of Children with Hepatoblastoma? An Update and Systematic Review of the Literature. Cancers (Basel) 2019; 11:E1693. [PMID: 31683629 PMCID: PMC6895839 DOI: 10.3390/cancers11111693] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 12/11/2022] Open
Abstract
Approximately 20% of children with hepatoblastoma (HB) have metastatic disease at diagnosis, most frequently in the lungs. In children with HB, lung metastatic disease is associated with poorer prognosis. Its treatment has been approached with a variety of methods that integrate chemotherapy and surgical resection. The timing and feasibility of complete extirpation of lung metastases, by chemotherapy and/or metastasectomy, is crucial for the surgical treatment of the primary liver tumor, which can vary from major hepatic resections to liver transplantation (LT). In children with unresectable HB, which can be surgically treated only by LT, the persistence of unresectable metastases after neoadjuvant chemotherapy excludes the possibility of recurring to LT with consequent negative impact on patients' outcomes. Due to limited evidence and experience, there is no consensus amongst oncologists and surgeons across institutions regarding the surgical treatment for HB with synchronous metastatic lung disease. This narrative review aimed to update the current management of pulmonary metastasis in children with HB and to define its role in the decision-making strategy for the surgical approach to primary liver tumours.
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Affiliation(s)
- Roberta Angelico
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
| | - Chiara Grimaldi
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
| | - Carlo Gazia
- Department of Surgery Science, HPB and Transplantation Unit, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - Maria Cristina Saffioti
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
| | - Tommaso Maria Manzia
- Department of Surgery Science, HPB and Transplantation Unit, University of Rome Tor Vergata, 00133 Rome, Italy.
| | - Aurora Castellano
- Division of Oncohematology, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
| | - Marco Spada
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, 00165 Rome, Italy.
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Vaske OM, Bjork I, Salama SR, Beale H, Tayi Shah A, Sanders L, Pfeil J, Lam DL, Learned K, Durbin A, Kephart ET, Currie R, Newton Y, Swatloski T, McColl D, Vivian J, Zhu J, Lee AG, Leung SG, Spillinger A, Liu HY, Liang WS, Byron SA, Berens ME, Resnick AC, Lacayo N, Spunt SL, Rangaswami A, Huynh V, Torno L, Plant A, Kirov I, Zabokrtsky KB, Rassekh SR, Deyell RJ, Laskin J, Marra MA, Sender LS, Mueller S, Sweet-Cordero EA, Goldstein TC, Haussler D. Comparative Tumor RNA Sequencing Analysis for Difficult-to-Treat Pediatric and Young Adult Patients With Cancer. JAMA Netw Open 2019; 2:e1913968. [PMID: 31651965 PMCID: PMC6822083 DOI: 10.1001/jamanetworkopen.2019.13968] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Pediatric cancers are epigenetic diseases; therefore, considering tumor gene expression information is necessary for a complete understanding of the tumorigenic processes. OBJECTIVE To evaluate the feasibility and utility of incorporating comparative gene expression information into the precision medicine framework for difficult-to-treat pediatric and young adult patients with cancer. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted as a consortium between the University of California, Santa Cruz (UCSC) Treehouse Childhood Cancer Initiative and clinical genomic trials. RNA sequencing (RNA-Seq) data were obtained from the following 4 clinical sites and analyzed at UCSC: British Columbia Children's Hospital (n = 31), Lucile Packard Children's Hospital at Stanford University (n = 80), CHOC Children's Hospital and Hyundai Cancer Institute (n = 46), and the Pacific Pediatric Neuro-Oncology Consortium (n = 24). The study dates were January 1, 2016, to March 22, 2017. EXPOSURES Participants underwent tumor RNA-Seq profiling as part of 4 separate clinical trials at partner hospitals. The UCSC either downloaded RNA-Seq data from a partner institution for analysis in the cloud or provided a Docker pipeline that performed the same analysis at a partner institution. The UCSC then compared each participant's tumor RNA-Seq profile with more than 11 000 uniformly analyzed tumor profiles from pediatric and young adult patients with cancer, downloaded from public data repositories. These comparisons were used to identify genes and pathways that are significantly overexpressed in each patient's tumor. Results of the UCSC analysis were presented to clinical partners. MAIN OUTCOMES AND MEASURES Feasibility of a third-party institution (UCSC Treehouse Childhood Cancer Initiative) to obtain tumor RNA-Seq data from patients, conduct comparative analysis, and present analysis results to clinicians; and proportion of patients for whom comparative tumor gene expression analysis provided useful clinical and biological information. RESULTS Among 144 samples from children and young adults (median age at diagnosis, 9 years; range, 0-26 years; 72 of 118 [61.0%] male [26 patients sex unknown]) with a relapsed, refractory, or rare cancer treated on precision medicine protocols, RNA-Seq-derived gene expression was potentially useful for 99 of 144 samples (68.8%) compared with DNA mutation information that was potentially useful for only 34 of 74 samples (45.9%). CONCLUSIONS AND RELEVANCE This study's findings suggest that tumor RNA-Seq comparisons may be feasible and highlight the potential clinical utility of incorporating such comparisons into the clinical genomic interpretation framework for difficult-to-treat pediatric and young adult patients with cancer. The study also highlights for the first time to date the potential clinical utility of harmonized publicly available genomic data sets.
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Affiliation(s)
- Olena M. Vaske
- Department of Molecular, Cell, and Developmental Biology, University of California, Santa Cruz
- University of California, Santa Cruz Genomics Institute, Santa Cruz
| | - Isabel Bjork
- University of California, Santa Cruz Genomics Institute, Santa Cruz
| | - Sofie R. Salama
- University of California, Santa Cruz Genomics Institute, Santa Cruz
- Howard Hughes Medical Institute, University of California, Santa Cruz
| | - Holly Beale
- Department of Molecular, Cell, and Developmental Biology, University of California, Santa Cruz
- University of California, Santa Cruz Genomics Institute, Santa Cruz
| | - Avanthi Tayi Shah
- Division of Hematology and Oncology, Department of Pediatrics, University of California, San Francisco
| | - Lauren Sanders
- University of California, Santa Cruz Genomics Institute, Santa Cruz
| | - Jacob Pfeil
- University of California, Santa Cruz Genomics Institute, Santa Cruz
| | - Du L. Lam
- University of California, Santa Cruz Genomics Institute, Santa Cruz
| | - Katrina Learned
- University of California, Santa Cruz Genomics Institute, Santa Cruz
| | - Ann Durbin
- University of California, Santa Cruz Genomics Institute, Santa Cruz
| | - Ellen T. Kephart
- University of California, Santa Cruz Genomics Institute, Santa Cruz
| | - Rob Currie
- University of California, Santa Cruz Genomics Institute, Santa Cruz
| | - Yulia Newton
- University of California, Santa Cruz Genomics Institute, Santa Cruz
| | - Teresa Swatloski
- University of California, Santa Cruz Genomics Institute, Santa Cruz
| | - Duncan McColl
- University of California, Santa Cruz Genomics Institute, Santa Cruz
| | - John Vivian
- University of California, Santa Cruz Genomics Institute, Santa Cruz
| | - Jingchun Zhu
- University of California, Santa Cruz Genomics Institute, Santa Cruz
| | - Alex G. Lee
- Division of Hematology and Oncology, Department of Pediatrics, University of California, San Francisco
| | - Stanley G. Leung
- Division of Hematology and Oncology, Department of Pediatrics, University of California, San Francisco
| | - Aviv Spillinger
- Division of Hematology and Oncology, Department of Pediatrics, University of California, San Francisco
| | - Heng-Yi Liu
- Division of Hematology and Oncology, Department of Pediatrics, University of California, San Francisco
| | - Winnie S. Liang
- Integrated Cancer Genomics Division, Translational Genomics Research Institute (TGen), Phoenix, Arizona
| | - Sara A. Byron
- Integrated Cancer Genomics Division, Translational Genomics Research Institute (TGen), Phoenix, Arizona
| | | | - Adam C. Resnick
- Center for Data Driven Discovery in Biomedicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Norman Lacayo
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Sheri L. Spunt
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Arun Rangaswami
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Van Huynh
- CHOC Children’s Hospital, Hyundai Cancer Institute, Orange, California
| | - Lilibeth Torno
- CHOC Children’s Hospital, Hyundai Cancer Institute, Orange, California
| | - Ashley Plant
- CHOC Children’s Hospital, Hyundai Cancer Institute, Orange, California
| | - Ivan Kirov
- CHOC Children’s Hospital, Hyundai Cancer Institute, Orange, California
| | | | - S. Rod Rassekh
- British Columbia Children’s Hospital Research Institute, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Rebecca J. Deyell
- British Columbia Children’s Hospital Research Institute, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | | | - Marco A. Marra
- Canada’s Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Leonard S. Sender
- CHOC Children’s Hospital, Hyundai Cancer Institute, Orange, California
| | - Sabine Mueller
- Department of Neurology, University of California, San Francisco
- Department of Neurosurgery, University of California, San Francisco
- Department of Pediatrics, University of California, San Francisco
| | | | - Theodore C. Goldstein
- University of California, Santa Cruz Genomics Institute, Santa Cruz
- Now with Anthem, Inc, Palo Alto, California
| | - David Haussler
- University of California, Santa Cruz Genomics Institute, Santa Cruz
- Howard Hughes Medical Institute, University of California, Santa Cruz
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121
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Rare malignant liver tumors in children. Pediatr Radiol 2019; 49:1404-1421. [PMID: 31620842 DOI: 10.1007/s00247-019-04402-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/07/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023]
Abstract
Malignant hepatic tumors in children are rare, comprising 1.3% of all pediatric malignancies. Following hepatoblastoma, hepatocellular carcinoma is the second most common. Other malignant hepatic tumors seen in childhood include those of mesenchymal origin including undifferentiated embryonal sarcoma, angiosarcoma, rhabdomyosarcoma and epithelioid hemangioendothelioma, as well as biliary tumors such as cholangiocarcinoma. Diagnosis can be challenging because of their rarity, and the recognition of distinctive imaging features for certain tumors such as epithelioid hemangioendothelioma and biliary rhabdomyosarcoma can focus the differential diagnosis and expedite the diagnostic process. A complete MRI examination with hepatocyte-specific contrast media and diffusion-weighted imaging helps to focus the differential diagnosis, and, although findings are often nonspecific, in some cases typical features on MRI can be helpful in diagnosis. Histopathological analysis is usually required for definitive diagnosis. Hepatic tumors tend to be aggressive, and full staging is imperative to establish disease extent. Significant proportions are not amenable to upfront surgical resection and often require a multimodality approach including neoadjuvant chemotherapy within a multidisciplinary setting. Facilitating complete surgical resection is usually required for better survival. In this review, we emphasize pathology and imaging features for rare liver tumors that are useful in reaching a prompt diagnosis. We also discuss general clinical findings, prognosis and management of these tumors.
