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Farooqui Z, Johnston M, Schepers E, Brewer N, Hartman S, Jenkins T, Bondoc A, Pai A, Geller J, Tiao GM. Quality of Life Outcomes for Patients Who Underwent Conventional Resection and Liver Transplantation for Locally Advanced Hepatoblastoma. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050890. [PMID: 37238438 DOI: 10.3390/children10050890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/04/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
Hepatoblastoma is the most common malignant liver tumor of childhood, with liver transplant and extended resection used as surgical treatments for locally advanced tumors. Although each approach has well-described post-operative complications, quality-of-life outcomes have not been described following the two interventions. Long-term pediatric survivors of hepatoblastoma who underwent conventional liver resection or liver transplantation at a single institution from January 2000-December 2013 were recruited to complete quality-of-life surveys. Survey responses for the Pediatric Quality of Life Generic Core 4.0 (PedsQL, n = 30 patient and n = 31 parent surveys) and Pediatric Quality of Life Cancer Module 3.0 (PedsQL-Cancer, n = 29 patient and n = 31 parent surveys) were collected from patients and parents. The mean total patient-reported PedsQL score was 73.7, and the parent-reported score was 73.9. There were no significant differences in scores on the PedsQL between patients who underwent resection compared to those who underwent transplantation (p > 0.05 for all comparisons). On the PedsQL-Cancer module, procedural anxiety scores were significantly lower for patients who underwent resection as compared to transplant (M = 33.47 points less, CI [-60.41, -6.53], p-value 0.017). This cross-sectional study demonstrates that quality of life outcomes are overall similar among patients receiving transplants and resections. Patients who received a resection reported worse procedural anxiety.
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Affiliation(s)
- Zishaan Farooqui
- Department of Surgery, University of Cincinnati College of Medicine, CARE/Crawley Building, Suite E-870 Eden Avenue, Cincinnati, OH 45267, USA
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Michael Johnston
- Department of Surgery, University of Cincinnati College of Medicine, CARE/Crawley Building, Suite E-870 Eden Avenue, Cincinnati, OH 45267, USA
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Emily Schepers
- Department of Surgery, University of Cincinnati College of Medicine, CARE/Crawley Building, Suite E-870 Eden Avenue, Cincinnati, OH 45267, USA
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Nathalie Brewer
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Stephen Hartman
- Department of Surgery, University of Cincinnati College of Medicine, CARE/Crawley Building, Suite E-870 Eden Avenue, Cincinnati, OH 45267, USA
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Todd Jenkins
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Alexander Bondoc
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Ahna Pai
- Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - James Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Gregory M Tiao
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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Abstract
Hepatoblastoma is the most common primary malignant paediatric liver tumour and surgery remains the cornerstone of its management. The aim of this article is to present the principles of surgical treatment of hepatoblastoma. All aspects of surgery in hepatoblastoma are discussed, from biopsy, through conventional and laparoscopic liver resections, to extreme resection with adjacent structures, staged hepatectomy and transplantation.
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Affiliation(s)
- Maciej Murawski
- Department of Pediatric Surgery and Urology, Medical University of Gdansk, Gdansk, Poland.
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, 1-6 Nowe Ogrody St., 80-803, Gdansk, Poland.
| | - Viola B Weeda
- Department of Surgery, University Academic Medical Centre Groningen, University of Amsterdam, Amsterdam, The Netherlands
| | - Piotr Czauderna
- Department of Pediatric Surgery and Urology, Medical University of Gdansk, Gdansk, Poland
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State of the art and perspectives in pediatric hepatocellular carcinoma. Biochem Pharmacol 2023; 207:115373. [PMID: 36513143 DOI: 10.1016/j.bcp.2022.115373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/29/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022]
Abstract
Hepatoblastoma (HB) and pediatric hepatocellular carcinoma (HCC) are rare primary malignant liver cancers in children and young adults. HB is the most common and accounts for about 70 % cases; it is usually diagnosed during the first 3 years of life. Instead, pediatric HCC is uncommon, and it is associated with a poor prognosis. Overall, the prognosis of pediatric HCC is dismal with 5-year event-free survival of <30 % as compared to >80 % for HB. Surgery approaches, either resection or transplant, remain the best chance for the cure of pediatric HCC. However, chemotherapy can be helpful as an adjuvant or neoadjuvant treatment. International groups have done trials in pediatric HCC with a chemotherapy regimen, based on cisplatin and doxorubicin (PLADO) as for HB, but the efficacy is limited. Sorafenib, a multi-kinase inhibitor, following positive results in adults and in a pilot study in children, is now tested in conjunction with chemotherapy in the PHITT phase III clinical trial. Some studies have been exploring the genetic profiles of patients to find biological hallmarks that determine the aggressiveness of pediatric HCC. Pathways involved in growth and differentiation are dysregulated and as demonstrated in HB and adult HCC, an important role of the Wnt/CTNNB1 pathway in the pathogenesis of pediatric HCC is also emerging. An extended molecular analysis of tumor samples could give information about pathways as possible targets of biological and immunotherapeutic agents bringing new pharmacological options for the treatment of pediatric HCC.
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Wu WK, Ziogas IA, Matsuoka LK, Izzy M, Pai AK, Benedetti DJ, Alexopoulos SP. Waitlist mortality and post-liver transplant outcomes of pediatric patients with hepatocellular carcinoma and hepatoblastoma in the United States. Pediatr Blood Cancer 2022; 69:e29425. [PMID: 34736292 DOI: 10.1002/pbc.29425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Liver transplantation (LT) is offered in cases of advanced disease for both pediatric patients with hepatoblastoma (HBL) and those with hepatocellular carcinoma (HCC). Current United States organ allocation priorities differ between the two groups. METHODS We retrospectively examined the waitlist and posttransplant outcomes of pediatric LT candidates with HBL and HCC using the United Network for Organ Sharing registry (February 2002 to September 2020). RESULTS Six hundred sixty-eight children with HBL and 95 children with HCC listed for first LT were identified. Patients with HBL were younger (p < .001), had lower laboratory Model for End-stage Liver Disease (MELD)/Pediatric End-stage Liver Disease (PELD) scores (p < .001), and had lesser proportion with encephalopathy (p = .01). Patients with HCC had an increased risk of waitlist mortality in univariable (unadjusted subdistribution hazard ratio [sHR] = 4.37, 95% confidence interval [CI], 2.01-9.51, p < .001) and multivariable competing risk regression (adjusted sHR = 3.08, 95% CI 1.13-8.37, p = .03) accounting for age and laboratory MELD/PELD score. Five hundred ninety-five children underwent LT for HBL and 76 for HCC. Patients transplanted for HBL had a significantly higher proportion with status 1B exception (71.3% vs. 7.9%, p < .001). No difference was observed in patient (unadjusted log-rank test, p = .52; adjusted hazard ratio [HR] = 0.77, 95% CI, 0.40-1.48, p = .43) or graft survival (unadjusted log-rank test, p = .93; adjusted HR = 0.74, 95% CI 0.42-1.33, p = .32) between HCC and HBL recipients. CONCLUSION Waitlist mortality for pediatric LT candidates with HCC is significantly higher than for HBL, while posttransplant patient and graft survival are similar. This highlights an opportunity to improve equitable prioritization for children with HCC who may have reduced access to size-appropriate deceased donor organs and less effective bridge-to-transplant therapies.
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Affiliation(s)
- W Kelly Wu
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ioannis A Ziogas
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lea K Matsuoka
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manhal Izzy
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anita K Pai
- Department of Pediatrics, D. Brent Polk Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel J Benedetti
- Department of Pediatrics, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sophoclis P Alexopoulos
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Moosburner S, Schmelzle M, Schöning W, Kästner A, Seika P, Globke B, Dziodzio T, Pratschke J, Öllinger R, Gül-Klein S. Liver Transplantation Is Highly Effective in Children with Irresectable Hepatoblastoma. MEDICINA-LITHUANIA 2021; 57:medicina57080819. [PMID: 34441025 PMCID: PMC8399470 DOI: 10.3390/medicina57080819] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 01/19/2023]
Abstract
Background and Objectives: In children, hepatoblastoma preferentially is managed by liver resection (LR). However, in irresectable cases, liver transplantation (LT) is required. The aim of our study was to compare short- and long-term results after LR and LT for the curative treatment of hepatoblastoma. Materials and Methods: Retrospective analysis of all patients treated surgically for hepatoblastoma from January 2000 until December 2019 was performed. Demographic and clinical data were collected before and after surgery. The primary endpoints were disease free survival and patient survival. Results: In total, 38 patients were included into our analysis (n = 28 for LR, n = 10 for LT) with a median follow-up of 5 years. 36 patients received chemotherapy prior to surgery. Total hospital stay and intensive care unit (ICU) stay were significantly longer within the LT vs. the LR group (ICU 23 vs. 4 days, hospital stay 34 vs. 16 days, respectively; p < 0.001). Surgical complications (≤Clavien–Dindo 3a) were equally distributed in both groups (60% vs. 57%; p = 1.00). Severe complications (≥Clavien–Dindo 3a) were more frequent after LT (50% vs. 21.4%; p = 0.11). Recurrence rates were 10.7% for LR and 0% for LT at 5 years after resection or transplantation (p = 0.94). Overall, 5-year survival was 90% for LT and 96% for LR (p = 0.44). Conclusions: In irresectable cases, liver transplantation reveals excellent outcomes in children with hepatoblastoma with an acceptable number of perioperative complications.
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Affiliation(s)
- Simon Moosburner
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
- BIH Charité (Digital) Clinician Scientist Program, Berlin Institute of Health, 10178 Berlin, Germany
- Correspondence: (S.M.); (S.G.-K.); Tel.: +01-76-3452-1755 (S.M.); +49-17-0740-2409 (S.G.-K.)
| | - Moritz Schmelzle
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
| | - Wenzel Schöning
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
| | - Anika Kästner
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
| | - Philippa Seika
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
| | - Brigitta Globke
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
- BIH Charité (Digital) Clinician Scientist Program, Berlin Institute of Health, 10178 Berlin, Germany
| | - Tomasz Dziodzio
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
| | - Johann Pratschke
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
| | - Robert Öllinger
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
| | - Safak Gül-Klein
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
- Correspondence: (S.M.); (S.G.-K.); Tel.: +01-76-3452-1755 (S.M.); +49-17-0740-2409 (S.G.-K.)
