1
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Riehle KJ, Vasudevan SA, Bondoc A, Cuenca AG, Garnier H, Kastenberg Z, Roach J, Weldon CB, Karpelowsky J, Hishiki T, Tiao G. Surgical management of liver tumors. Pediatr Blood Cancer 2024:e31155. [PMID: 38953150 DOI: 10.1002/pbc.31155] [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: 04/22/2024] [Accepted: 06/05/2024] [Indexed: 07/03/2024]
Abstract
Two percent of pediatric malignancies arise primarily in the liver; roughly 60% of these cancers are hepatoblastoma (HB). Despite the rarity of these cases, international collaborative efforts have led to the consistent histological classification and staging systems, which facilitate ongoing clinical trials. Other primary liver malignancies seen in children include hepatocellular carcinoma (HCC) with or without underlying liver disease, fibrolamellar carcinoma (FLC), undifferentiated embryonal sarcoma of the liver (UESL), and hepatocellular neoplasm not otherwise specified (HCN-NOS). This review describes principles of surgical management of malignant pediatric primary liver tumors, within the context of comprehensive multidisciplinary care.
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Affiliation(s)
- Kimberly J Riehle
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | | | - Alexander Bondoc
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alex G Cuenca
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Zachary Kastenberg
- Primary Children's Hospital, University of Utah, Salt Lake City, Utah, USA
| | | | | | | | | | - Gregory Tiao
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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2
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Hino Y, Kohashi K, Tamaki A, Kawakubo N, Hamada H, Fukuhara M, Shibui Y, Tajiri T, Oda Y. FOXM1 and CHD4 expression is associated with chemoresistance in hepatoblastoma. Pathol Res Pract 2024; 258:155348. [PMID: 38761648 DOI: 10.1016/j.prp.2024.155348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/01/2024] [Accepted: 05/09/2024] [Indexed: 05/20/2024]
Abstract
Hepatoblastoma (HB) is the most common malignant liver tumor in childhood. Although pre-operative cisplatin (CDDP)-based chemotherapy is often used in cases of HB, about 20% of HB patients exhibit resistance to CDDP. Forkhead box protein M1 (FOXM1) and chromo-domain-helicase-DNA-binding protein 4 (CHD4) have been associated with CDDP resistance in various tumors. We here analyzed the immunohistochemical expression of FOXM1 and CHD4 in HB specimens of 33 patients (mean age: 20 months) post-chemotherapy. The differentiation of specimens was assessed using the digital pathology software QuPath®, and then the relation between the FOXM1 or CHD4 expression and the differentiation and various other clinicopathological parameters was investigated. The histological type was epithelial in 19 cases (57.6%) and mixed epithelial and mesenchymal in 14 cases (42.4%). Nine cases had only a fetal component, 1 case had only an embryonal component, 22 cases had both fetal and embryonal components, and 1 case had no viable tumor. Both the FOXM1 and CHD4 immunoexpressions were found significantly more frequently in the embryonal than fetal components (p<0.0001 and p<0.0001, respectively). Regarding chemotherapy efficacy, the alpha-fetoprotein (AFP) level after chemotherapy was correlated with both the imaging shrinkage rate (R=-0.52) and histological residual rate (the percentage of the viable tumors of HB after chemotherapy)(R=0.62). High FOXM1 score was correlated with a high-postoperative AFP value (p<0.01) and a low AFP attenuation rate (p<0.05), but the FOXM1 score was not correlated with the imaging shrinkage rate (p=0.4418) or histological residual rate (p=0.4418). High CHD4 score showed a nonsignificant trend toward correlation with high postoperative AFP value (p=0.0849) and was not significantly correlated with the other parameters. Collectively, our results showed that FOXM1 expression may be useful in evaluating the response to CDDP-based chemotherapeutic regimens. Accurate measurement of FOXM1 expression by our scoring system using QuPath® is important in cases with mixed HB components of various differentiation levels.