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122
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Yamada Y, Ohno M, Fujino A, Kanamori Y, Irie R, Yoshioka T, Miyazaki O, Uchida H, Fukuda A, Sakamoto S, Kasahara M, Matsumoto K, Fuchimoto Y, Hoshino K, Kuroda T, Hishiki T. Fluorescence-Guided Surgery for Hepatoblastoma with Indocyanine Green. Cancers (Basel) 2019; 11:cancers11081215. [PMID: 31434361 PMCID: PMC6721588 DOI: 10.3390/cancers11081215] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 01/06/2023] Open
Abstract
Fluorescence-guided surgery with indocyanine green (ICG) for malignant hepatic tumors has been gaining more attention with technical advancements. Since hepatoblastomas (HBs) possess similar features to hepatocellular carcinoma, fluorescence-guided surgery can be used for HBs, as aggressive surgical resection, even for distant metastases of HBs, often contributes positively to R0 (complete) resection and subsequent patient survival. Despite a few caveats, fluorescence-guided surgery allows for the more sensitive identification of lesions that may go undetected by conventional imaging or be invisible macroscopically. This leads to precise resection of distant metastatic tumors as well as primary liver tumors.
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Affiliation(s)
- Yohei Yamada
- Department of Pediatric Surgery, National Center for Child Health and Development, Tokyo 157-0074, Japan.
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Michinobu Ohno
- Department of Pediatric Surgery, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Akihiro Fujino
- Department of Pediatric Surgery, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Yutaka Kanamori
- Department of Pediatric Surgery, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Rie Irie
- Department of Pathology, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Takako Yoshioka
- Department of Pathology, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Osamu Miyazaki
- Department of Radiology, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Hajime Uchida
- Center for Organ Transplantation, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Akinari Fukuda
- Center for Organ Transplantation, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Seisuke Sakamoto
- Center for Organ Transplantation, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Mureo Kasahara
- Center for Organ Transplantation, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Kimikazu Matsumoto
- Children Cancer Center, National Center for Child Health and Development, Tokyo 157-0074, Japan
| | - Yasushi Fuchimoto
- Department of Pediatric Surgery, International University of Health and Welfare, Chiba 286-0048, Japan
| | - Ken Hoshino
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tomoro Hishiki
- Division of Surgical Oncology, National Center for Child Health and Development, Tokyo 157-0074, Japan
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123
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Lucas DJ, Rubinstein J, Gosain A, Tiao G, Head T, Pratap JN, Williams R, Helmig S, Geller J, Langham M, Trobaugh-Lotrario A. Surgical and anesthetic management for hepatectomy in two pediatric patients with trisomy 18, pulmonary hypertension, and hepatoblastoma. Pediatr Blood Cancer 2019; 66:e27678. [PMID: 30803146 DOI: 10.1002/pbc.27678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 11/06/2022]
Abstract
Children with trisomy 18 are surviving longer and undergoing more aggressive life-sustaining therapy. This report describes two patients with trisomy 18 and hepatoblastoma (HB) successfully resected in the setting of significant pulmonary hypertension. Forty-four previously published cases of the association between HB and trisomy 18 are reviewed. With careful multidisciplinary preoperative planning, successful resection of HB in children with trisomy 18 who have significant pulmonary hypertension is feasible. Because HB and trisomy 18 are increasing in prevalence, the need for timely liver tumor resection in the setting of pulmonary hypertension will be more common.
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Affiliation(s)
- Donald J Lucas
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Jeremy Rubinstein
- Department of Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ankush Gosain
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Greg Tiao
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Tim Head
- Department of Anesthesia, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - J Nick Pratap
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.,Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Regan Williams
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Sara Helmig
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - James Geller
- Department of Cancer and Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Max Langham
- Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Angela Trobaugh-Lotrario
- Division of Pediatric Hematology/Oncology, Providence Sacred Heart Children's Hospital, Spokane, Washington
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124
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Takahashi N, Yamada Y, Hoshino K, Kawaida M, Mori T, Abe K, Fujimura T, Matsubara K, Hibi T, Shinoda M, Obara H, Isshiki K, Shima H, Shimada H, Kameyama K, Fuchimoto Y, Kitagawa Y, Kuroda T. Living Donor Liver Re-Transplantation for Recurrent Hepatoblastoma in the Liver Graft following Complete Eradication of Peritoneal Metastases under Indocyanine Green Fluorescence Imaging. Cancers (Basel) 2019; 11:cancers11050730. [PMID: 31130716 PMCID: PMC6562613 DOI: 10.3390/cancers11050730] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/16/2019] [Accepted: 05/25/2019] [Indexed: 12/18/2022] Open
Abstract
The curability of chemotherapy-resistant hepatoblastoma (HB) largely depends on the achievement of radical surgical resection. Navigation techniques utilizing indocyanine green (ICG) are a powerful tool for detecting small metastatic lesions. We herein report a patient who underwent a second living donor liver transplantation (LDLTx) for multiple recurrent HBs in the liver graft following metastasectomy for peritoneal dissemination with ICG navigation. The patient initially presented with ruptured HB at 6 years of age and underwent 3 liver resections followed by the first LDLTx with multiple sessions of chemotherapy at 11 years of age. His alpha-fetoprotein (AFP) level increased above the normal limit, and metastases were noted in the transplanted liver and peritoneum four years after the first LDLTx. The patient underwent metastasectomy of the peritoneally disseminated HBs with ICG navigation followed by the second LDLTx for multiple metastases in the transplanted liver. The patient has been recurrence-free with a normal AFP for 30 months since the second LDLTx. To our knowledge, this report is the first successful case of re-LDLTx for recurrent HBs. Re-LDLTx for recurrent HB can be performed in highly select patients, and ICG navigation is a powerful surgical tool for achieving tumor clearance.