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Sarin Y, Narang R, Tomar R, Kumar S, Giri P, Radhakrishnan A. Extrahepatic hepatoblastoma- an extremely rare occurrence. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Murawski M, Scheer M, Leuschner I, Stefanowicz J, Bonar J, Dembowska-Bagińska B, Kaliciński P, Koscielniak E, Czauderna P, Fuchs J. Undifferentiated sarcoma of the liver: Multicenter international experience of the Cooperative Soft-Tissue Sarcoma Group and Polish Paediatric Solid Tumor Group. Pediatr Blood Cancer 2020; 67:e28598. [PMID: 32706511 DOI: 10.1002/pbc.28598] [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: 11/12/2019] [Revised: 06/23/2020] [Accepted: 06/29/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Undifferentiated embryonal sarcomas of the liver (UESL) are extremely rare and continue to pose a diagnostic and therapeutic challenge. The aim of the study was to present a multicenter experience of the German CWS and Polish PPSTG groups in the treatment of UESL in children. PROCEDURE Twenty-five patients were treated according to the CWS-96, CWS-2002, and CYVADIC protocols. Distant metastases were observed in four cases (16%). In four cases, an initial disease presentation mimicked other entities. A pure cystic appearance of liver mass led to misdiagnosis of hydatid cyst in three cases. In one case, laparotomy was performed due to the signs of appendicitis, and bleeding from ruptured liver tumor was found. All these patients were finally diagnosed as UESL. RESULTS Thirteen patients received preoperative chemotherapy. Partial response was observed in 10 cases. Tumor resection was performed in 20 patients (primary resections, 12; delayed resections-, 8). In five patients, the primary tumor never became operable. The macroscopically complete resection rate was 95% (19/20). Postoperative chemotherapy was given to 20 children. Local radiotherapy was used in three children. After a median follow-up time of 136 months, 17 patients (68%) were alive with no evidence of disease. All children with unresectable tumor and three out of four patients with distant metastases died. The five-year overall survival (OS) rate was 72%. CONCLUSIONS In summary, a complete tumor excision plays the central role in the treatment of UESL. A cystic presentation of the liver lesion on imaging does not exclude the diagnosis of malignant tumor.
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Affiliation(s)
- Maciej Murawski
- Deptartment of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
| | - Monika Scheer
- Department of Pediatric Hematology, Oncology and Immunology, Olgahospital, Klinikum Stuttgart, Germany
| | - Ivo Leuschner
- Department of Pediatric Hematology, Oncology and Immunology, Olgahospital, Klinikum Stuttgart, Germany.,Department of Pediatric Pathology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Joanna Stefanowicz
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Jolanta Bonar
- Department of Bone Marrow Transplantation, Children Oncology and Haematology, Medical University of Wroclaw, Wroclaw, Poland
| | | | - Piotr Kaliciński
- Department of Pediatric Surgery and Organ Transplantation, Children's Memorial Health Institute, Warsaw, Poland
| | - Ewa Koscielniak
- Department of Pediatric Hematology, Oncology and Immunology, Olgahospital, Klinikum Stuttgart, Germany
| | - Piotr Czauderna
- Deptartment of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
| | - Jörg Fuchs
- Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital, Tuebingen, Germany
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Kumar A, Acharya SK, Singh SP, Arora A, Dhiman RK, Aggarwal R, Anand AC, Bhangui P, Chawla YK, Datta Gupta S, Dixit VK, Duseja A, Kalra N, Kar P, Kulkarni SS, Kumar R, Kumar M, Madhavan R, Mohan Prasad V, Mukund A, Nagral A, Panda D, Paul SB, Rao PN, Rela M, Sahu MK, Saraswat VA, Shah SR, Shalimar, Sharma P, Taneja S, Wadhawan M. 2019 Update of Indian National Association for Study of the Liver Consensus on Prevention, Diagnosis, and Management of Hepatocellular Carcinoma in India: The Puri II Recommendations. J Clin Exp Hepatol 2020; 10:43-80. [PMID: 32025166 PMCID: PMC6995891 DOI: 10.1016/j.jceh.2019.09.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/15/2019] [Indexed: 01/27/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is one of the major causes of morbidity, mortality, and healthcare expenditure in patients with chronic liver disease in India. The Indian National Association for Study of the Liver (INASL) had published its first guidelines on diagnosis and management of HCC (The Puri Recommendations) in 2014, and these guidelines were very well received by the healthcare community involved in diagnosis and management of HCC in India and neighboring countries. However, since 2014, many new developments have taken place in the field of HCC diagnosis and management, hence INASL endeavored to update its 2014 consensus guidelines. A new Task Force on HCC was constituted that reviewed the previous guidelines as well as the recent developments in various aspects of HCC that needed to be incorporated in the new guidelines. A 2-day round table discussion was held on 5th and 6th May 2018 at Puri, Odisha, to discuss, debate, and finalize the revised consensus statements. Each statement of the guideline was graded according to the Grading of Recommendations Assessment Development and Evaluation system with minor modifications. We present here the 2019 Update of INASL Consensus on Prevention, Diagnosis, and Management of Hepatocellular Carcinoma in India: The Puri-2 Recommendations.
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Key Words
- AFP, alpha-fetoprotein
- AIH, autoimmune hepatitis
- ALT, alanine aminotransferase
- DAA, direct-acting antiviral
- DALY, disability-adjusted life-year
- DNA, deoxyribonucleic acid
- GRADE, Grading of Recommendations Assessment Development and Evaluation
- Gd-BOPTA, gadolinium benzyloxypropionictetraacetate
- Gd-EOB-DTPA, gadolinium ethoxybenzyl diethylenetriamine penta-acetic acid
- HBV, hepatitis B virus
- HBeAg, hepatitis B envelope antigen
- HCC, hepatocellular carcinoma
- HIV, human immunodeficiency virus
- IARC, International Agency for Research on Cancer
- IFN, interferon
- INASL, Indian National Association for Study of the Liver
- MiRNA, micro-RNA
- NAFLD, non-alcoholic fatty liver disease
- NASH, non-alcoholic steatohepatitis
- PIVKA, protein induced by vitamin K absence
- RFA
- RNA, ribonucleic acid
- SVR, sustained virological response
- TACE
- TACE, trans-arterial chemoembolization
- TARE, transarterial radioembolization
- TNF, tumor necrosis factor
- WHO, World Health Organization
- liver cancer
- targeted therapy
- transplant
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Affiliation(s)
- Ashish Kumar
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Subrat K. Acharya
- Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, Odisha, 751 024, India
| | - Shivaram P. Singh
- Department of Gastroenterology, SCB Medical College, Cuttack, Dock Road, Manglabag, Cuttack, Odisha, 753 007, India
| | - Anil Arora
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Rakesh Aggarwal
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226 014, India
| | - Anil C. Anand
- Department of Gastroenterology, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, 110 076, India
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta the Medicity, CH Baktawar Singh Road, Sector 38, Gurugram, Haryana, 122 001, India
| | - Yogesh K. Chawla
- Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India
| | - Siddhartha Datta Gupta
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Vinod K. Dixit
- Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221 005, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Naveen Kalra
- Department of Radio Diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Premashish Kar
- Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, 201 012, India
| | - Suyash S. Kulkarni
- Division of Interventional Radiology, Tata Memorial Hospital, Dr. E Borges Road, Parel, Mumbai, Maharashtra, 400 012, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Manoj Kumar
- Department of Hepatology, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Ram Madhavan
- Department of Radiation Oncology, Amrita Institute of Medical Sciences, Amrita University, Peeliyadu Road, Ponekkara, Edappally, Kochi, Kerala, 682 041, India
| | - V.G. Mohan Prasad
- Department of Gastroenterology, VGM Gastro Centre, 2100, Trichy Road, Rajalakshmi Mills Stop, Singanallur, Coimbatore, Tamil Nadu, 641 005, India
| | - Amar Mukund
- Department of Radiology, Institute of Liver & Biliary Sciences, Sector D-1, Vasant Kunj, New Delhi, 110 070, India
| | - Aabha Nagral
- Department of Gastroenterology, Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India
| | - Dipanjan Panda
- Department of Oncology, Institutes of Cancer, Indraprastha Apollo Hospital, Sarita Vihar, New Delhi, 110 076, India
| | - Shashi B. Paul
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Padaki N. Rao
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, No. 6-3-661, Punjagutta Road, Somajiguda, Hyderabad, Telangana, 500 082, India
| | - Mohamed Rela
- The Institute of Liver Disease & Transplantation, Gleneagles Global Health City, 439, Cheran Nagar, Perumbakkam, Chennai, Tamil Nadu, 600 100, India
| | - Manoj K. Sahu
- Department of Medical Gastroenterology, IMS & SUM Hospital, K8 Kalinga Nagar, Shampur, Bhubaneswar, Odisha 751 003, India
| | - Vivek A. Saraswat
- Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh, 226 014, India
| | - Samir R. Shah
- Department of Gastroenterology, Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India
| | - Shalimar
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India
| | - Praveen Sharma
- Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India
| | - Manav Wadhawan
- Liver & Digestive Diseases Institute, Institute of Liver & Digestive Diseases, BLK Super Specialty Hospital, Delhi, 110 005, India
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9
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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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10
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Histone deacetylase SIRT6 regulates chemosensitivity in liver cancer cells via modulation of FOXO3 activity. Oncol Rep 2018; 40:3635-3644. [PMID: 30542728 PMCID: PMC6196608 DOI: 10.3892/or.2018.6770] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/03/2018] [Indexed: 12/23/2022] Open
Abstract
Liver cancer is the leading cause of cancer-related mortality worldwide and its incidence is increasing. Considerable effort has been made in recent decades to improve the diagnosis and treatment of liver cancer. Advanced liver cancer often exhibits a poor response to chemotherapy and poor prognosis due to acquired chemoresistance and tumor recurrence. Understanding the precise molecular mechanisms that are responsible for chemotherapeutic drug-induced cell death could potentially identify novel therapeutic targets and improve liver cancer treatment. In the present study, it was demonstrated that in response to doxorubicin, the most frequently used chemical compound for liver cancer treatment, histone deacetylase sirtuin 6 (SIRT6) is specifically downregulated. This enables forkhead box O3 (FOXO3) upregulation, translocation into the nucleus and increased expression of its target genes p27 and Bim, which further induce apoptosis. Overexpression of SIRT6, but not enzyme-inactivated mutants, prevents FOXO3 translocation into the nucleus and doxorubicin-induced cell death. SIRT6 interacts with FOXO3 and this interaction increases FOXO3 ubiquitination and decreases its stability. Finally, it was identified that the effect of SIRT6 in preventing doxorubicin-induced cell death requires FOXO3. Overexpression of SIRT6 could not prevent doxorubicin-induced cell death in FOXO3-knockdown cells. Therefore, it was concluded that SIRT6 plays a central role in determining doxorubicin-induced cell death via modulation of FOXO3 activity. Therapeutic targeting of SIRT6 and/or FOXO3 may offer novel strategies for treatment of liver cancer.