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Affiliation(s)
- Yuko Hino
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kenichi Kohashi
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Department of Pathology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Akihiko Tamaki
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Naonori Kawakubo
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Hamada
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Fukuhara
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichi Shibui
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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3
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Roehrig A, Hirsch TZ, Pire A, Morcrette G, Gupta B, Marcaillou C, Imbeaud S, Chardot C, Gonzales E, Jacquemin E, Sekiguchi M, Takita J, Nagae G, Hiyama E, Guérin F, Fabre M, Aerts I, Taque S, Laithier V, Branchereau S, Guettier C, Brugières L, Fresneau B, Zucman-Rossi J, Letouzé E. Single-cell multiomics reveals the interplay of clonal evolution and cellular plasticity in hepatoblastoma. Nat Commun 2024; 15:3031. [PMID: 38589411 PMCID: PMC11001886 DOI: 10.1038/s41467-024-47280-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 03/21/2024] [Indexed: 04/10/2024] Open
Abstract
Hepatoblastomas (HB) display heterogeneous cellular phenotypes that influence the clinical outcome, but the underlying mechanisms are poorly understood. Here, we use a single-cell multiomic strategy to unravel the molecular determinants of this plasticity. We identify a continuum of HB cell states between hepatocytic (scH), liver progenitor (scLP) and mesenchymal (scM) differentiation poles, with an intermediate scH/LP population bordering scLP and scH areas in spatial transcriptomics. Chromatin accessibility landscapes reveal the gene regulatory networks of each differentiation pole, and the sequence of transcription factor activations underlying cell state transitions. Single-cell mapping of somatic alterations reveals the clonal architecture of each tumor, showing that each genetic subclone displays its own range of cellular plasticity across differentiation states. The most scLP subclones, overexpressing stem cell and DNA repair genes, proliferate faster after neo-adjuvant chemotherapy. These results highlight how the interplay of clonal evolution and epigenetic plasticity shapes the potential of HB subclones to respond to chemotherapy.
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Affiliation(s)
- Amélie Roehrig
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
| | - Theo Z Hirsch
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
| | - Aurore Pire
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
| | - Guillaume Morcrette
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
- Department of Pathology, Robert Debré and Necker-Enfants Malades Hospitals, APHP, Paris, France
| | - Barkha Gupta
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
| | | | - Sandrine Imbeaud
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France
| | | | - Emmanuel Gonzales
- Pediatric Hepatology and Liver Transplantation Unit, National Reference Centre for Rare Pediatric Liver Diseases, FILFOIE, ERN RARE LIVER, APHP, Bicêtre University Hospital, University of Paris-Saclay, Le Kremlin Bicêtre, and INSERM UMR_S 1193, Hepatinov, University of Paris-Saclay, Orsay, France
| | - Emmanuel Jacquemin
- Pediatric Hepatology and Liver Transplantation Unit, National Reference Centre for Rare Pediatric Liver Diseases, FILFOIE, ERN RARE LIVER, APHP, Bicêtre University Hospital, University of Paris-Saclay, Le Kremlin Bicêtre, and INSERM UMR_S 1193, Hepatinov, University of Paris-Saclay, Orsay, France
| | - Masahiro Sekiguchi
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Junko Takita
- Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Genta Nagae
- Genome Science Laboratory, Research Center for Advanced Science and Technology (RCAST), the University of Tokyo, Tokyo, Japan
| | - Eiso Hiyama
- Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
- Department of Biomedical Science, Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima, Japan
| | - Florent Guérin
- Department of Pediatric Surgery, Bicêtre Hospital, APHP, Paris-Saclay University, Orsay, France
| | - Monique Fabre
- Department of Pathology, Hôpital Universitaire Necker-Enfants malades, AP-HP, Paris, France
| | - Isabelle Aerts
- Oncology Center SIREDO, Institut Curie, PSL Research University, Paris, France
| | - Sophie Taque
- Département de Pédiatrie, CHU Fontenoy, Rennes, France
| | - Véronique Laithier
- Department of Children Oncology, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Sophie Branchereau
- Department of Pediatric Surgery, Bicêtre Hospital, APHP, Paris-Saclay University, Orsay, France
| | - Catherine Guettier
- Department of Pathology Hôpital Bicêtre-AP-HP, INSERM U1193, Paris-Saclay University, Orsay, France
| | - Laurence Brugières
- Gustave Roussy, Université Paris-Saclay, Department of Children and Adolescents Oncology, Villejuif, France
| | - Brice Fresneau
- Gustave Roussy, Université Paris-Saclay, Department of Children and Adolescents Oncology, Villejuif, France
| | - Jessica Zucman-Rossi
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France.
- Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Paris, France.
| | - Eric Letouzé
- Centre de Recherche des Cordeliers, Université Paris Cité, Sorbonne Université, INSERM, Paris, France.