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Affiliation(s)
- Nobuhiro Takahashi
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Yohei Yamada
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
- Department of Pediatric Surgery, National Center for Child Health and Development, Tokyo 157-0074, Japan.
| | - Ken Hoshino
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Miho Kawaida
- Department of Pathology, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Teizaburo Mori
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Kiyotomo Abe
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Takumi Fujimura
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Kentaro Matsubara
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Taizo Hibi
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
- Department of Pediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto 860-0862, Japan.
| | - Masahiro Shinoda
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Hideaki Obara
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Kyohei Isshiki
- Department of Pediatrics, Keio University School of Medicine, Tokyo 160-8582, Japan.
- Children's Cancer Center, National Center for Child Health and Development, Tokyo 157-0074, Japan.
| | - Haruko Shima
- Department of Pediatrics, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Hiroyuki Shimada
- Department of Pediatrics, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Kaori Kameyama
- Department of Pathology, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Yasushi Fuchimoto
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
- Department of Pediatric Surgery, International University of Health and Welfare, Chiba 286-0048, Japan.
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
| | - Tatsuo Kuroda
- Department of Pediatric Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan.
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125
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Retrospective Analysis of Childhood Hepatoblastoma in a Single Centre in China. Clin Oncol (R Coll Radiol) 2019; 31:471-478. [PMID: 31000431 DOI: 10.1016/j.clon.2019.03.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/27/2019] [Accepted: 02/28/2019] [Indexed: 01/23/2023]
Abstract
AIMS To investigate the protocol efficacy and prognostic factors for paediatric hepatoblastoma in a multidisciplinary model in our centre. MATERIALS AND METHODS Consecutive hepatoblastoma patients (<18 years old) treated at Shanghai Children's Medical Center in China from August 2011 to October 2017 were analysed retrospectively for clinical features, chemotherapy courses, surgical treatment and outcomes. RESULTS One hundred and four cases of paediatric hepatoblastoma (64 males, 40 females; median age at diagnosis 1.64 years) had a median follow-up of 30.68 months (range 8.3-73.3 months). First complete remission was achieved in 95 cases, 85 of which achieved continuous complete remission. Another three cases were lost to follow-up after a median of 24.73 months in complete remission. Seven cases relapsed later, with two achieving a second complete remission and four deaths. Nine cases did not achieve complete remission and five of them died. In general, the 5-year overall survival rate and 5-year event-free survival (EFS) rate were 86.3 ± 5.0% and 81.8 ± 4.3%, respectively. Thirty-two cases were classified as standard risk and 72 as high risk with 5-year EFS of 96.8 ± 3.2% and 75.7 ± 5.7% (P = 0.029) and 5-year overall survival of 100% and 80.5 ± 7.0%, respectively. The mean platelet count (P = 0.0036), lactate dehydrogenase (P = 0.0443) and ferritin level (P = 0.0006) at diagnosis were much higher in the high-risk group than in the standard-risk group. Univariate analysis showed that patients <5 years of age (P = 0.018), with higher α-fetoprotein (AFP) level (>100 ng/ml, P = 0.008), without metastases at diagnosis (P = 0.001) and postoperative AFP recovery after no more than three chemocycles (P = 0.014) had better overall survival. In addition, the above factors, except metastases at diagnosis and risk group, were associated with prognosis in the multivariate analysis. CONCLUSIONS The result of this protocol had similar overall survival and EFS rates compared with those in developed countries. Normal postoperative AFP levels after three chemocycles has prognostic value.
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126
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Czauderna P. Is it worth completely resecting hepatoblastoma at diagnosis? Lancet Oncol 2019; 20:614-615. [PMID: 30975628 DOI: 10.1016/s1470-2045(19)30096-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/04/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Piotr Czauderna
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, 80-210 Gdansk, Poland.
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127
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Skoczen S, Stepien K, Krzysztofik M, Luszawska T, Hnatko-Kolacz M, Korostynski M, Piechota M, Kolanek K, Wyrobek L, Wysocka K, Gorecki W, Balwierz W. Genetic Profile and Clinical Implications of Hepatoblastoma and Neuroblastoma Coexistence in a Child. Front Oncol 2019; 9:230. [PMID: 31019896 PMCID: PMC6458242 DOI: 10.3389/fonc.2019.00230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/14/2019] [Indexed: 01/06/2023] Open
Abstract
The aim of the following case report is to provide a description of the coexistence of two independent tumors in a child. A 9-month-old male was referred to Department of Pediatric Oncology and Hematology with hepatic tumor present on ultrasound imaging and symptoms of enlarged abdominal circumference. Physical examination revealed a palpable epigastric mass and the imaging techniques showed a tumor of the left hepatic lobe measuring 11 × 6.5 × 8.9 cm with pancreas infiltration, distant metastases in both lungs and abnormal lesion in the left adrenal gland. Basing on histopathological examination, after a core-needle biopsy, hepatoblastoma (HBL) (mixed epithelial-mesenchymal subtype) was diagnosed. The α-fetoprotein level was 112 993 ng/ml. Elevated values of normetanephrine, 3-methoxytyramine as well as neuron-specific enolase were observed. Due to the clinical picture and diagnosis, the patient was qualified to preoperative chemotherapy according to the SIOPEL-3 protocol, followed by SIOPEL-4 protocol for the high-risk patients. After undergoing preoperative chemotherapy, imaging tests revealed regression of hepatic tumor and no focal pulmonary masses, while regression of adrenal gland mass was not completed. The patient was qualified for left hemihepatectomy with left adrenalectomy. Histopathological examination of liver specimen confirmed the HBL diagnosis. However, in left adrenal gland and paraaortic lymph nodes the residual neuroblastoma (NBL) cells were detected. Whole exome sequencing (WES) was utilized to identify disease-associated germline mutations. WES revealed a novel germline insertion variant in TWIST1 (p.Gly86dup), along with the potentially pathogenic non-synonymous variants in NF1 (p.Val2511Ile), RAF1 (p.Leu445Arg), and WHSC1 (p.Ser4Asn) genes. Currently, 6 months after completion of treatment according to the SIOPEL-4 protocol, the patient is in good general condition, without any signs, and symptoms of relapse of both neoplasms. The coexistence of two different primary childhood malignancies is rarely seen. So far, only one case of synchronous HBL and NBL has been reported. However, for the first time therapeutic process was successful. A specific signature of rare germline mutations can be proposed as a predisposing factor to synchronous HBL and NBL occurrence.
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Affiliation(s)
- Szymon Skoczen
- Department of Oncology and Hematology, University Children's Hospital, Krakow, Poland.,Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Konrad Stepien
- Student Scientific Group of Pediatric Oncology and Hematology, Jagiellonian University Medical College, Krakow, Poland
| | - Marta Krzysztofik
- Student Scientific Group of Pediatric Oncology and Hematology, Jagiellonian University Medical College, Krakow, Poland
| | - Teresa Luszawska
- Department of Oncology and Hematology, University Children's Hospital, Krakow, Poland
| | | | - Michal Korostynski
- Department of Molecular Neuropharmacology, Institute of Pharmacology of Polish Academy of Sciences, Krakow, Poland.,Intelliseq sp. z o.o., Krakow, Poland
| | - Marcin Piechota
- Department of Molecular Neuropharmacology, Institute of Pharmacology of Polish Academy of Sciences, Krakow, Poland.,Intelliseq sp. z o.o., Krakow, Poland
| | | | - Lukasz Wyrobek
- Department of Radiology, University Children's Hospital, Krakow, Poland
| | - Katarzyna Wysocka
- Department of Pathology, University Children's Hospital, Krakow, Poland
| | - Wojciech Gorecki
- Department of Pediatric Surgery, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Walentyna Balwierz
- Department of Oncology and Hematology, University Children's Hospital, Krakow, Poland.,Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
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128
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Stage at diagnosis for childhood solid cancers in Australia: A population-based study. Cancer Epidemiol 2019; 59:208-214. [DOI: 10.1016/j.canep.2019.02.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/12/2019] [Accepted: 02/16/2019] [Indexed: 12/17/2022]
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129
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Seng MS, Berry B, Karpelowsky J, Thomas G, Mews C, Stormon M, Shun A, Cole C. Successful treatment of a metastatic hepatocellular malignant neoplasm, not otherwise specified with chemotherapy and liver transplantation. Pediatr Blood Cancer 2019; 66:e27603. [PMID: 30609257 DOI: 10.1002/pbc.27603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 10/22/2018] [Accepted: 11/17/2018] [Indexed: 01/04/2023]
Abstract
Hepatocellular malignant neoplasm, not otherwise specified (HCN-NOS) is a provisional entity describing a subset of rare malignant pediatric liver tumors with overlapping features of hepatoblastoma and hepatocellular carcinoma. We present a case illustration of metastatic HCN-NOS successfully treated with a backbone of hepatoblastoma chemotherapy, pulmonary metastastectomy, and liver transplantation, along with a literature review of the clinical outcomes of HCN.