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11
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Khanna R, Verma SK. Pediatric hepatocellular carcinoma. World J Gastroenterol 2018; 24:3980-3999. [PMID: 30254403 PMCID: PMC6148423 DOI: 10.3748/wjg.v24.i35.3980] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 07/11/2018] [Accepted: 08/01/2018] [Indexed: 02/06/2023] Open
Abstract
Pediatric hepatocellular carcinoma (HCC) is the second common malignant liver tumor in children after hepatoblastoma. It differs from the adult HCC in the etiological predisposition, biological behavior and lower frequency of cirrhosis. Perinatally acquired hepatitis-B virus, hepatorenal tyrosinemia, progressive familial intrahepatic cholestasis, glycogen storage disease, Alagille’s syndrome and congenital portosystemic shunts are important predisposing factors. Majority of children (87%) are older than 5 years of age. Following mass immunization against hepatitis-B, there has been a drastic fall in the incidence of new cases of pediatric HCC in the Asia-Pacific region. Management is targeted on complete surgical removal either by resection or liver transplantation. There is a trend towards improving survival of children transplanted for HCC beyond Milan criteria. Chemotherapeutic regimens do not offer good results but may be helpful for down-staging of advanced HCC. Surveillance of children with chronic liver diseases with ultrasound and alpha-fetoprotein may be helpful in timely detection, intervention and overall improvement in outcome of HCC.
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Affiliation(s)
- Rajeev Khanna
- Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi 110070, India
| | - Sanjeev Kumar Verma
- Department of Pediatrics, King George Medical University, Uttar Pradesh 226003, India
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12
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Chen J, Sun M, Sun B, Yi J, Jiang B, Huang L. Isolated hepatoblastoma arising from the hepatogastric ligament: a case report. J Med Case Rep 2017; 11:327. [PMID: 29157294 PMCID: PMC5697092 DOI: 10.1186/s13256-017-1488-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 10/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Almost all hepatoblastomas are isolated to the liver. Hepatoblastoma arising from and limited to extrahepatic tissue is an extremely rare clinical entity. CASE PRESENTATION Here we present a case of a 7-year-old Chinese boy of Han ethnicity with hepatoblastoma originating from the hepatogastric ligament. A complete resection was performed and the entire course was uneventful. He received six cycles of postoperative chemotherapy and had no signs of recurrence for 3 years after surgery. CONCLUSIONS Hepatoblastoma arising from extrahepatic tissue is extremely rare. A pedunculated hepatoblastoma is prone to hemorrhage and tumor metastasis. The best treatment for a long-term cure is complete resection of the primary tumor combined with chemotherapy.
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Affiliation(s)
- Ji Chen
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Mengjiao Sun
- Department of Hematology/Oncology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Bin Sun
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Jun Yi
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Bin Jiang
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Lei Huang
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
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13
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Hamilton EC, Balogh J, Nguyen DT, Graviss EA, Heczey AA, Austin MT. Liver transplantation for primary hepatic malignancies of childhood: The UNOS experience. J Pediatr Surg 2017; 53:S0022-3468(17)30657-7. [PMID: 29108844 DOI: 10.1016/j.jpedsurg.2017.10.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 10/05/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE The purpose of this study was to determine factors associated with patient and graft survival following orthotopic liver transplantation (OLT) in children and adolescents with primary hepatic malignancies. METHODS The United Network for Organ Sharing (UNOS) database was queried for all patients <18years old who received an OLT with a primary malignant liver tumor between 1987 and 2012 (n=544). Five-year patient and graft survival were determined using Kaplan-Meier methodology, and independent predictors of survival were determined using multivariate Cox proportional hazards model. RESULTS The majority of patients were diagnosed with hepatoblastoma (HB) (n=376, 70%) with 84 (15%) hepatocellular carcinoma (HCC) and 84 (15%) other. HCC patients were older, more often hospitalized at the time of transplant, and more likely to receive a cadaveric organ compared to HB patients. Five-year patient and graft survival for the entire cohort was 73% and 74%, respectively, with the majority of deaths owing to malignancy. On multivariate analysis, independent predictors of 5-year patient and graft survival included diagnosis, transplant era, and medical condition at transplant. CONCLUSIONS In recent years, there has been significant improvement in posttransplant patient and graft survival for children and adolescents with primary hepatic malignancies. However, patients with HCC continue to have worse outcomes than those with other cancer types. TYPE OF STUDY Case series with no comparison group. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Emma C Hamilton
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Julius Balogh
- Department of Anesthesia, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Department of Surgery, Houston Methodist Hospital, Houston, TX
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX
| | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX; Houston Methodist Hospital, Houston, TX
| | - Andras A Heczey
- Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX; Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Mary T Austin
- Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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14
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Khan AS, Brecklin B, Vachharajani N, Subramanian V, Nadler M, Stoll J, Turmelle Y, Lowell JA, Chapman WC, Doyle MBM. Liver Transplantation for Malignant Primary Pediatric Hepatic Tumors. J Am Coll Surg 2017; 225:103-113. [DOI: 10.1016/j.jamcollsurg.2017.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 02/05/2017] [Accepted: 02/06/2017] [Indexed: 02/08/2023]
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15
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Shi Y, Commander SJ, Masand PM, Heczey A, Goss JA, Vasudevan SA. Vascular invasion is a prognostic indicator in hepatoblastoma. J Pediatr Surg 2017; 52:956-961. [PMID: 28347528 DOI: 10.1016/j.jpedsurg.2017.03.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/09/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The data regarding vascular invasion as a prognostic factor in hepatoblastoma (HB) are conflicted. The purpose of this study is to examine the relationship between vascular invasion and outcomes. METHODS This is a retrospective review of patients <18 years old who underwent resection for hepatoblastoma from 1998 to 2015. Pathology reports were used to identify patients who had pathologic vascular invasion (VI), and those who did not (NVI). RESULTS Sixty-six children were identified with a median age at diagnosis of 21months (interquartile range: 10-33months). Pathologic vascular invasion was present in 42/66 (64%) patients. A significant difference (P=0.02) in 3-year overall survival (3YOS) was detected between NVI (95%) and VI (61%). Recurrent disease was present in 8/66 (12%) patients. A marginally significant difference (P=0.08) was found in 3-year recurrence free survival (3YRFS) between NVI (94%) and the VI (76%) groups. Patients with NVI had no metastatic disease, had a lower recurrence rate, universally responded to neoadjuvant chemotherapy, and were less likely to have small cell undifferentiated histology. Twenty-one children underwent orthotopic liver transplant (OLT), with no difference in 3YROS or 3YRFS. CONCLUSION Pathologic vascular invasion is associated with significantly worse 3YOS in HB, and lack of vascular invasion was associated with more favorable disease characteristics. The presence of pathologic vascular invasion did not confer a worse outcome in patients treated with liver transplantation in this cohort of patients. TYPE OF STUDY Retrospective review. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Yan Shi
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Sarah J Commander
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Prakash M Masand
- Department of Pediatric Radiology, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Andras Heczey
- Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - John A Goss
- Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Sanjeev A Vasudevan
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, United States.
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16
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Abstract
Although rare, hepatoblastoma is the most common pediatric liver tumor. Complete resection is a critical component for cure; however, most patients will have tumors that are not resected at diagnosis. For these patients, administration of neoadjuvant chemotherapy renders tumors resectable in most patients. For patients whose tumors remain unresectable after chemotherapy, liver transplantation is indicated (in the absence of active unresectable metastatic disease). In patients whose tumors remain unresectable after conventional chemotherapy, interventional techniques may serve as a promising option to reduce tumor size, decrease systemic toxicity, decrease need for liver transplantation, and increase feasibility of tumor resection.