- CRCI2NA, Nantes Université, INSERM, CNRS, Nantes, France.
- University Hospital Hôtel-Dieu, Nantes, France.
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4
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Glaser K, Schepers EJ, Zwolshen HM, Lake CM, Timchenko NA, Karns RA, Cairo S, Geller JI, Tiao GM, Bondoc AJ. EZH2 is a key component of hepatoblastoma tumor cell growth. Pediatr Blood Cancer 2024; 71:e30774. [PMID: 37990130 PMCID: PMC10842061 DOI: 10.1002/pbc.30774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/17/2023] [Accepted: 11/06/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Enhancer of zeste homolog 2 (EZH2) catalyzes the trimethylation of histone H3 at lysine 27 via the polycomb recessive complex 2 (PRC2) and plays a time-specific role in normal fetal liver development. EZH2 is overexpressed in hepatoblastoma (HB), an embryonal tumor. EZH2 can also promote tumorigenesis via a noncanonical, PRC2-independent mechanism via proto-oncogenic, direct protein interaction, including β-catenin. We hypothesize that the pathological activation of EZH2 contributes to HB propagation in a PRC2-independent manner. METHODS AND RESULTS We demonstrate that EZH2 promotes proliferation in HB tumor-derived cell lines through interaction with β-catenin. Although aberrant EZH2 expression occurs, we determine that both canonical and noncanonical EZH2 signaling occurs based on specific gene-expression patterns and interaction with SUZ12, a PRC2 component, and β-catenin. Silencing and inhibition of EZH2 reduce primary HB cell proliferation. CONCLUSIONS EZH2 overexpression promotes HB cell proliferation, with both canonical and noncanonical function detected. However, because EZH2 directly interacts with β-catenin in human tumors and EZH2 overexpression is not equal to SUZ12, it seems that a noncanonical mechanism is contributing to HB pathogenesis. Further mechanistic studies are necessary to elucidate potential pathogenic downstream mechanisms and translational potential of EZH2 inhibitors for the treatment of HB.
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Affiliation(s)
- Kathryn Glaser
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Emily J Schepers
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Harrison M Zwolshen
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Charissa M Lake
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nikolai A Timchenko
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rebekah A Karns
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Stefano Cairo
- Champions Oncology, US Research Headquarters, Rockville, Maryland, USA
| | - James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gregory M Tiao
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexander J Bondoc
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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5
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Cao Y, Wu S, Tang H. An update on diagnosis and treatment of hepatoblastoma. Biosci Trends 2024; 17:445-457. [PMID: 38143081 DOI: 10.5582/bst.2023.01311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2023]
Abstract
Hepatoblastoma (HB) remains the most common paediatric liver tumour and survival in children with hepatoblastoma has improved considerably since the advent of sequential surgical regimens of chemotherapy based on platinum-based chemotherapeutic agents in the 1980s. With the advent of modern diagnostic imaging and pathology techniques, new preoperative chemotherapy regimens and the maturation of surgical techniques, new diagnostic and treatment options for patients with hepatoblastoma have emerged and international collaborations are investigating the latest diagnostic approaches, chemotherapy drug combinations and surgical strategies. Diagnosis of hepatoblastoma relies on imaging studies (such as ultrasound, computed tomography, and magnetic resonance imaging), alpha-fetoprotein (AFP) levels, and histological confirmation through biopsy. The standard treatment approach involves a multimodal strategy with neoadjuvant chemotherapy followed by surgical resection. In cases where complete resection is not feasible or tumors exhibit invasive characteristics, liver transplantation is considered. The management of metastatic and recurrent hepatoblastoma poses significant challenges, and ongoing research focuses on developing targeted therapies and exploring the potential of immunotherapy. Further studies are necessary to gain a better understanding of the etiology of hepatoblastoma, develop prevention strategies, and personalize treatment approaches. We aim to review the current status of diagnosis and treatment of hepatoblastoma.