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Affiliation(s)
- Michaela S Seng
- Department of Haematology and Oncology, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Department of Haematology and Oncology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Bligh Berry
- Department of Anatomical Pathology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Jonathan Karpelowsky
- Department of Paediatric Surgery, Children's Hospital at Westmead, Westmead, Australia.,Division of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - Gordon Thomas
- Department of Paediatric Surgery, Children's Hospital at Westmead, Westmead, Australia.,Division of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - Catherine Mews
- Department of Gastroenterology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Michael Stormon
- Division of Child and Adolescent Health, University of Sydney, Sydney, Australia.,Department of Gastroenterology, Children's Hospital at Westmead, Westmead, Australia
| | - Albert Shun
- Department of Paediatric Surgery, Children's Hospital at Westmead, Westmead, Australia.,Division of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - Catherine Cole
- Paediatric Haematology and Oncology, Sidra Medicine, Doha, Qatar
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130
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Disease-specific Hospitalizations Among 5-Year Survivors of Hepatoblastoma: A Nordic Population-based Cohort Study. J Pediatr Hematol Oncol 2019; 41:181-186. [PMID: 30557167 DOI: 10.1097/mph.0000000000001378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The long-term risk of somatic disease in hepatoblastoma survivors has not been thoroughly evaluated in previous studies. In this population-based study of 86 five-year HB survivors, we used inpatient registers to evaluate the risk for a range of somatic diseases. METHODS In total, 86 five-year survivors of hepatoblastoma were identified in the Nordic cancer registries from 1964 to 2008 and 152,231 population comparisons were selected. Study subjects were followed in national hospital registries for somatic disease classified into 12 main diagnostic groups. Standardized hospitalization rate ratios (RRs) and absolute excess risks were calculated. RESULTS After a median follow-up of 11 years, 35 of the 86 five-year hepatoblastoma survivors had been hospitalized with a total of 69 hospitalizations, resulting in an RR of 2.7 (95% confidence interval [CI], 2.2-3.5) and an overall absolute excess risk of 4.2 per 100 person-years. Highest risk was seen for benign neoplasms (RR=16) with 6 hospitalizations for benign neoplasms in the colon and one in rectum. CONCLUSIONS The pattern of hospitalizations found in this first comprehensive follow-up of hepatoblastoma survivors seems reassuring. Less than 50% of the 5-year survivors had been hospitalized and often for diseases that were not severe or life-threatening.
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131
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Addition of Vincristine and Irinotecan to Standard Therapy in a Patient With Refractory High-risk Hepatoblastoma Achieving Long-term Relapse-free Survival. J Pediatr Hematol Oncol 2019; 41:e171-e173. [PMID: 29668545 DOI: 10.1097/mph.0000000000001171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Children with metastatic hepatoblastoma have a poor prognosis, even with dose intensification of cisplatin and doxorubicin. Vincristine and irinotecan have demonstrated activity in high risk disease. This report describes a 3-year-old girl with metastatic hepatoblastoma with unresectable disease after 5 cycles of cisplatin, 5-fluorouracil, vincristine, and doxorubicin who had a complete response of her metastatic disease to vincristine and irinotecan (intravenous and oral forms), allowing surgical resection of her liver disease. She remains in remission 48 months since therapy completion.
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132
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Editorial: Advances in clinical liver transplantation: expanding indications and improving peri- and post-transplant care. Curr Opin Organ Transplant 2019; 24:111-112. [PMID: 30730355 DOI: 10.1097/mot.0000000000000626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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133
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Aronson DC, Weeda VB, Maibach R, Czauderna P, Dall’Igna P, de Ville de Goyet J, Branchereau S, Perilongo G, Brock P, Zsiros J, Semeraro M, Chardot C, Wildhaber B, Morland B, Brugières L. Microscopically positive resection margin after hepatoblastoma resection: what is the impact on prognosis? A Childhood Liver Tumours Strategy Group (SIOPEL) report. Eur J Cancer 2019; 106:126-132. [DOI: 10.1016/j.ejca.2018.10.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/08/2018] [Accepted: 10/22/2018] [Indexed: 12/21/2022]
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134
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Liu APY, Ip JJK, Leung AWK, Luk CW, Li CH, Ho KKH, Lo R, Chan EKW, Chan ACY, Chung PHY, Chiang AKS. Treatment outcome and pattern of failure in hepatoblastoma treated with a consensus protocol in Hong Kong. Pediatr Blood Cancer 2019; 66:e27482. [PMID: 30270490 DOI: 10.1002/pbc.27482] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 09/04/2018] [Accepted: 09/10/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIM We reviewed the results and pattern of failure of the consensus HB/HCC 1996 treatment protocol for pediatric hepatoblastoma (HB) in Hong Kong. The role of SIOPEL and Children's Hepatic tumors International Collaboration (CHIC) risk stratification was evaluated. METHODS Patients enrolled on the protocol from 1996 to 2014 were included. PRETEXT staging, SIOPEL, and CHIC risk groups were retrospectively assigned. RESULTS Sixty patients were enrolled with median age at diagnosis of 1.1 years and median follow-up time of 6.8 years. Alpha-fetoprotein (AFP) was raised (>100 ng/mL) in 58 (97%) patients. Five (8%) had metastases at presentation and 7 (12%) experienced tumor rupture prior to or during treatment. Twenty-nine patients (48%) received a first-line cisplatin, 5-fluorouracil, and vincristine regimen only while 23 (38%) also had alternative chemotherapeutic agents. Hepatic resection could be performed in 48 (80%) patients. Three (5%) patients underwent upfront liver transplantation. Five-year event-free survival and overall survival rates were 69.2% ± 6.1% and 77.6% ± 5.5% respectively. Among the 16 patients with relapse/progression, 9 had intrahepatic failure only, 5 had distant failure only, and 2 had combined local and distant failure. Predictors of inferior outcome included advanced Evans staging, disease involving both lobes, rupture, low AFP, and suboptimal response to first-line chemotherapy. Assigned in 44 patients, PRETEXT staging, SIOPEL, and CHIC risk groups significantly predicted EFS and OS. CONCLUSIONS Although the consensus HB/HCC 1996 protocol led to cure in three-quarters of pediatric HB patients, an upfront risk stratification system is required to identify and improve the outcome of high-risk patients.
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Affiliation(s)
- Anthony P Y Liu
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
| | - Janice J K Ip
- Department of Radiology, Queen Mary Hospital, Hong Kong SAR
| | - Alex W K Leung
- Department of Paediatrics, Prince of Wales Hospital, Hong Kong SAR
| | - C W Luk
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong SAR
| | - C H Li
- Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong SAR
| | - Karin K H Ho
- Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong SAR
| | - Regina Lo
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
| | - Edwin K W Chan
- Department of Surgery, Prince of Wales Hospital, Hong Kong SAR
| | - Albert C Y Chan
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
| | - Patrick H Y Chung
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
| | - Alan K S Chiang
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR
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135
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Ren X, Li H, Diao M, Chen L, Xu H, Li L. Results of surgical resections with positive margins for children with hepatoblastoma: Case series from a single Asian center. Pediatr Blood Cancer 2019; 66:e27479. [PMID: 30255649 DOI: 10.1002/pbc.27479] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/25/2018] [Accepted: 09/10/2018] [Indexed: 01/16/2023]
Abstract
The influence of margin status on the survival of patients with hepatoblastoma (HB) remains controversial. Here, we report long-term follow-up outcomes of 26 patients with HB who underwent hepatectomy with positive microscopic margins. Although these patients had microscopic residuals, the 5-year overall survival and event-free survival rates of those who had no metastases or macrovascular involvement (MVI) were 86.7% and 80.8%, respectively. This may support the hypothesis that patients with HB who undergo hepatectomy with positive microscopic residuals but without MVI or metastases can also achieve satisfactory survival rate. Further studies in this field are required.