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Affiliation(s)
- Angela D Trobaugh-Lotrario
- Department of Pediatric Hematology and Oncology, Providence Sacred Heart Children's Hospital, Spokane, WA
| | - Rebecka L Meyers
- Primary Children's Hospital, University of Utah, Salt Lake City, UT
| | | | - James H Feusner
- Children's Hospital & Research Center Oakland, Oakland, CA, USA
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17
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Liu B, Cui X, Zheng S, Dong K, Dong R. Aberrant KLK4 gene promoter hypomethylation in pediatric hepatoblastomas. Oncol Lett 2017; 13:1360-1364. [PMID: 28454262 DOI: 10.3892/ol.2017.5558] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/24/2016] [Indexed: 12/20/2022] Open
Abstract
DNA methylation has a crucial role in cancer biology and has been recognized as an activator of oncogenes and inactivator of tumor suppressor genes, both of which are mechanisms for tumorigenesis. Kallikrein-related peptidase 4 (KLK4), has been suggested to be an oncogene in various types of cancer. The aim of the present study was to assess the DNA methylation patterns of the KLK4 gene in cancerous samples harvested from patients with hepatoblastoma (HB). KLK4 mRNA expression levels were detected using reverse transcription-quantitative polymerase chain reaction and assessed its DNA methylation patterns using high-throughput mass spectrometry on a matrix-assisted laser desorption/ionization time-of-flight mass array. A total of 10 HB and 10 normal liver tissue samples were obtained from patients with HB. The results of the present study showed that a significantly higher level of KLK4 mRNA expression levels were detected in HB tissues, as compared with the matched controls. Furthermore, the KLK4 gene promoter region was distinctively less methylated in the HB samples compared with the controls and negatively correlated with KLK4 mRNA expression levels. These findings indicate that aberrant methylation of KLK4 may contribute to its upregulated mRNA expression in HB.
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Affiliation(s)
- Baihui Liu
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defects and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai 201102, P.R. China
| | - Ximao Cui
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defects and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai 201102, P.R. China
| | - Shan Zheng
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defects and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai 201102, P.R. China
| | - Kuiran Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defects and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai 201102, P.R. China
| | - Rui Dong
- Department of Pediatric Surgery, Children's Hospital of Fudan University, Shanghai Key Laboratory of Birth Defects and Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai 201102, P.R. China
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18
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Palaniappan K, Borkar VV, Safwan M, Vij M, Govil S, Shanmugam N, Rela M. Pediatric hepatocellular carcinoma in a developing country: Is the etiology changing? Pediatr Transplant 2016; 20:898-903. [PMID: 27392999 DOI: 10.1111/petr.12754] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2016] [Indexed: 12/26/2022]
Abstract
HCC is the second most common malignant liver tumor of childhood. It typically affects children with a median age of 10-14 yr on background hepatitis B-related liver disease and is often metastatic or locally advanced at diagnosis. Children below the age of five yr typically constitute <10% of all children with HCC. In these children, it occurs on a background of congenital or metabolic liver disease. The records of all children with HCC who presented to our department over a six-yr study period were reviewed. Twelve patients with a median age of 5.9 yr (range 1.6-15.4) were diagnosed to have HCC. All patients underwent liver transplantation, and none were resected. Eleven patients had background congenital or metabolic liver disease. All five of those with hereditary tyrosinemia type 1 who presented to us were found to have HCC. No patient had hepatitis B-related liver (HBV) disease. Eight (66.7%) patients had incidentally discovered HCC on examination of the explant. Incidentally discovered HCC were smaller, well differentiated, and did not show microvascular invasion compared to those diagnosed preoperatively. There was no recurrence with a median follow-up of five months. The patient demographic for pediatric HCC is changing probably as a consequence of successful immunization against HBV. Younger patients with congenital and metabolic liver disease in whom liver transplantation is the ideal treatment are likely to constitute an ever-increasing proportion of patients with pediatric HCC as HBV disease is controlled or eradicated.
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Affiliation(s)
- Kumar Palaniappan
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India
| | - Vibhor V Borkar
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India
| | - Mohamed Safwan
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India
| | - Mukul Vij
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India
| | - Sanjay Govil
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India
| | - Naresh Shanmugam
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India.,National Foundation for Liver Research, Chennai, India
| | - Mohamed Rela
- Institute of Liver Disease and Transplantation, Global Health City, Chennai, India. .,National Foundation for Liver Research, Chennai, India.
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19
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Abstract
This article aims to give an overview of pediatric liver tumors; in particular of the two most frequently occurring groups of hepatoblastomas and hepatocellular carcinomas. Focus lays on achievements gained through worldwide collaboration. We present recent advances in insight, treatment results, and future questions to be asked. Increasing international collaboration between the four major Pediatric Liver Tumor Study Groups (SIOPEL/GPOH, COG, and JPLT) may serve as a paradigm to approach rare tumors. This international effort has been catalyzed by the Children's Hepatic tumor International Collaboration (CHIC) formation of a large collaborative database. Interrogation of this database has led to a new universal risk stratification system for hepatoblastoma using PRETEXT/POSTTEXT staging as a backbone. Pathologists in this international collaboration have established a new histopathological consensus classification for pediatric liver tumors. Concomitantly there have been advances in chemotherapy options, an increased role of liver transplantation for unresectable tumors, and a web portal system developed at www.siopel.org for international education, consultation, and collaboration. These achievements will be further tested and validated in the upcoming Paediatric Hepatic International Tumour Trial (PHITT).
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Affiliation(s)
- Daniel C Aronson
- Department of Paediatric Surgery, Noah's Ark Children's Hospital for Wales, University Hospital of Wales, Cardiff and Vale University Health Board NHS Trust, Cardiff CF14 4XW, UK.
| | - Rebecka L Meyers
- Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
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20
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Trobaugh-Lotrario AD, Meyers RL, Tiao GM, Feusner JH. Pediatric liver transplantation for hepatoblastoma. Transl Gastroenterol Hepatol 2016; 1:44. [PMID: 28138611 DOI: 10.21037/tgh.2016.04.01] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 03/16/2016] [Indexed: 01/03/2023] Open
Abstract
Hepatoblastoma is the most common pediatric liver tumor and is usually diagnosed before five years of age. Treatment consists of a combination of chemotherapy and surgery, with the goal being attainment of complete local control by surgical resection and eradication of any extrahepatic disease. Neoadjuvant chemotherapy is utilized and is often beneficial in rendering tumors resectable; however, prolonged chemotherapy administration attempting to render tumors resectable by conventional resection should be avoided. For patients whose tumors are too extensive to be conventionally resected, liver transplantation can be curative and remains the treatment of choice for eligible patients otherwise incurable by conventional resection.
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Affiliation(s)
- Angela D Trobaugh-Lotrario
- Department of Pediatric Hematology/Oncology, Providence Sacred Heart Children's Hospital, Spokane, WA, USA
| | - Rebecka L Meyers
- Department of Pediatric Surgery, Primary Children's Medical Center, Salt Lake City, UT, USA
| | - Greg M Tiao
- Department of Pediatric Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - James H Feusner
- Department of Pediatric Hematology/Oncology, Children's Hospital & Research Center Oakland, Oakland, CA, USA
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21
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Samuk I, Tekin A, Tryphonopoulos P, Pinto IG, Garcia J, Weppler D, Levi DM, Nishida S, Selvaggi G, Ruiz P, Tzakis AG, Vianna R. Abdominal transplantation for unresectable tumors in children: the zooming out principle. Pediatr Surg Int 2016; 32:337-46. [PMID: 26711121 DOI: 10.1007/s00383-015-3852-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 12/15/2022]
Abstract
PURPOSE To present our experience in abdominal transplantations to manage unresectable abdominal neoplasms in children and to describe the role of extensive surgeries in such cases. METHODS This is a retrospective study of 22 abdominal transplantations in 21 patients for abdominal tumors over 16 years. Transplantation techniques included liver transplant (LT), multivisceral transplant (MVTx), and intestinal autotransplant (IA). Follow-up intervals ranged from 0.3 to 168 months (median 20 months). RESULTS LT alone was performed in 15 patients for primary malignant (11) and benign (4) liver tumors. Pathological classification included HB hepatoblastoma (6), HCC hepatocellular cancer (3), hepatic epithelioid hemangioendothelioma HEH (1), angiosarcoma (1), benign vascular tumors (3), and adenoma (1). IA was performed in four patients for lesions involving the root of the mesentery; tumors of the head of pancreas (3) and mesenteric hemangioma (1). MVTx was performed in 2 patients for malignancies; pancreaticoblastoma (1), recurrent hepatoblastoma (1), and in one patient as a rescue procedure after IA failure. Four of the eleven patients who underwent LT for malignant liver tumor had metastatic disease at presentation. Six of them died of recurrent neoplasm (3), transplant-related complications (2), and underlying disease (1). All LT patients who had benign tumors are alive with functioning grafts. All IA patients survived and are on an oral diet, with one patient requiring TPN supplementation. One of the three patients who underwent MVTx died of metastatic disease. CONCLUSIONS Allo/auto transplantation for abdominal tumors is a valuable modality when conventional treatments fail or are not feasible.
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Affiliation(s)
- Inbal Samuk
- Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Sackler School of Medicine, Tel Aviv University, 14 kaplan Street, Petach-Tikvha, 49202, Israel. .,Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Akin Tekin
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Ignacio G Pinto
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Universidad de Oviedo, Beca, Spain
| | | | - Debbie Weppler
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David M Levi
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Seigo Nishida
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gennaro Selvaggi
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Phillip Ruiz
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.,Pathology, University of Miami, Miami, USA
| | - Andreas G Tzakis
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Rodrigo Vianna
- Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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22
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Qiao GL, Chen Z, Wang C, Ge J, Zhang Z, Li L, Ren J. Pure fetal histology subtype was associated with better prognosis of children with hepatoblastoma: A Chinese population-based study. J Gastroenterol Hepatol 2016; 31:621-7. [PMID: 26401976 DOI: 10.1111/jgh.13165] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/17/2015] [Accepted: 09/14/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM The aim of this study is to identify the association between histologic types and the prognosis of hepatoblastoma (HB) in a large Asian cohort of a single institution and to explore the interaction of histologic types with other independently risk factors in the process of affecting prognosis of HB. METHODS We retrospectively reviewed 176 children with HB (82 female, 94 male) managed in our institution between May 1, 2001 and July 30, 2014. Prognostic factors were evaluated using Kaplan-Meier curves and Cox proportional hazards models. RESULTS For the entire cohort of 176 patients, the overall median survival was 80.4 months(95% CI: 71.6-89.2 months), and the 5-year event-free survival and overall survival rates were 54.6 and 66.7%. Descriptive survival statistics and Kaplan-Meier curves suggested that alpha fetoprotein levels, tumor metastases, multifocality, histologic types, and Pre-Treatment Extent of Disease staging System stage had prognostic significance in this relatively selected cohort. Moreover, after eliminating the impact of the interaction of different classification methods of histologic types, pure fetal histologic (PFH) was an independent prognostic factor of HB (hazard ratio [HR]: 2.752, P = 0.021). Further stratification analysis showed that the impaction of other identified risk factors on the influence of PFH on the prognosis of HB patients was different. CONCLUSIONS We have confirmed that the HB prognostic factors of HB and PFH was associated with better prognosis of children with HB based on an Asian population. PFH showed different significance in the process of affecting prognosis of HB with the interaction of other independent risk factors.