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Affiliation(s)
- Yinbiao Cao
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China
- The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Shurui Wu
- The First Medical Center of the Chinese PLA General Hospital, Beijing, China
| | - Haowen Tang
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China
- The First Medical Center of the Chinese PLA General Hospital, Beijing, China
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Murawski M, Garnier H, Stefanowicz J, Sinacka K, Izycka-Swieszewska E, Sawicka-Zukowska M, Wawrykow P, Wrobel G, Mizia-Malarz A, Marciniak-Stepak P, Czauderna P. Parenchyma Sparing Anatomic Liver Resections (Bi- and Uni-Segmentectomies) for Liver Tumours in Children-A Single-Centre Experience. Cancers (Basel) 2023; 16:38. [PMID: 38201466 PMCID: PMC10778279 DOI: 10.3390/cancers16010038] [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: 11/19/2023] [Revised: 12/12/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
Purpose: To present a single-centre experience in bi- and uni-segmentectomies for primary liver tumours in children. METHODS This study included 23 patients that underwent (bi)segmentectomy. There were 15 malignant tumours (hepatoblastoma-13 patients), 7 benign tumours, and 1 calcifying nested stromal epithelial tumour. RESULTS The median tumour diameter was 52 mm (range 15-170 mm). Bisegmentectomy 2-3 was most frequently performed (seven patients), followed by bisegmentectomy 5-6 (four patients). The median operative time was 225 min (range 95-643 min). Intraoperative complications occurred in two patients-small bowel perforation in one and an injury of the small peripheral bile duct resulting in biloma in the other. The median resection margin in patients with hepatoblastoma was 3 mm (range 1-15 mm). Microscopically negative margin status was achieved in 12 out of 13 patients. There were two recurrences. After a median follow-up time of 38 months (range 12-144 months), all 13 patients with HB were alive with no evidence of disease. Two relapsed patients were alive with no evidence of disease. CONCLUSIONS From the available literature and data presented here, we propose that (bi)segmentectomy can become a viable surgical option in carefully selected paediatric patients and is sufficient to achieve a cure. Further studies evaluating the impact of parenchymal preservation surgery on surgical and oncological outcome should be conducted with a larger dataset.
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Affiliation(s)
- Maciej Murawski
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, 80-210 Gdansk, Poland; (H.G.); (P.C.)
| | - Hanna Garnier
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, 80-210 Gdansk, Poland; (H.G.); (P.C.)
| | - Joanna Stefanowicz
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Katarzyna Sinacka
- Department of Radiology, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | - Ewa Izycka-Swieszewska
- Department of Pathology and Neuropathology, Medical University of Gdansk, 80-210 Gdansk, Poland;
| | | | - Pawel Wawrykow
- Department of Pediatric Oncology, Pomeranian Medical University, 71-210 Szczecin, Poland;
| | - Grazyna Wrobel
- Department and Clinic of Haematology, Blood Neoplasms, and Bone Marrow Transplantation, Medical University of Wroclaw, 50-425 Wroclaw, Poland;
| | - Agnieszka Mizia-Malarz
- Department of Pediatric Oncology, Hematology and Chemotherapy, Medical University of Silesia, 40-752 Katowice, Poland;
| | - Patrycja Marciniak-Stepak
- Department of Pediatric Oncology Hematology and Transplantology, Poznan University of Medical Sciences, 60-572 Poznan, Poland;
| | - Piotr Czauderna
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, 80-210 Gdansk, Poland; (H.G.); (P.C.)
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Dong Y, Cekuolis A, Schreiber-Dietrich D, Augustiniene R, Schwarz S, Möller K, Nourkami-Tutdibi N, Chen S, Cao JY, Huang YL, Wang Y, Taut H, Grevelding L, Dietrich CF. Review on Pediatric Malignant Focal Liver Lesions with Imaging Evaluation: Part I. Diagnostics (Basel) 2023; 13:3568. [PMID: 38066809 PMCID: PMC10706220 DOI: 10.3390/diagnostics13233568] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/13/2023] [Accepted: 11/27/2023] [Indexed: 01/09/2024] Open
Abstract
Malignant focal liver lesions (FLLs) are commonly reported in adults but rarely seen in the pediatric population. Due to the rarity, the understanding of these diseases is still very limited. In children, most malignant FLLs are congenital. It is very important to choose appropriate imaging examination concerning various factors. This paper will outline common pediatric malignant FLLs, including hepatoblastoma, hepatocellular carcinoma, and cholangiocarcinoma and discuss them against the background of the latest knowledge on comparable/similar tumors in adults. Medical imaging features are of vital importance for the non-invasive diagnosis and follow-up of treatment of FLLs in pediatric patients. The use of CEUS in pediatric patients for characterizing those FLLs that remain indeterminate on conventional B mode ultrasounds may be an effective option in the future and has great potential to be integrated into imaging algorithms without the risk of exposure to ionizing radiation.