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Affiliation(s)
- Xianghai Ren
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Haibo Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Long Chen
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Hang Xu
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, People's Republic of China
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136
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Fujita H, Hirose K, Sato M, Fujioka I, Fujita T, Aoki M, Takai Y. Metformin attenuates hypoxia-induced resistance to cisplatin in the HepG2 cell line. Oncol Lett 2018; 17:2431-2440. [PMID: 30719114 DOI: 10.3892/ol.2018.9869] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 11/14/2018] [Indexed: 12/30/2022] Open
Abstract
Hepatoblastoma is the most commonly occurring liver tumor in children. Preoperative chemotherapy and surgery have improved treatment outcomes; however, further improvements are required in the treatment of advanced cases. Recently, the efficacy of transarterial chemoembolization (TACE) has garnered attention. TACE increases the local concentration of drugs by transcatheterically administering antitumor agents, and induces necrosis in the tumor by embolizing the feeding artery. However, studies have revealed that tumors exhibit resistance to anticancer drugs in hypoxic environments. Metformin is a drug used to treat type 2 diabetes; however, recent reports have indicated that it may also exhibit antitumor effects in various cancer cell lines. These effects are hypothesized to be mediated by the activation of adenosine monophosphate-activated protein kinase and reduction of mammalian target of rapamycin signaling, but these effects occur at high concentrations that are not suitable for use in a clinical setting. The potential efficacy of metformin at increased physiological concentrations has not been evaluated. The present study investigated the therapeutic effect of low concentrations of metformin in combination with cisplatin on liver cancer HepG2 cells in hypoxic conditions. HepG2 cells were treated with cisplatin alone, metformin alone, or a combination of these two drugs and cultured in normoxia or hypoxia. Treatment with either 5 µM cisplatin or 1 mM metformin alone did not significantly affect cell proliferation or apoptosis in hypoxic conditions. However, when 5 µM cisplatin was combined with 1 mM metformin, a significant inhibition of cell proliferation and induction of apoptosis was observed in hypoxic HepG2 cells. In conclusion, a low concentration of metformin attenuates hypoxia-induced resistance to cisplatin in HepG2 cells. Selective delivery of an effective dose of metformin to a hepatoblastoma tumor may be achievable and clinically useful with TACE.
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Affiliation(s)
- Hiromasa Fujita
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036-8562, Japan
| | - Katsumi Hirose
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036-8562, Japan.,Department of Radiation Oncology, Southern Tohoku BNCT Research Center, Koriyama, Fukushima 963-8052, Japan
| | - Mariko Sato
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036-8562, Japan
| | - Ichitaro Fujioka
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036-8562, Japan
| | - Tamaki Fujita
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036-8562, Japan
| | - Masahiko Aoki
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036-8562, Japan
| | - Yoshihiro Takai
- Department of Radiology and Radiation Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori 036-8562, Japan.,Department of Radiation Oncology, Southern Tohoku BNCT Research Center, Koriyama, Fukushima 963-8052, Japan
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137
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Uchida H, Sakamoto S, Sasaki K, Takeda M, Hirata Y, Fukuda A, Hishiki T, Irie R, Nakazawa A, Miyazaki O, Nosaka S, Kasahara M. Surgical treatment strategy for advanced hepatoblastoma: Resection versus transplantation. Pediatr Blood Cancer 2018; 65:e27383. [PMID: 30084209 DOI: 10.1002/pbc.27383] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/26/2018] [Accepted: 07/03/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Excellent outcomes of the extreme procedure of liver resection (LR) for advanced hepatoblastoma (HB) have been achieved in recent reports. However, liver transplantation (LT) remains the only surgical treatment for patients with unresectable HB. The aim of this study was to evaluate our retrospective data for cases of advanced HB necessitating surgical intervention and analyze the prognostic factors of recurrence by comparing patients with tumors resected by LR and LT. PATIENTS AND METHODS We retrospectively reviewed 24 children with PRETEXT II/III/IV tumors that required consideration for LT between August 2011 and September 2016. RESULT The staging at the time of the diagnosis was PRETEXT II/III/IV in 1/13/10 patients, respectively, while the preoperative staging after neoadjuvant chemotherapy was POSTTEXT II/III/IV in 5/17/2 patients. Among those 24 patients, complete resection of the primary tumor was achieved with LT in 12 patients and LR in 12 patients. A high serum level of alpha-fetoprotein (AFP) at the time of surgery, no significant decrease in the rate of change of AFP, and low tumor shrinkage rate were related to the risk of tumor recurrence, and patients with tumors resected by LR with those risks had a higher recurrence rate than those without them. The overall survival was higher in patients with tumors resected by LT (100%) than in patients with tumors resected by LR. CONCLUSION Patients with advanced HB with a poor response to chemotherapy should definitively be prioritized for primary LT, given the possibility of vascular invasion and microscopic residual tumor.
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Affiliation(s)
- Hajime Uchida
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Seisuke Sakamoto
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Kengo Sasaki
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Masahiro Takeda
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Yoshihiro Hirata
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Akinari Fukuda
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Tomoro Hishiki
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
| | - Rie Irie
- Division of Clinical Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Atsuko Nakazawa
- Division of Clinical Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Osamu Miyazaki
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Shunsuke Nosaka
- Division of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Mureo Kasahara
- Organ Transplantation Center, National Center for Child Health and Development, Tokyo, Japan
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138
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Chen E, Rangaswami A, Esquivel CO, Concepcion W, Lungren M, Thakor AS, Yoo CH, Donaldson SS, Hiniker SM. Orthotopic Liver Transplantation After Stereotactic Body Radiotherapy for Pediatric Hepatocellular Carcinoma with Central Biliary Obstruction and Nodal Involvement. Cureus 2018; 10:e3499. [PMID: 30648040 PMCID: PMC6318132 DOI: 10.7759/cureus.3499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Here we describe the case of a 10-year-old boy with a history of chronic hepatitis B who was diagnosed with hepatocellular carcinoma (HCC) with a large central hepatic mass and metastatic disease in a celiac lymph node. His tumor was unresectable, due to location and lack of clear margins, and he could not receive chemotherapy due to elevated bilirubin. He was treated with stereotactic body radiotherapy (SBRT) to the primary site and involved nodal region. After completing radiotherapy, his total bilirubin level fell below 1.0 mg/dL, allowing him to begin systemic therapy with cisplatin and doxorubicin. At three months after SBRT, his bilirubin was 0.1 mg/dL, alpha-fetoprotein (AFP) was 88 ng/mL, and imaging demonstrated a decrease in tumor size (total volume 28.7 cc), with no evidence of local or distant disease progression. He then developed distant disease within the liver, but his disease remained controlled at the primary site and nodes that had been treated with SBRT. He underwent orthotopic liver transplantation (OLT) with an uneventful operative course and remains with no evidence of disease at seven months after OLT. This is one of the first reported cases of successful downstaging of pediatric HCC with nodal involvement to allow for OLT, and it argues for consideration of similar patients for OLT.
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Affiliation(s)
- Emily Chen
- Radiation Oncology, Stanford University School of Medicine, Stanford, USA
| | - Arun Rangaswami
- Pediatric Hematology / Oncology, Lucile Packard Children's Hospital, Stanford, USA
| | | | | | - Matt Lungren
- Interventional Radiology, Stanford University School of Medicine, Stanford, USA
| | - Avnesh S Thakor
- Interventional Radiology, Stanford University School of Medicine, Stanford, USA
| | - Christopher H Yoo
- Radiation Oncology, Stanford University School of Medicine, Stanford, USA
| | - Sarah S Donaldson
- Radiation Oncology, Stanford University School of Medicine, Stanford, USA
| | - Susan M Hiniker
- Radiation Oncology, Stanford University Medical Center, Stanford, USA
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139
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Hathway GJ, Murphy E, Lloyd J, Greenspon C, Hulse RP. Cancer Chemotherapy in Early Life Significantly Alters the Maturation of Pain Processing. Neuroscience 2018; 387:214-229. [PMID: 29196027 PMCID: PMC6150930 DOI: 10.1016/j.neuroscience.2017.11.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/24/2017] [Accepted: 11/16/2017] [Indexed: 12/22/2022]
Abstract
Advances in pediatric cancer treatment have led to a ten year survival rate greater than 75%. Platinum-based chemotherapies (e.g. cisplatin) induce peripheral sensory neuropathy in adult and pediatric cancer patients. The period from birth through to adulthood represents a period of maturation within nociceptive systems. Here we investigated how cisplatin impacts upon postnatal maturation of nociceptive systems. Neonatal Wistar rats (Postnatal day (P) 7) were injected (i.p.) daily with either vehicle (PBS) or cisplatin (1mg/kg) for five consecutive days. Neither group developed mechanical or thermal hypersensitivity immediately during or after treatment. At P22 the cisplatin group developed mechanical (P < 0.05) and thermal (P < 0.0001) hypersensitivity versus vehicle group. Total DRG or dorsal horn neuronal number did not differ at P45, however there was an increase in intraepidermal nerve fiber density in cisplatin-treated animals at this age. The percentage of IB4+ve, CGRP+ve and NF200+ve DRG neurons was not different between groups at P45. There was an increase in TrkA+ve DRG neurons in the cisplatin group at P45, in addition to increased TrkA, NF200 and vGLUT2 immunoreactivity in the lumbar dorsal horn versus controls. These data highlight the impact pediatric cancer chemotherapy has upon the maturation of pain pathways and later life pain experience.