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Affiliation(s)
- Guo-liang Qiao
- Department of Medical Oncology, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Beijing, China.,Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Zhen Chen
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Chen Wang
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Juntao Ge
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Zhen Zhang
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Jun Ren
- Department of Medical Oncology, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Beijing, China
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Murawski M, Weeda VB, Maibach R, Morland B, Roebuck DJ, Zimmerman A, Casanova M, Perilongo G, Laithier V, Kebudi R, Scopinaro MJ, Shun A, Brichard B, de Camargo B, Childs M, Aronson DC, Czauderna P. Hepatocellular Carcinoma in Children: Does Modified Platinum- and Doxorubicin-Based Chemotherapy Increase Tumor Resectability and Change Outcome? Lessons Learned From the SIOPEL 2 and 3 Studies. J Clin Oncol 2016; 34:1050-6. [PMID: 26811523 DOI: 10.1200/jco.2014.60.2250] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The aim of this article is to present an experience of two prospective studies from the International Childhood Liver Tumor Strategy Group (SIOPEL 2 [S2] and SIOPEL [S3]) trials and to evaluate whether modified platinum- and doxorubicin-based chemotherapy is capable of increasing tumor resectability and changing patient outcomes. METHODS Between 1995 and 2006, 20 patients with hepatocellular carcinoma (HCC) were included in the S2 trial and 70 were included in the S3 trial. Eighty-five patients remained evaluable. RESULTS Response to preoperative chemotherapy was observed in 29 of 72 patients (40%) who did not have primary surgery, whereas 13 patients underwent upfront surgery. Thirty-three patients had a delayed resection. Thirty-nine tumors never became resectable. Complete tumor resection was achieved in 34 patients (40%), including seven of those treated with liver transplantation (LTX). After a median follow-up period of 75 months, 63 patients (74%) had an event (a progression during treatment, a relapse after treatment, or death from any cause). Sixty patients died. Twenty-three of 46 patients (50%) who underwent tumor resection died. Eighteen of 27 patients (63%) with complete tumor resection (without LTX) and 20 of 34 patients (59%) with LTX survived. Only one of seven patients (14%) with microscopically involved margins survived. Overall survival at 5 years was 22%. CONCLUSION Survival in pediatric HCC is more likely when complete tumor resection can be achieved. Intensification of platinum agents in the S2 and S3 trials has not resulted in improved survival. New treatment approaches in pediatric HCC should be postulated.
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Affiliation(s)
- Maciej Murawski
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Víola B Weeda
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Rudolf Maibach
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Bruce Morland
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Derek J Roebuck
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Arthur Zimmerman
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Michela Casanova
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Giorgio Perilongo
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Veronique Laithier
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Rejin Kebudi
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Marcelo J Scopinaro
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Albert Shun
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Benedicte Brichard
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Beatriz de Camargo
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Margaret Childs
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Daniel C Aronson
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil
| | - Piotr Czauderna
- Maciej Murawski and Piotr Czauderna, Medical University of Gdansk, Gdansk, Poland; Viola B. Weeda and Daniel C. Aronson, Emma Children's Hospital Academic Medical Center, Amsterdam, the Netherlands; Rudolf Maibach, International Breast Cancer Study Group Coordinating Center; Arthur Zimmerman, Institute of Pathology, Berne, Switzerland; Bruce Morland, Birmingham Children's Hospital, Birmingham; Derek J. Roebuck, Great Ormond Street Hospital, London; Margaret Childs, University of Nottingham, Nottingham, United Kingdom; Michela Casanova, National Cancer Institute, Milan; Giorgio Perilongo, University of Padova, Padova, Italy; Veronique Laithier, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France; Rejin Kebudi, İstanbul University, Oncology Institute, İstanbul, Turkey; Marcelo J. Scopinaro, Hospital de Pediatrı´a SAMIC J.P. Garrahan, Buenos Aires, Argentina; Albert Shun, Children's Hospital at Westmead, Sydney, Australia; Benedicte Brichard, Cliniques Universitaires Saint Luc, University of Louvain, Brussels, Belgium; and Beatriz de Camargo, Cancer Hospital A.C. Camargo, São Paulo, Brazil.
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Qureshi SS, Bhagat M, Kembhavi S, Vora T, Ramadwar M, Chinnaswamy G, Prasad M, Khanna N, Laskar S. Benign liver tumors in children: outcomes after resection. Pediatr Surg Int 2015; 31:1145-9. [PMID: 26263875 DOI: 10.1007/s00383-015-3763-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Benign liver tumors in children are rare and data regarding the surgical outcomes are deficient. We reviewed our experience in the management of these tumors particularly the extent, safety, and effectiveness of surgical resection. METHODS Between March 2005 and March 2014, 10/90 liver resections were performed for benign liver tumors. Three other patients received conservative treatment. Demographic characteristics, operative management, morbidity, and mortality were analyzed. RESULTS The median age of the patients was 12 months. The distribution of pathology was infantile hepatic hemangioendothelioma/hemangioma (n = 7), mesenchymal hamartoma (n = 4), adenoma (n = 1) and focal nodular hyperplasia (n = 1). Median tumor size was 12.25 cm (range 3.5-21 cm) with a median tumor volume of 576.64 cm(3) (range 13.9-1822.64 cm(3)). Non-anatomic resection was performed in 6/10 patients and the median blood loss was 100 ml (range 10-850 ml). Median length of hospital stay was 7 days (range 5-9 days). There were no mortality, none of the patients had a local recurrence, and all are alive at a median follow-up of 33 months. CONCLUSIONS Two-third patients with benign liver tumors were managed with surgical excision, which comprised 11% of our resectional practice. Non-anatomical resection whenever feasible can be performed safely and does not compromise the oncological outcomes.
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Affiliation(s)
- Sajid S Qureshi
- Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Ernest Borges Road, Parel, Bombay, 400012, India.
| | - Monica Bhagat
- Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Tata Memorial Centre, Ernest Borges Road, Parel, Bombay, 400012, India
| | - Seema Kembhavi
- Department of Radiology, Tata Memorial Centre, Bombay, India
| | - Tushar Vora
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Centre, Bombay, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Centre, Bombay, India
| | - Girish Chinnaswamy
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Centre, Bombay, India
| | - Maya Prasad
- Division of Pediatric Oncology, Department of Medical Oncology, Tata Memorial Centre, Bombay, India
| | - Nehal Khanna
- Department of Radiation Oncology, Tata Memorial Centre, Bombay, India
| | - Sidharth Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Bombay, India
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Al-Sinani S, Al-Naamani K. Adult Hepatoblastoma: What do we know? Sultan Qaboos Univ Med J 2015; 15:e155-e156. [PMID: 26052446 PMCID: PMC4450776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 03/26/2015] [Accepted: 03/29/2015] [Indexed: 06/04/2023] Open
Affiliation(s)
- Siham Al-Sinani
- Oman Medical Specialty Board, Muscat, Oman
- Department of Child Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Khalid Al-Naamani
- Department of Internal Medicine, Division of Gastroenterology & Hepatology, Armed Forces Hospital, Muscat, Oman
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Becker K, Furch C, Schmid I, von Schweinitz D, Häberle B. Impact of postoperative complications on overall survival of patients with hepatoblastoma. Pediatr Blood Cancer 2015; 62:24-8. [PMID: 25251521 DOI: 10.1002/pbc.25240] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 08/06/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND Complete resection of hepatoblastoma (HB) is a demanding procedure in advanced tumors. Perioperative complications are still common. The influence of complication rates on course of disease and survival of patients with HB has not been analyzed yet. PROCEDURES Patients with high risk (HR) HB and standard-risk (SR) HB registered from 1999 to 2008 to the German prospective multicenter study HB99 were evaluated regarding perioperative complications, reasons (e.g., tumor size and vessel involvement) and impact on further treatment and overall survival (OS). RESULTS Surgical data from 126 patients were available (47 HR-HB, 79 SR-HB). Postoperative complications occurred in 26 (21%) patients consisting of biliary leakage (n = 9), cholestasis (n = 5), deficit of liver perfusion (n = 5) and others (n = 7). Twenty of these 26 patients (77%) required a second operation. The rate of postoperative complications was higher in the HR-group (26%) compared to the SR-group (17%). Patients with vessel involvement had significantly more complications (17% vs. 54%, P = 0.01). Patients with PRETEXT I/II-tumors had the same rate of postoperative complications (19% vs. 20%) as patients with PRETEXT III/IV. Patients of HR-group with postoperative complications showed delayed start in adjuvant chemotherapy (>21 d) (75% vs. 25%, n.s.) combined with significant lower 5-year-OS (75% vs. 50%, P = 0.02). In multivariate analysis postoperative complications were an independent negative prognostic factor for HR-patients (HR 3.1, P = 0.04). CONCLUSIONS Postoperative complications after HB resection are frequent and associated with worsened OS of patients with HR-HB. One possible reason is delay in postoperative chemotherapy. The approach to precarious liver resection should be carefully planned and executed by specialists.