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Affiliation(s)
- Yi Dong
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (Y.D.); (S.C.); (J.-Y.C.); (Y.-L.H.); (Y.W.)
| | - Andrius Cekuolis
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania; (A.C.); (R.A.)
| | | | - Rasa Augustiniene
- Ultrasound Section, Department of Pediatric Radiology, Radiology and Nuclear Medicine Centre, Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania; (A.C.); (R.A.)
| | - Simone Schwarz
- Department of Neonatology and Pediatric Intensive Care Medicine, Sana Kliniken Duisburg GmbH, 47055 Duisburg, Germany;
| | - Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, 10365 Berlin, Germany;
| | - Nasenien Nourkami-Tutdibi
- Saarland University Medical Center, Hospital of General Pediatrics and Neonatology, 66421 Homburg, Germany;
| | - Sheng Chen
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (Y.D.); (S.C.); (J.-Y.C.); (Y.-L.H.); (Y.W.)
| | - Jia-Ying Cao
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (Y.D.); (S.C.); (J.-Y.C.); (Y.-L.H.); (Y.W.)
| | - Yun-Lin Huang
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (Y.D.); (S.C.); (J.-Y.C.); (Y.-L.H.); (Y.W.)
| | - Ying Wang
- Department of Ultrasound, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; (Y.D.); (S.C.); (J.-Y.C.); (Y.-L.H.); (Y.W.)
| | - Heike Taut
- Children’s Hospital, Universitätsklinikum Dresden, Technische Universität Dresden, 01069 Dresden, Germany;
| | - Lara Grevelding
- Department of Pediatrics, Division of Pneumology, Allergology, Infectious Diseases and Gastroenterology, University Hospital Frankfurt, Goethe University, 60323 Frankfurt, Germany
| | - Christoph F. Dietrich
- Department Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Beau Site, Salem und Permanence, 3013 Bern, Switzerland
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8
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Zhang L, Ren BC, Wei F, Liu Y, Gao Y, Yuan B. Ferroptosis regulator NOS2 is closely associated with the prognosis and cell malignant behaviors of hepatoblastoma: a bioinformatic and in vitro study. Front Oncol 2023; 13:1228199. [PMID: 37795447 PMCID: PMC10546316 DOI: 10.3389/fonc.2023.1228199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Background Hepatoblastoma (HB) is the most common liver tumor in children with easy metastasis. The emergence of ferroptosis as a novel form of cell death has gained increased attention in various human cancers. However, the roles of ferroptosis-related (FR) genes in HB remain elusive. Methods The GSE133039, GSE131329, and GSE81928 datasets were utilized for screening core FR genes in HB. Through Lasso regression analysis and using the support vector machine recursive feature elimination (SVM-RFE) algorithm, three candidate FR genes were obtained for characterizing HB. Their expression patterns and their clinical associations were explored through the 'Limma' R package, and their diagnostic potential was evaluated using ROC curves. Nitric oxide synthase 2 (NOS2) emerged as a candidate for further analyses. The CIBERSORT algorithm and GSEA dataset were used to respectively investigate the immune and metabolism effects of NOS2; the former was validated through immunofluorescence. The GSDC database was employed to analyze the correlation between NOS2 expression and the therapeutic efficacy of multiple drugs. PCR, Western blotting, colony formation assays, and Transwell experiments, were used to determine biological functions of NOS2 in HB cells. Potential upstream transcription factors of NOS2 were predicted through the TRRUST, hTFtarget, GeneCards, and JASPAR databases. Results NQO1, SLC1A4, and NOS2 were identified as potential genes in HB and found to be significantly upregulated in tumor samples. Nevertheless, only NOS2 was closely associated with HB clinicopathological characteristics; high NOS2 expression indicated poor prognosis, metastatic tendency, and late clinical stage. Immune analyses indicated that high NOS2 expression was concomitant with decreased infiltration levels of CD8+ T cells but increased infiltration levels of macrophages. GSEA revealed that NOS2 failed to affect the enrichments of glycolysis, fatty acid metabolism, and cholesterol biosynthesis in HB. Moreover, NOS2 was positively correlated with the IC50 values of trametinib, lapatinib, and cisplatin. NOS2 overexpression promoted the proliferation, migration and invasion of HepG2 and HuH-6 cells. JUND was identified as a potential transcriptional regulator of NOS2 by binding to its promoter (5'-TTCTGACTCTTTT-3'). Conclusion NOS2 plays a significant role in HB clinical assessments and holds promise as a novel therapeutic target.