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Affiliation(s)
- G J Hathway
- School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom.
| | - Emily Murphy
- Cancer Biology, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Joseph Lloyd
- School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - Charles Greenspon
- School of Life Sciences, University of Nottingham, Nottingham NG7 2UH, United Kingdom
| | - R P Hulse
- Cancer Biology, School of Medicine, University of Nottingham, Nottingham NG7 2UH, United Kingdom; School of Science and Technology, Nottingham Trent University, Clifton Lane, Nottingham NG11 8NS, United Kingdom.
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140
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von Frowein J, Hauck SM, Kappler R, Pagel P, Fleischmann KK, Magg T, Cairo S, Roscher A, von Schweinitz D, Schmid I. MiR-492 regulates metastatic properties of hepatoblastoma via CD44. Liver Int 2018; 38:1280-1291. [PMID: 29314711 DOI: 10.1111/liv.13687] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 12/18/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS MicroRNAs are important genetic regulators of physiological and pathophysiological processes including cancer initiation and progression of hepatoblastoma, the most common liver tumour in childhood. We aimed to identify malignant and metastasis promoting effects of miR-492, a miRNA, previously reported to be overexpressed in metastatic hepatoblastoma. Furthermore, we intended to evaluate its diagnostic and prognostic potential. METHODS Stable and transient overexpression of miR-492 in two liver tumour cell lines HepT1 and HUH7 was used to analyse features of metastatic tumour progression such as proliferation, anchorage-independent growth, migration and invasion. Via a mass spectrometry based proteomic screen, we investigated miRNA-492-dependent effects on proteome level and explored the underlying biology. One of the predicted target genes, CD44, was experimentally validated via luciferase assays. Diagnostic and prognostic properties of miR-492 were studied in hepatoblastoma tumour samples. RESULTS We show that miR-492 significantly enhances cell proliferation, anchorage-independent growth, migration and invasion of hepatoblastoma cells. We also identified and validated CD44, a transmembrane adhesion receptor for hyaluronan, as direct and functional target of miR-492. This miRNA has a strong direct impact on two CD44 isoforms (standard and v10). High miR-492 expression correlates with high-risk or aggressive tumours and further bears potential for predicting reduced event-free survival. CONCLUSIONS We identified miR-492 and its target CD44 as regulators of a number of biological features important for malignancy and metastasis. Furthermore, we demonstrated the diagnostic and prognostic potential of miR-492, a promising novel therapeutic target and biomarker for hepatoblastoma.
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Affiliation(s)
- Julia von Frowein
- Department of Pediatric Hematology and Oncology, Children's Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stefanie M Hauck
- Research Unit Protein Science, Helmholtz Zentrum Munich (GmbH), German Research Center for Environmental Health, Munich, Germany
| | - Roland Kappler
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Philipp Pagel
- Lehrstuhl für Genomorientierte Bioinformatik, Technische Universität München, Freising, Germany.,numares AG, Regensburg, Germany
| | - Katrin K Fleischmann
- Department of Pediatric Hematology and Oncology, Children's Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Thomas Magg
- Department of Pediatric Hematology and Oncology, Children's Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Stefano Cairo
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy.,XenTech, Evry, France
| | - Adelbert Roscher
- Children's Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Dietrich von Schweinitz
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Irene Schmid
- Department of Pediatric Hematology and Oncology, Children's Research Center, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
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141
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Brock PR, Maibach R, Childs M, Rajput K, Roebuck D, Sullivan MJ, Laithier V, Ronghe M, Dall'Igna P, Hiyama E, Brichard B, Skeen J, Mateos ME, Capra M, Rangaswami AA, Ansari M, Rechnitzer C, Veal GJ, Covezzoli A, Brugières L, Perilongo G, Czauderna P, Morland B, Neuwelt EA. Sodium Thiosulfate for Protection from Cisplatin-Induced Hearing Loss. N Engl J Med 2018; 378:2376-2385. [PMID: 29924955 PMCID: PMC6117111 DOI: 10.1056/nejmoa1801109] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cisplatin chemotherapy and surgery are effective treatments for children with standard-risk hepatoblastoma but may cause considerable and irreversible hearing loss. This trial compared cisplatin with cisplatin plus delayed administration of sodium thiosulfate, aiming to reduce the incidence and severity of cisplatin-related ototoxic effects without jeopardizing overall and event-free survival. METHODS We randomly assigned children older than 1 month and younger than 18 years of age who had standard-risk hepatoblastoma (≤3 involved liver sectors, no metastatic disease, and an alpha-fetoprotein level of >100 ng per milliliter) to receive cisplatin alone (at a dose of 80 mg per square meter of body-surface area, administered over a period of 6 hours) or cisplatin plus sodium thiosulfate (at a dose of 20 g per square meter, administered intravenously over a 15-minute period, 6 hours after the discontinuation of cisplatin) for four preoperative and two postoperative courses. The primary end point was the absolute hearing threshold, as measured by pure-tone audiometry, at a minimum age of 3.5 years. Hearing loss was assessed according to the Brock grade (on a scale from 0 to 4, with higher grades indicating greater hearing loss). The main secondary end points were overall survival and event-free survival at 3 years. RESULTS A total of 109 children were randomly assigned to receive cisplatin plus sodium thiosulfate (57 children) or cisplatin alone (52) and could be evaluated. Sodium thiosulfate was associated with few high-grade toxic effects. The absolute hearing threshold was assessed in 101 children. Hearing loss of grade 1 or higher occurred in 18 of 55 children (33%) in the cisplatin-sodium thiosulfate group, as compared with 29 of 46 (63%) in the cisplatin-alone group, indicating a 48% lower incidence of hearing loss in the cisplatin-sodium thiosulfate group (relative risk, 0.52; 95% confidence interval [CI], 0.33 to 0.81; P=0.002). At a median of 52 months of follow-up, the 3-year rates of event-free survival were 82% (95% CI, 69 to 90) in the cisplatin-sodium thiosulfate group and 79% (95% CI, 65 to 88) in the cisplatin-alone group, and the 3-year rates of overall survival were 98% (95% CI, 88 to 100) and 92% (95% CI, 81 to 97), respectively. CONCLUSIONS The addition of sodium thiosulfate, administered 6 hours after cisplatin chemotherapy, resulted in a lower incidence of cisplatin-induced hearing loss among children with standard-risk hepatoblastoma, without jeopardizing overall or event-free survival. (Funded by Cancer Research UK and others; SIOPEL 6 ClinicalTrials.gov number, NCT00652132 ; EudraCT number, 2007-002402-21 .).
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Affiliation(s)
- Penelope R Brock
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Rudolf Maibach
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Margaret Childs
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Kaukab Rajput
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Derek Roebuck
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Michael J Sullivan
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Véronique Laithier
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Milind Ronghe
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Patrizia Dall'Igna
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Eiso Hiyama
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Bénédicte Brichard
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Jane Skeen
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - M Elena Mateos
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Michael Capra
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Arun A Rangaswami
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Marc Ansari
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Catherine Rechnitzer
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Gareth J Veal
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Anna Covezzoli
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Laurence Brugières
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Giorgio Perilongo
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Piotr Czauderna
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Bruce Morland
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
| | - Edward A Neuwelt
- From Great Ormond Street Hospital, London (P.R.B., K.R., D.R.), Nottingham Clinical Trials Unit, Nottingham (M. Childs), Royal Hospital for Sick Children, Glasgow (M.R.), Northern Institute for Cancer Research, Newcastle University, Newcastle upon Tyne (G.J.V.), and University of Birmingham, Birmingham (B.M.) - all in the United Kingdom; International Breast Cancer Study Group, Bern (R.M.), and Hôpital Universitaire de Genève, Geneva (M.A.) - both in Switzerland; University of Melbourne, Melbourne, VIC, Australia (M.J.S.); University of Otago, Christchurch (M.J.S.), and Starship Children's Hospital, Auckland (J.S.) - both in New Zealand; Centre Hospitalier Universitaire, Besançon (V.L.), and Institut de Cancerologie Gustave Roussy, Villejuif (L.B.) - both in France; University of Padua, Padua (P.D., G.P.), and Consorzio Interuniversitario (CINECA), Bologna (A.C.) - both in Italy; Hiroshima University, Hiroshima, Japan (E.H.); Cliniques Universitaires Saint Luc, Brussels (B.B.); University Hospital Reina Sofia, Cordoba, Spain (M.E.M.); Our Lady's Children's Hospital, Dublin (M. Capra); Stanford University Medical Center, Palo Alto, CA (A.A.R.); University Hospital Rigshospitalet, Copenhagen (C.R.); Medical University of Gdansk, Gdansk, Poland (P.C.); and Oregon Health and Science University, Portland (E.A.N.)