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Affiliation(s)
- Kristina Becker
- Department of Pediatric Surgery, Ludwig-Maximilian-University of Munich, Munich, Germany
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Qiao GL, Li L, Cheng W, Ge J, Zhang Z, Wei Y. Predictors of survival after resection of children with hepatoblastoma: A single Asian center experience. Eur J Surg Oncol 2014; 40:1533-9. [DOI: 10.1016/j.ejso.2014.07.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 07/02/2014] [Accepted: 07/11/2014] [Indexed: 11/27/2022] Open
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Ayllon Teran D, Gómez Beltran O, Ciria Bru R, Mateos González E, Peña Rosa MJ, Luque Molina A, López Cillero P, Briceño Delgado J. Efficacy of neoadjuvant therapy and surgical rescue for locally advanced hepatoblastomas: 10 year single-center experience and literature review. World J Gastroenterol 2014; 20:10137-10143. [PMID: 25110441 PMCID: PMC4123343 DOI: 10.3748/wjg.v20.i29.10137] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/18/2013] [Accepted: 12/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To report our experience with long-term outcomes after multimodal management therapy.
METHODS: An observational retrospective study was performed containing seven patients with hepatoblastoma (Hbl) treated in our institution, a tertiary referral center, from 2003 to 2011. Demographic, preoperative, surgical, and outcome variables were collected. A survival analysis and a review of the current literature related to combination neoadjuvant chemotherapy and surgical resection on Hbl were performed.
RESULTS: The median age at surgery was 14.4 mo, with a male to female ratio of 4:3. Pretext staging at diagnosis was as follows: stage I, 4 cases; stage II, 2 patients; and stage III, 1 case. Mean pretreatment tumor volume was 735 cm3. Five out of seven patients received neoadjuvant chemotherapy according to SIOPEL-3 or SIOPEL-6 protocols. Tumor volume and alpha-fetoprotein levels significantly dropped after neoadjuvant therapy. Surgical procedures performed included hemihepatectomies, segmentectomies and atypical resection. All patients received chemotherapy after surgery. Median postoperative hospital stay was 8 d. All patients were alive and disease-free after a median follow-up period of 23 mo. With regards to the literature review, seventeen articles were found that were related to our search.
CONCLUSION: Our series shows how multimodal management of Hbl, exhaustive control and a meticulous surgical approach leads to almost 100% complete resection with optimal postoperative results.
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Paganelli M, Beaunoyer M, Samson Y, Dal Soglio D, Dubois J, Lallier M, Alvarez F. A child with unresectable biliary rhabdomyosarcoma: 48-month disease-free survival after liver transplantation. Pediatr Transplant 2014; 18:E146-51. [PMID: 24815678 DOI: 10.1111/petr.12279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2014] [Indexed: 01/27/2023]
Abstract
We describe here a two-yr-old boy with biliary RMS successfully treated by chemotherapy and LT. The child presented with obstructive jaundice at 20 months of age. A mildly vascularized, non-calcified, partially cystic lesion was visualized in the left hepatic lobe. Solid infiltration of the common bile duct and of both left and right hepatic ducts was suspected. Liver biopsy suggested a botryoid-type embryonal RMS originating from the biliary tract. After extrahepatic spread of the tumor was excluded, a biliary drain was applied and neoadjuvant chemotherapy was started. After the treatment, although reduced in volume, the mass was still unresectable without aggressive surgery and gross residual disease. LT with a reduced segment II/III graft was performed four months after diagnosis. The patient received six cycles of adjuvant chemotherapy, and he is alive and recurrence-free 48 months post-transplantation. A posteriori, the transplant might have possibly been avoided with an aggressive resection with biliary reconstruction. Nevertheless, although the risk of the transplant has to be balanced against the chemoresponsiveness of the tumor, the four-yr disease-free survival of this patient suggests that, when coupled with effective chemotherapy, transplantation might be considered a potential treatment for unresectable biliary RMS.
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Affiliation(s)
- M Paganelli
- Department of Gastroenterology, Hepatology and Nutrition, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
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Hepatoblastoma state of the art: pre-treatment extent of disease, surgical resection guidelines and the role of liver transplantation. Curr Opin Pediatr 2014; 26:29-36. [PMID: 24362406 DOI: 10.1097/mop.0000000000000042] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW This is part two of a two-part state of the art--hepatoblastoma. International hepatoblastoma specialists were brought together to highlight advances, controversies, and future challenges in the treatment of this rare pediatric tumor. RECENT FINDINGS Pretreatment extent of disease (PRETEXT) is a grouping system introduced as part of the multicenter international childhood liver tumors strategy group, SIOPEL-1, study in 1990. The system has been refined over the ensuing years and has now come to be adopted for risk stratification by all of the major pediatric liver tumor multicenter trial groups. PRETEXT is being intensively studied in the current Children's Oncology Group (COG) AHEP-0731 trial in an attempt to validate interobserver reproducibility and ability to monitor response to neoadjuvant chemotherapy, and determine surgical resectability. PRETEXT is now used to identify those patients who are at risk for having an unresectable tumor and who should be referred to a liver specialty center with transplant capability early in their treatment schema. SUMMARY International collaborative efforts in hepatoblastoma have led to increased refinements in the use of the PRETEXT and post-treatment extent to define prognosis and surgical resectability. PRETEXT criteria which suggest a possible need for liver transplantation are discussed in detail.
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Allan BJ, Wang B, Davis JS, Parikh PP, Perez EA, Neville HL, Sola JE. A review of 218 pediatric cases of hepatocellular carcinoma. J Pediatr Surg 2014; 49:166-71; discussion 171. [PMID: 24439603 DOI: 10.1016/j.jpedsurg.2013.09.050] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 09/30/2013] [Indexed: 11/27/2022]
Abstract
PURPOSE This study evaluates the incidence trends and clinical outcomes of children with hepatocellular carcinoma (HCC) and assesses factors predictive of patient survival. METHODS The Surveillance, Epidemiology, and End Results registry was queried from 1973 to 2009 for all patients between ages 0 and 19 with primary HCC. Demographics, tumor histology, surgical intervention, and patient survival were collected. RESULTS Overall, 218 patients were identified. The annual age-adjusted incidence was 0.05 cases per 100,000 in 2009. Fibrolamellar subtype tumors were exclusive to children >5years old and exhibited greater survival compared to non-fibrolamellar subtype (57% vs. 28%, respectively, p=0.002). Tumor extirpation for patients with resectable disease significantly improved overall survival at 5years compared to no surgery (60% vs. 0%, respectively, p<0.0001). Overall 5-, 10- and 20-year survival for the entire cohort was 24%, 23%, and 8%, respectively. Independent prognostic factors of lower mortality according to multivariate analysis were surgical resection (hazard ratio (HR)=0.18), non-Hispanic ethnicity (HR=0.52), and local disease at presentation (HR=0.46). CONCLUSION Over the past four decades, the incidence of HCC has remained relatively stable. Children of Hispanic ethnicity have high mortality rates. However, HCC resection for curative intent significantly improves outcomes.
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Affiliation(s)
- Bassan J Allan
- Department of Surgery, Division of Pediatric Surgery, DeWitt-Daughtry Family, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Bo Wang
- Department of Surgery, Division of Pediatric Surgery, DeWitt-Daughtry Family, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - James S Davis
- Department of Surgery, Division of Pediatric Surgery, DeWitt-Daughtry Family, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Punam P Parikh
- Department of Surgery, Division of Pediatric Surgery, DeWitt-Daughtry Family, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Eduardo A Perez
- Department of Surgery, Division of Pediatric Surgery, DeWitt-Daughtry Family, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Holly L Neville
- Department of Surgery, Division of Pediatric Surgery, DeWitt-Daughtry Family, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Juan E Sola
- Department of Surgery, Division of Pediatric Surgery, DeWitt-Daughtry Family, University of Miami Miller School of Medicine, Miami, FL 33136, USA.
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McAteer JP, Goldin AB, Healey PJ, Gow KW. Surgical treatment of primary liver tumors in children: outcomes analysis of resection and transplantation in the SEER database. Pediatr Transplant 2013; 17:744-50. [PMID: 23992390 DOI: 10.1111/petr.12144] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2013] [Indexed: 12/20/2022]
Abstract
Adjusted survival outcomes following hepatic resection and transplantation for pediatric liver tumors have not been compared. To address this question, we conducted a retrospective cohort study using the SEER registry. While SEER lacks certain specifics regarding staging, chemotherapy, comorbidities, and recurrence, important hypothesis-generating data are available and were analyzed using Kaplan-Meier statistics and Cox proportional hazards regression. All SEER patients under the age of 20 yr undergoing surgery for HB (n = 318) or HCC (n = 80) between 1998 and 2009 were included. Of HB patients, 83.3% underwent resection and 16.7% transplantation. Advanced disease, vascular invasion, and satellite lesions were more common among transplant patients. Unadjusted five-yr survival was equivalent, as was the adjusted hazard of death for transplant relative to resection (HR = 0.58, p = 0.63). Of HCC patients, 75.0% underwent resection and 25.0% transplantation. Transplant patients had a higher prevalence of vascular invasion and satellite lesions. Five-yr survival was 53.4% after resection and 85.3% after transplant, and the adjusted hazard of death was significantly lower after transplantation (HR = 0.05, p = 0.045). While transplantation is generally reserved for unresectable tumors, the favorable survival seen in HCC patients suggests that liberalized transplant criteria might improve survival, although further prospective data are needed.
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Affiliation(s)
- Jarod P McAteer
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA; Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
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Affiliation(s)
- Ashley Walther
- Division of Pediatric General and Thoracic SurgeryCincinnati Children's Hospital and Medical CenterCincinnatiOH
| | - Greg Tiao
- Division of Pediatric General and Thoracic SurgeryCincinnati Children's Hospital and Medical CenterCincinnatiOH
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Allan BJ, Parikh PP, Diaz S, Perez EA, Neville HL, Sola JE. Predictors of survival and incidence of hepatoblastoma in the paediatric population. HPB (Oxford) 2013; 15:741-6. [PMID: 23600968 PMCID: PMC3791112 DOI: 10.1111/hpb.12112] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 03/17/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES This study evaluates current trends in incidence, clinical outcomes and factors predictive of survival in children with hepatoblastoma (HB). METHODS The Surveillance, Epidemiology and End Results (SEER) database was queried for the period 1973-2009 for all patients aged <20 years with HB. RESULTS A total of 606 patients were identified. The age-adjusted incidence was 0.13 patients per 100 000 in 2009. An annual percentage change of 2.18% (95% confidence interval (CI) 1.10-3.27; P < 0.05) was seen over the study period. Overall survival rates at 5, 10 and 20 years were 63%, 61% and 59%, respectively. Ten-year survival rates significantly improved in patients with resectable disease who underwent operative treatment in comparison with those with non-resectable HB (86% versus 39%; P < 0.0001). Multivariate analysis showed surgical treatment (hazard ratio (HR) = 0.23, 95% CI 0.17-0.31; P < 0.0001), Hispanic ethnicity (HR = 0.61, 95% CI 0.43-0.89; P = 0.01), local disease at presentation (HR = 0.43, 95% CI 0.29-0.63; P < 0.0001) and age < 5 years (HR = 0.63, 95% CI 0.41-0.95; P < 0.03) to be independent prognostic factors of survival. CONCLUSIONS The incidence of paediatric HB has increased over time. Hepatoblastoma is almost exclusively seen in children aged < 5 years. When HB presents after the age of 5 years, the prognosis is most unfavourable. Tumour extirpation markedly improves survival in paediatric patients with local disease.
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Affiliation(s)
- Bassan J Allan
- Division of General Surgery, University of Miami Miller School of MedicineMiami, FL, USA
| | - Punam P Parikh
- Division of General Surgery, University of Miami Miller School of MedicineMiami, FL, USA
| | - Sofia Diaz
- Division of General Surgery, University of Miami Miller School of MedicineMiami, FL, USA
| | - Eduardo A Perez
- Division of Paediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of MedicineMiami, FL, USA
| | - Holly L Neville
- Division of Paediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of MedicineMiami, FL, USA
| | - Juan E Sola
- Division of Paediatric Surgery, DeWitt-Daughtry Family Department of Surgery, University of Miami Miller School of MedicineMiami, FL, USA
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Kelly DA, Bucuvalas JC, Alonso EM, Karpen SJ, Allen U, Green M, Farmer D, Shemesh E, McDonald RA. Long-term medical management of the pediatric patient after liver transplantation: 2013 practice guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transpl 2013; 19:798-825. [PMID: 23836431 DOI: 10.1002/lt.23697] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 06/15/2013] [Indexed: 12/15/2022]
Affiliation(s)
- Deirdre A Kelly
- Liver Unit, Birmingham Children's Hospital, National Health Service Trust, Birmingham, United Kingdom.
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Alonso EM, Ng VL, Anand R, Anderson CD, Ekong UD, Fredericks EM, Furuya KN, Gupta NA, Lerret SM, Sundaram S, Tiao G. The SPLIT research agenda 2013. Pediatr Transplant 2013; 17:412-22. [PMID: 23718800 PMCID: PMC4157303 DOI: 10.1111/petr.12090] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2013] [Indexed: 12/17/2022]
Abstract
This review focuses on active clinical research in pediatric liver transplantation with special emphasis on areas that could benefit from studies utilizing the SPLIT infrastructure and data repository. Ideas were solicited by members of the SPLIT Research Committee and sections were drafted by members of the committee with expertise in those given areas. This review is intended to highlight priorities for clinical research that could successfully be conducted through the SPLIT collaborative and would have significant impact in pediatric liver transplantation.
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Affiliation(s)
- Estella M. Alonso
- Department of Pediatrics; Ann & Robert H. Lurie Children's Hospital of Chicago; Chicago; IL; USA
| | - Vicky L. Ng
- SickKids Transplant Center; The Hospital for Sick Children and University of Toronto; Toronto; ON; Canada
| | | | - Christopher D. Anderson
- Division of Transplant and Hepatobiliary Surgery; University of Mississippi Medical Center; Jackson; MS; USA
| | - Udeme D. Ekong
- Department of Pediatrics; Ann & Robert H. Lurie Children's Hospital of Chicago; Chicago; IL; USA
| | - Emily M. Fredericks
- Division of Child Behavioral Health; Department of Pediatrics and Communicable Diseases; University of Michigan; Ann Arbor; MI; USA
| | - Katryn N. Furuya
- Department of Pediatrics; Thomas Jefferson University; Philadelphia; PA; USA
| | - Nitika A. Gupta
- Department of Pediatrics; Emory University School of Medicine; Atlanta; GA; USA
| | - Stacee M. Lerret
- Department of Pediatrics; Medical College of Wisconsin; Milwaukee; WI; USA
| | - Shikha Sundaram
- Pediatric Liver Center and Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics; University of Colorado Denver School of Medicine; Children's Hospital Colorado; Denver; CO; USA
| | - Greg Tiao
- Departments of Pediatric and Thoracic Surgery; Cincinnati Children's Hospital and Medical Center; Cincinnati; OH; USA
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Zsiros J, Brugieres L, Brock P, Roebuck D, Maibach R, Zimmermann A, Childs M, Pariente D, Laithier V, Otte JB, Branchereau S, Aronson D, Rangaswami A, Ronghe M, Casanova M, Sullivan M, Morland B, Czauderna P, Perilongo G. Dose-dense cisplatin-based chemotherapy and surgery for children with high-risk hepatoblastoma (SIOPEL-4): a prospective, single-arm, feasibility study. Lancet Oncol 2013; 14:834-42. [PMID: 23831416 PMCID: PMC3730732 DOI: 10.1016/s1470-2045(13)70272-9] [Citation(s) in RCA: 191] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background The objective of this study was to establish the efficacy and safety of a new treatment regimen consisting of dose-dense cisplatin-based chemotherapy and radical surgery in children with high-risk hepatoblastoma. Methods SIOPEL-4 was a prospective single-arm feasibility study. Patients aged 18 years or younger with newly diagnosed hepatoblastoma with either metastatic disease, tumour in all liver segments, abdominal extrahepatic disease, major vascular invasion, low α fetoprotein, or tumour rupture were eligible. Treatment consisted of preoperative chemotherapy (cycles A1–A3: cisplatin 80 mg/m2 per day intravenous in 24 h on day 1; cisplatin 70 mg/m2 per day intravenous in 24 h on days 8, 15, 29, 36, 43, 57, and 64; and doxorubicin 30 mg/m2 per day intravenous in 24 h on days 8, 9, 36, 37, 57, and 58) followed by surgical removal of all remaining tumour lesions if feasible (including liver transplantation and metastasectomy, if needed). Patients whose tumour remained unresectable received additional preoperative chemotherapy (cycle B: doxorubicin 25 mg/m2 per day in 24 h on days 1–3 and 22–24, and carboplatin area under the curve [AUC] 10·6 mg/mL per min per day intravenous in 1 h on days 1 and 22) before surgery was attempted. After surgery, postoperative chemotherapy was given (cycle C: doxorubicin 20 mg/m2 per day in 24 h on days 1, 2, 22, 23, 43, and 44, and carboplatin AUC 6·6 mg/mL per min per day in 1 h on days 1, 22, and 43) to patients who did not receive cycle B. The primary endpoint was the proportion of patients with complete remission at the end of treatment. Analysis was by intention to treat. This trial is registered at ClinicalTrials.gov, NCT00077389. Findings We report the final analysis of the trial. 62 eligible patients (39 with lung metastases) were included and analysed. 60 (98%, 95% CI 91–100) of 61 evaluable patients (one child underwent primary hepatectomy) had a partial response to preoperative chemotherapy. Complete resection of all tumour lesions was achieved in 46 patients (74%). At the end of therapy, 49 (79%, 95% CI 67–88) of 62 patients were in complete remission. With a median follow-up of 52 months, 3-year event-free survival was 76% (95% CI 65–87) and 3-year overall survival was 83% (73–93). 60 (97%) patients had grade 3–4 haematological toxicity (anaemia, neutropenia, or thrombocytopenia) and 44 (71%) had at least one episode of febrile neutropenia. Other main grade 3 or 4 toxicities were documented infections (17 patients, 27%), anorexia (22, 35%), and mucositis (seven, 11%). One child died of fungal infection in neutropenia. Moderate-to-severe ototoxicity was documented in 31 (50%) patients. 18 serious adverse events (including two deaths) reflecting the observed side-effects were reported in the trial (the most common was ototoxicity in five patients). Interpretation The SIOPEL-4 treatment regimen is feasible and efficacious for complete remission at the end of treatment for patients with high-risk hepatoblastoma. Funding Cancer Research UK and Cancer Research Switzerland/Oncosuisse.
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Affiliation(s)
- József Zsiros
- Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, Netherlands.
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Mogane P, Motshabi-Chakane P. Anaesthetic considerations for liver resections in paediatric patients. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2013. [DOI: 10.1080/22201173.2013.10872943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- P Mogane
- Chris Hani Baragwanath Academic Hosptial, Johannesburg Department of Anaesthesia, University of Witwatersrand, Johannesburg
| | - P Motshabi-Chakane
- Charlotte Maxeke Johannesburg Academic Hospital, Johanensburg Department of Anaesthesia, University of Witwatersrand, Johannesburg
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Perilongo G, Malogolowkin M, Feusner J. Hepatoblastoma clinical research: lessons learned and future challenges. Pediatr Blood Cancer 2012; 59:818-21. [PMID: 22678761 DOI: 10.1002/pbc.24217] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 05/08/2012] [Indexed: 11/09/2022]
Abstract
The past four decades has brought significant improvement to the diagnosis, treatment, and outcomes of children diagnosed with hepatoblastoma. These improvements are the results of multidisciplinary and multi-institutional international cooperative trials, such as those conducted by the Children's Oncology Group (COG) or the International Childhood Liver Tumor Strategy Group (SIOPEL) and national studies such as those conducted in Germany and Japan. Due to the different treatment strategies used by the various groups, the information generated has been at times complementary but at other times contradictory. In this manuscript, we will provide a global picture of where "we stand and where we are going" in regards to clinical research of childhood hepatoblastoma. We will focus on lessons learned, especially in reference to the experiences of the COG and SIOPEL study groups, and discuss future challenges.