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142
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Thomas F, Veal GJ, El Balkhi S, Lafont T, Picard N, Brugières L, Chatelut E, Piguet C. Therapeutic drug monitoring and dose adaptation of cisplatin in a newborn with hepatoblastoma: a case report. Cancer Chemother Pharmacol 2018; 82:361-365. [DOI: 10.1007/s00280-018-3625-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/12/2018] [Indexed: 11/24/2022]
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143
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Yamada Y, Hoshino K, Mori T, Kawaida M, Abe K, Takahashi N, Fujimura T, Kameyama K, Kuroda T. Metastasectomy of Hepatoblastoma Utilizing a Novel Overlay Fluorescence Imaging System. J Laparoendosc Adv Surg Tech A 2018; 28:1152-1155. [PMID: 29906233 DOI: 10.1089/lap.2017.0735] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The curability of hepatoblastoma (HB) largely depends on the achievement of radical surgical resection, even for metastatic tumors. However, the extension of the metastatic tumor when viewed through an endoscope with the conventional white-light mode is often unclear. Advancements in imaging technology utilizing indocyanine green (ICG) have facilitated precise resection of metastatic HBs, owing to the longer retention of ICG in such lesions than in other normal tissues. CASE We utilized an endoscope loaded with the PINPOINT system (NOVADAQ Technologies, Inc., Ontario, Canada), which allows for real-time overlay visualization with the same focal range between the white-light mode and near-infrared mode. Metastatic HBs that have taken up ICG are visualized as an area of green color superimposed on a high-definition white-light image. A 19-year-old female who underwent liver transplantation for an unresectable HB 2 years earlier was noted to have metastases on the diaphragm and the pleura. Preoperative magnetic resonance imaging showed metastatic HBs on the right pleura extending from the ribs and the diaphragm. The margin of the metastatic tumor was more sharply demarcated by the PINPOINT system than that detected in the normal white-light mode. The tumor was successfully resected en bloc with real-time guidance utilizing the overlay image. The alphafetoprotein levels were normalized and have remained within normal limits in the 12 months since the operation. CONCLUSION Novel overlay imaging technology with ICG makes it possible to achieve real-time precise resection of metastatic HBs.
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Affiliation(s)
- Yohei Yamada
- 1 Department of Pediatric Surgery, Keio University School of Medicine , Tokyo, Japan
| | - Ken Hoshino
- 1 Department of Pediatric Surgery, Keio University School of Medicine , Tokyo, Japan
| | - Teisaburo Mori
- 1 Department of Pediatric Surgery, Keio University School of Medicine , Tokyo, Japan
| | - Miho Kawaida
- 2 Department of Pathology, Keio University School of Medicine , Tokyo, Japan
| | - Kiyotomo Abe
- 1 Department of Pediatric Surgery, Keio University School of Medicine , Tokyo, Japan
| | - Nobuhiro Takahashi
- 1 Department of Pediatric Surgery, Keio University School of Medicine , Tokyo, Japan
| | - Takumi Fujimura
- 1 Department of Pediatric Surgery, Keio University School of Medicine , Tokyo, Japan
| | - Kaori Kameyama
- 2 Department of Pathology, Keio University School of Medicine , Tokyo, Japan
| | - Tatsuo Kuroda
- 1 Department of Pediatric Surgery, Keio University School of Medicine , Tokyo, Japan
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144
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Yang T, Tan T, Yang J, Pan J, Hu C, Li J, Xu T, Zou Y. Ruptured hepatoblastoma successfully treated with cisplatin monochemotherapy: A case report. Mol Clin Oncol 2018; 9:223-225. [PMID: 30101027 DOI: 10.3892/mco.2018.1643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 06/03/2018] [Indexed: 11/05/2022] Open
Abstract
Traditionally, ruptured hepatoblastoma is considered a high-risk occurrence, necessitating a chemotherapy regimen usually consisting of cisplatin alternating with carboplatin plus doxorubicin, based on International Childhood Liver Tumours Strategy Group studies. However, ruptured hepatoblastomas with intact hepatic capsules may represent a unique subgroup that may be successfully treated with TAE, cisplatin monotherapy, and surgical excision. We herein present a case of ruptured hepatoblastoma (pretreatment tumor extension stage II) in a 1-year-old female patient that was successfully managed with transarterial embolization (TAE), eight courses of cisplatin chemotherapy and surgical removal. The patient currently remains disease-free for >12 months. Given the rarity of ruptured hepatoblastomas, further study of patients within this subgroup is required to confirm the findings of the present study.
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Affiliation(s)
- Tianyou Yang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, P.R. China
| | - Tianbao Tan
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, P.R. China
| | - Jiliang Yang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, P.R. China
| | - Jing Pan
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, P.R. China
| | - Chao Hu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, P.R. China
| | - Jiahao Li
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, P.R. China
| | - Tao Xu
- Department of Hematology-Oncology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, P.R. China
| | - Yan Zou
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong 510623, P.R. China
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145
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Nguyen R, McCarville MB, Sykes A, Mao S, Wu J, Langham MR, Furman WL. Rapid decrease of serum alpha-fetoprotein and tumor volume predicts outcome in children with hepatoblastoma treated with neoadjuvant chemotherapy. Int J Clin Oncol 2018; 23:900-907. [DOI: 10.1007/s10147-018-1285-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 04/24/2018] [Indexed: 12/30/2022]
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146
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Towbin AJ, Meyers RL, Woodley H, Miyazaki O, Weldon CB, Morland B, Hiyama E, Czauderna P, Roebuck DJ, Tiao GM. 2017 PRETEXT: radiologic staging system for primary hepatic malignancies of childhood revised for the Paediatric Hepatic International Tumour Trial (PHITT). Pediatr Radiol 2018; 48:536-554. [PMID: 29427028 DOI: 10.1007/s00247-018-4078-z] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 11/01/2017] [Accepted: 01/11/2018] [Indexed: 02/07/2023]
Abstract
Imaging is crucial in the assessment of children with a primary hepatic malignancy. Since its inception in 1992, the PRETEXT (PRE-Treatment EXTent of tumor) system has become the primary method of risk stratification for hepatoblastoma and pediatric hepatocellular carcinoma in numerous cooperative group trials across the world. The PRETEXT system is made of two components: the PRETEXT group and the annotation factors. The PRETEXT group describes the extent of tumor within the liver while the annotation factors help to describe associated features such as vascular involvement (either portal vein or hepatic vein/inferior vena cava), extrahepatic disease, multifocality, tumor rupture and metastatic disease (to both the lungs and lymph nodes). This manuscript is written by members of the Children's Oncology Group (COG) in North America, the International Childhood Liver Tumors Strategy Group (SIOPEL) in Europe, and the Japanese Study Group for Pediatric Liver Tumor (JPLT; now part of the Japan Children's Cancer Group) and represents an international consensus update to the 2005 PRETEXT definitions. These definitions will be used in the forthcoming Trial to Pediatric Hepatic International Tumor Trial (PHITT).
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Affiliation(s)
- Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA.
| | - Rebecka L Meyers
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Helen Woodley
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Osamu Miyazaki
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Christopher B Weldon
- Departments of Surgery and Oncology, Boston Children's Hospital/Dana Farber Cancer Institute, Boston, MA, USA
| | - Bruce Morland
- Department of Oncology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Eiso Hiyama
- Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Piotr Czauderna
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
| | - Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital for Children, London, WC1N 3JH, UK
| | - Greg M Tiao
- Division of General and Thoracic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA
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147
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Lungren MP, Towbin AJ, Roebuck DJ, Monroe EJ, Gill AE, Thakor A, Towbin RB, Cahill AM, Matthew Hawkins C. Role of interventional radiology in managing pediatric liver tumors : Part 1: Endovascular interventions. Pediatr Radiol 2018; 48:555-564. [PMID: 29362840 DOI: 10.1007/s00247-018-4068-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/02/2017] [Accepted: 01/03/2018] [Indexed: 12/14/2022]
Abstract
Primary liver malignancies are rare in children. Hepatoblastoma and hepatocellular carcinoma (HCC) together represent the overwhelming majority of cases. Overall survival of hepatoblastoma approaches 80% with multimodal treatment approaches that include chemotherapy, surgery and transplantation. However, there remains a subset of children with hepatoblastoma in whom resection or transplantation is not possible. The 5-year survival for children diagnosed with HCC is less than 30% and remains a significant therapeutic challenge. The poor outcomes for children with primary liver tumors motivate investigation of new therapeutic alternatives. Interventional oncology offers a broad scope of percutaneous and transcatheter endovascular cancer therapies that might provide clinical benefits. Minimally invasive approaches are distinct from medical, surgical and radiation oncologic treatments, and in adults these approaches have been established as the fourth pillar of cancer care. Transarterial chemoembolization is a minimally invasive locoregional treatment option performed by interventional radiologists with level-I evidence as standard of care in adults with advanced liver malignancy; transarterial chemoembolization in adults has served to prolong disease-free progression, downstage and bridge patients for surgical and transplant interventions, and improve overall survival. However, while several groups have reported that transarterial chemoembolization is feasible in children, the published experience is limited primarily to small retrospective case series. The lack of prospective trial evidence has in part limited the utilization of transarterial chemoembolization in the pediatric patient population. The purpose of this article is to provide an overview of the role of interventional radiology in the diagnosis and endovascular management of hepatic malignancies in children.
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Affiliation(s)
- Matthew P Lungren
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Road Room 1862, Stanford, CA, 94305-5913, USA.
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Derek J Roebuck
- Department of Radiology, Great Ormond Street Hospital, London, UK
| | - Eric J Monroe
- Department of Radiology, Division of Interventional Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Anne E Gill
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
| | - Avnesh Thakor
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, 725 Welch Road Room 1862, Stanford, CA, 94305-5913, USA
| | - Richard B Towbin
- Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Anne Marie Cahill
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - C Matthew Hawkins
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-guided Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA
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148
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Zhao T, Xu Y, Ren S, Liang C, Zhou X, Wu J. The siRNA silencing of DcR3 expression induces Fas ligand-mediated apoptosis in HepG2 cells. Exp Ther Med 2018; 15:4370-4378. [PMID: 29725377 PMCID: PMC5920343 DOI: 10.3892/etm.2018.5964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/08/2018] [Indexed: 12/30/2022] Open
Abstract
Dysfunctional Fas ligand (FasL) may inhibit the apoptosis of tumor cells. FasL contains two receptors, Fas and Decoy Receptor 3 (DcR3). DcR3 competitively binds to FasL over Fas, resulting in the inhibition of FasL-mediated apoptosis. Therefore, it was suggested that the downregulation of DcR3 expression enhances FasL-mediated apoptosis. In the current study, the expression of DcR3 was silenced in liver cancer HepG2 cells in order to study the effect of FasL on HepG2 cell activity and invasiveness. DcR3 siRNA knockdown HepG2 cells (KD), DcR3 blank plasmid control HepG2 cells and wild-type HepG2 cells (WT) were treated with FasL (10 ng/ml). Flow cytometry was used to detect changes in the cell cycle and apoptosis. MTS, clonogenic, wound healing and Transwell assays were performed to examine changes in cell activity, proliferation, migration and invasiveness. Reverse transcription polymerase chain reaction and western blot analysis were performed to measure the expression of DcR3, matrix metallopeptidase 9 (MMP9), vascular endothelial growth factor (VEGF)-C and VEGF-D. The results demonstrated that, compared with WT cells, the proportion of KD cells in the G2/M phase decreased following treatment with FasL. KD cells were more sensitive to FasL-induced apoptosis. Following treatment with FasL, the activity and proliferation, migration and invasion of KD cells were reduced, and the expression of MMP9, VEGF-C and VEGF-D decreased. Furthermore, it was demonstrated that DcR3 is involved in the proliferation and invasion of HepG2 cells, and this mechanism may be associated with the regulatory effect of the expression of MMP9, VEGF-C and VEGF-D; however, the exact mechanism of action remains unclear. FollowingDcR3 silencing, FasL-mediated apoptosis increased in HepG2 cells. Therefore, DcR3 combined with FasL may be a potential target for the treatment of liver cancer.
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Affiliation(s)
- Tuanjie Zhao
- Department of General Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
| | - Yingchen Xu
- Department of General Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
| | - Shulin Ren
- Department of General Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
| | - Chaojie Liang
- Department of General Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
| | - Xiaona Zhou
- Department of General Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
| | - Jixiang Wu
- Department of General Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P.R. China
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149
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Umeda K, Okajima H, Kawaguchi K, Nodomi S, Saida S, Kato I, Hiramatsu H, Ogawa E, Yoshizawa A, Okamoto S, Uemoto S, Watanabe K, Adachi S. Prognostic and therapeutic factors influencing the clinical outcome of hepatoblastoma after liver transplantation: A single-institute experience. Pediatr Transplant 2018; 22. [PMID: 29341393 DOI: 10.1111/petr.13113] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 12/14/2022]
Abstract
LT has contributed to an elevation in cure rates for patients with unresectable HB; however, patients with recurrent HB after LT have poor prognosis. To analyze the prognostic and therapeutic factors that influence the clinical outcome of patients with HB receiving LT, we retrospectively analyzed 24 patients with HB who underwent LT between 1997 and 2015. The 5-year OS rate of all patients was 69.6±9.7%. The 5-year OS rate of 11 patients receiving salvage LT for recurrent tumor after a primary resection was comparable to that of 13 patients receiving primary LT. Among 12 evaluable patients receiving primary LT, six of 10 patients with a decline of serum AFP >95% at LT are currently alive and in remission, whereas two patients with a decline of AFP ≤95% experienced post-LT relapse. Among 9 evaluable patients receiving salvage LT, all three patients with any decline of AFP at LT are currently alive in remission, and three of six patients with no response to pre-LT salvage chemotherapy are also alive and in remission. Response to chemotherapy may be a reliable marker for prediction of post-LT relapse, even for patients receiving salvage LT.
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Affiliation(s)
- Katsutsugu Umeda
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideaki Okajima
- Department of Pediatric Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Kawaguchi
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Hematology and Oncology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Seishiro Nodomi
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Satoshi Saida
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Itaru Kato
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hidefumi Hiramatsu
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Eri Ogawa
- Department of Pediatric Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Yoshizawa
- Department of Pediatric Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinya Okamoto
- Department of Pediatric Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Department of Pediatric Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenichiro Watanabe
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Hematology and Oncology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Souichi Adachi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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150
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Tracking cellular and molecular changes in a species-specific manner during experimental tumor progression in vivo. Oncotarget 2018; 9:16149-16162. [PMID: 29662633 PMCID: PMC5882324 DOI: 10.18632/oncotarget.24598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 02/21/2018] [Indexed: 01/29/2023] Open
Abstract
Hepatoblastoma (HBL) is a pediatric liver cancer with defined molecular alterations driving its progression. Here, we describe an animal model for HBL on the chick chorioallantoic membrane (CAM), which recapitulates relevant features of HBL in patients. Expression of classic tumor-associated proteins such as β-catenin, EpCAM and CK19 was maintained in acini-like organized tumors on CAM, as was synthesis of AFP, a tumor marker used for monitoring patient response. RNA sequencing revealed an unexpected molecular evolution of HBL cells on the CAM, with significant deregulation of more than 6,000 genes including more than half of all HOX genes. Bioinformatic analysis distinguish between tumor cell-expressed genes and chick genes, thereby shedding new light on the complex interactions taking place during HBL progression. Importantly, human tumor suppressive ribosomal genes were downregulated after implantation, whereas mitochondrial genes encoding for anti-apoptotic peptides were strongly induced in vivo. Meprin-1α expression was increased during evolution of CAM tumors and confirmed by immunohistochemistry. Cisplatin, a commonly used chemotherapeutic agent for HBL, showed significant anti-tumoral effects. Our results broaden the understanding of the molecular adaptation process of human cancer cells to the microenvironment and might help to elaborate novel therapeutic concepts for the treatment of this pediatric liver tumor.
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