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Affiliation(s)
- Giorgio Perilongo
- Department of Pediatric, University Hospital, University of Padua, Italy.
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Abstract
Liver tumors in children can be classified into benign or malignant; some of the benign lesions can have the potential of malignant transformation, and therefore the therapeutic approach may change. These neoplasms account for nearly 1-2% of all pediatric tumors and they have gained significant attention in the last decades due to data suggesting that the incidence may be increasing 5% annually. We know that with new and improved imaging modalities some of these lesions may be detected more often than before. Recent studies showed that liver cancer represented 2% of malignancies in infants by 1980s and this was doubled in incidence to 4% in the following 10 yr. In this review our aim is to discuss all primary liver tumors in children with attention to their clinicopathological and immunohistochemical features followed by the current standard of care.
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Affiliation(s)
- Sukru Emre
- Department of Surgery, Yale University School of Medicine, Yale, New Haven, CT, USA.
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Rougemont AL, McLin VA, Toso C, Wildhaber BE. Adult hepatoblastoma: learning from children. J Hepatol 2012; 56:1392-403. [PMID: 22326463 DOI: 10.1016/j.jhep.2011.10.028] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 10/17/2011] [Accepted: 10/17/2011] [Indexed: 01/16/2023]
Abstract
Hepatoblastoma is the most common malignant liver tumour in infants and young children. Its occurrence in the adult population is debated and has been questioned. The aim of this paper is to review the histological and clinical features of adult hepatoblastoma as described in the adult literature, and to compare the findings with those of paediatric hepatoblastoma. The developmental and molecular aspects of hepatoblastoma are reviewed and their potential contribution to diagnosis of adult hepatoblastoma discussed. Case reports of adult hepatoblastoma identified by a PubMed search of the English, French, German, Italian, and Spanish literature through March 2011 were reviewed. Forty-five cases of hepatoblastoma were collected. Age at presentation was variable. Survival was uniformly poor, except for the rare patients who presented with the relatively differentiated, foetal type. The common denominator between adult and paediatric cases is the occurrence of embryonal or immature aspect of the tumours. Whether the adult cases of hepatoblastoma represent blastemal tumours, stem cell tumours, or unusual differentiation patterns in otherwise more frequent adult liver tumours remains to be established. Adult tumours labelled as hepatoblastoma are characterised by malignant appearing mesenchymal components. Surgical management is the cornerstone of therapy in children and also appears to confer an improved prognosis in adults. Whether adult hepatoblastoma exists, remains controversial. Indeed, several features described in adult cases are markedly different from hepatoblastoma as it is understood in children, and other differential diagnoses should also be entertained. Nonetheless, hepatoblastoma should be considered in adults presenting with primary liver tumours in the absence of pre-existing liver disease. Adult and paediatric patients with immature hepatoblastoma appear to have worse outcomes, and adults presenting with presumed hepatoblastoma have an overall poorer prognosis than children with hepatoblastoma. In all patients, surgery should be the treatment of choice, neoadjuvant chemotherapy is advisable.
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Affiliation(s)
- Anne-Laure Rougemont
- Division of Clinical Pathology, Geneva University Hospitals, 1211 Geneva 4, Switzerland
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Davidoff AM, Fernandez-Pineda I, Santana VM, Shochat SJ. The role of neoadjuvant chemotherapy in children with malignant solid tumors. Semin Pediatr Surg 2012; 21:88-99. [PMID: 22248974 DOI: 10.1053/j.sempedsurg.2011.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pediatric surgeons play a critical role in diagnosing, staging, and treating malignant solid tumors in children. Over the years, the surgical management of the primary tumor site has evolved from an aggressive en-bloc resection at diagnosis to a more tailored surgical approach, often affecting definitive local control after the delivery of neoadjuvant therapy, as currently directed by many solid tumor protocols. In fact, inappropriate upfront resection can lead to unnecessary short- and long-term morbidity, an incomplete resection, and may be associated with a delay in the initiation of the systemic chemotherapy that is critical to the treatment of gross or occult metastatic disease. Therefore, it is important for the pediatric surgeon, as a member of the multidisciplinary team involved in the care of these children, to understand the indications for and implications of neoadjuvant therapy in the treatment of pediatric solid tumors. Here we review the current management of childhood solid tumors focusing on the role of neoadjuvant therapy.
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Affiliation(s)
- Andrew M Davidoff
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee, USA
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Koh KN, Park M, Kim BE, Bae KW, Kim KM, Im HJ, Seo JJ. Prognostic implications of serum alpha-fetoprotein response during treatment of hepatoblastoma. Pediatr Blood Cancer 2011; 57:554-60. [PMID: 21370433 DOI: 10.1002/pbc.23069] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Accepted: 01/10/2011] [Indexed: 01/05/2023]
Abstract
BACKGROUND We evaluated the outcomes and prognostic factors, especially serum levels of alpha-fetoprotein (AFP) and their changes during the treatment of hepatoblastoma (HB). PROCEDURE We retrospectively analyzed the medical records of 43 consecutive children with HB treated at a single institution between 1991 and 2010. RESULTS Of 43 patients, 5 (12%) underwent primary tumor resection at diagnosis and 38 (88%) received preoperative chemotherapy. Of those 38 patients, 7 (16%) died of progressive disease during preoperative chemotherapy, and 31 (72%) underwent curative operations, including 5 who underwent liver transplantation, after a median 4 cycles of chemotherapy (range, 3-14 cycles). The 5-year overall survival and disease-free survival rates were 62.1 ± 8.3% and 65.6 ± 7.6%, respectively. AFP >263,000 ng/mL at diagnosis, a decline of <1 log in AFP levels after the first cycle of chemotherapy, preoperative AFP levels in the highest tertile, and postoperative AFP levels in the highest tertiles were significantly associated with treatment failure. Age younger than 1 year at diagnosis, thrombocytosis at diagnosis, and early PRETEXT (pretreatment extent of disease) stage were significantly associated with better survival outcomes, whereas gender and metastasis were not. Multivariate analysis showed that high level of preoperative AFP was an independent predictor of treatment failure. CONCLUSIONS Serial monitoring of changes in AFP levels during the treatment, especially perioperative changes, may help identify favorable and poor responders to chemotherapy. Alternative treatment, such as liver transplantation, should be considered for poor responders.
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Affiliation(s)
- Kyung Nam Koh
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Romano F, Stroppa P, Bravi M, Casotti V, Lucianetti A, Guizzetti M, Sonzogni A, Colledan M, D'Antiga L. Favorable outcome of primary liver transplantation in children with cirrhosis and hepatocellular carcinoma. Pediatr Transplant 2011; 15:573-9. [PMID: 21797955 DOI: 10.1111/j.1399-3046.2011.01528.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The outcome of HCC after transplantation (OLT) in children is not well known. Unfavorable features based on adult reports may lead to contraindicate OLT even in children. We reviewed a cohort of children with cirrhosis and HCC to evaluate their outcome after primary transplantation. We considered children with cirrhosis and HCC who had a primary OLT. We retrospectively recorded demographic, medical and surgical features, and MC as predictors of outcome. Among 456 children transplanted in the last 15 yr, 10 (2%), median age at diagnosis 1.8 yr (range 0.5-7.2), had HCC in biliary atresia (3), BSEP deficiency (3), tyrosinemia type 1 (2), complications of choledocal cyst and glycogen storage disease type IV (1 each). At HCC discovery, median AFP was 2322 ng/mL (3-35,000), high or rising in 9/10 patients. Six patients were outside the MC. Median time on the waiting list was 38 days (1-152). Two patients died from early complications of OLT. In the other eight patients, there was no tumor recurrence after a median follow-up of four yr. Children with cirrhosis may develop HCC at a very young age. The outcome appears excellent even outside MC. Primary liver transplantation is advisable for children with cirrhosis, HCC, and no extrahepatic disease.
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Affiliation(s)
- Fabrizio Romano
- Department of Surgical Science, S. Gerardo Hospital, Milan, Italy
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Moon SB, Shin HB, Seo JM, Lee SK. Hepatoblastoma: 15-year experience and role of surgical treatment. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:134-40. [PMID: 22066113 PMCID: PMC3204570 DOI: 10.4174/jkss.2011.81.2.134] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 04/18/2011] [Indexed: 11/30/2022]
Abstract
Purpose Hepatoblastoma is the most common malignant liver tumor in children. The aim of this study was to review our results of hepatoblastoma treatment and to determine the role of surgical treatment in hepatoblastoma. Methods This is a retrospective clinical study. The medical records of patients with hepatoblastoma, treated between October 1994 and October 2009, were reviewed. The patients were classified according to the pretreatment extent of disease (PRETEXT) grouping system. The main outcome variable was survival. Secondary outcome variables were complete, partial and no response to chemotherapy and surgery, when indicated. Results Twenty-seven patients were treated during the observation period. Eighteen were males. Five were PRETEXT group I, 8 group II, 13 group III and 1 group IV. Complete excision was achieved in all patients except in one case that underwent liver transplantation (group IV). Median follow-up and survival rate were 2.3 years and 100%, 6.6 years and 75%, 5.8 years and 92%, 7.7 years and 100%, for groups I to IV, respectively. Twenty patients are currently considered to be in complete response status and three patients are receiving postoperative chemotherapy. Four patients died; the causes of death were cytomegalovirus hepatitis, bone marrow suppression during adjuvant chemotherapy, primarynonfunction after the transplantation for recurrent tumor and metachronous rectal cancer, respectively. Conclusion Favorable long-term outcome could be expected for hepatoblastoma with complete tumor excision and adjuvant chemotherapy.
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Affiliation(s)
- Suk-Bae Moon
- Division of Pediatric Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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