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Affiliation(s)
- Lan Zhang
- Department of Pediatrics, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Bin-cheng Ren
- Department of Rheumatology and Immunology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Fei Wei
- Department of Pediatrics, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Yan Liu
- Department of Pediatrics, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Ya Gao
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Bo Yuan
- Department of General Surgery, Xi’an Central Hospital, Xi’an, China
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9
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Thompson PA, Malogolowkin MH, Furman WL, Piao J, Krailo MD, Chung N, Brock L, Towbin AJ, McCarville EB, Finegold MJ, Ranganathan S, Dunn SP, Langham MR, McGahren ED, Tiao GM, Weldon CB, O'Neill AF, Rodriguez-Galindo C, Meyers RL, Katzenstein HM. Vincristine/irinotecan/temsirolimus upfront window treatment of high-risk hepatoblastoma: A report from the Children's Oncology Group AHEP0731 Study Committee. Pediatr Blood Cancer 2023; 70:e30365. [PMID: 37073741 PMCID: PMC10205685 DOI: 10.1002/pbc.30365] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/08/2023] [Accepted: 03/27/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Survival for children with metastatic hepatoblastoma (HB) remains suboptimal. We report the response rate and outcome of two courses of vincristine/irinotecan/temsirolimus (VIT) in children with high-risk (HR)/metastatic HB. PROCEDURES Patients with newly diagnosed HB received HR window chemotherapy if they had metastatic disease or a serum alpha-fetoprotein (AFP) level less than 100 ng/mL. Patients received vincristine (days 1 and 8), irinotecan (days 1-5), and temsirolimus (days 1 and 8). Cycles were repeated every 21 days. Responders had either a 30% decrease using RECIST (Response Evaluation Criteria in Solid Tumors) criteria OR a 90% (>1 log10 decline) AFP decline after two cycles. Responders received two additional cycles of VIT intermixed with six cycles of cisplatin/doxorubicin/5-fluorouracil/vincristine (C5VD). Nonresponders received six cycles of C5VD alone. RESULTS Thirty-six eligible patients enrolled on study. The median age at enrollment was 27 months (range: 7-170). Seventeen of 36 patients were responders (RECIST and AFP = 3, RECIST only = 4, AFP only = 10). The median AFP at diagnosis was 222,648 ng/mL and the median AFP following two VIT cycles was 19,262 ng/mL. Three-year event-free survival was 47% (95% confidence interval [CI]: 30%-62%), while overall survival was 67% (95% CI: 49%-80%). CONCLUSION VIT did not achieve the study efficacy endpoint. Temsirolimus does not improve the response rate seen in patients treated with vincristine and irinotecan (VI) alone as part of the initial treatment regimen explored in this study. Additionally, AFP response may be a more sensitive predictor of disease response than RECIST in HB.
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Affiliation(s)
- Patrick A Thompson
- North Carolina Children's Hospital and the University of North Carolina, Chapel Hill, North Carolina, USA
| | - Marcio H Malogolowkin
- University of California at Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Wayne L Furman
- University of Tennessee Health Science Center and St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jin Piao
- University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Mark D Krailo
- University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Nadia Chung
- Children's Oncology Group, Monrovia, California, USA
| | - Lindsay Brock
- Children's Oncology Group, Monrovia, California, USA
| | | | - Elizabeth B McCarville
- University of Tennessee Health Science Center and St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | | | | | - Max R Langham
- University of Tennessee Health Science Center and St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Eugene D McGahren
- University of Virginia Children's Hospital, Charlottesville, Virginia, USA
| | - Gregory M Tiao
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christopher B Weldon
- Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Allison F O'Neill
- Dana-Farber Cancer Institute/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
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10
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Nousiainen R, Eloranta K, Isoaho N, Cairo S, Wilson DB, Heikinheimo M, Pihlajoki M. UBE2C expression is elevated in hepatoblastoma and correlates with inferior patient survival. Front Genet 2023; 14:1170940. [PMID: 37377594 PMCID: PMC10291054 DOI: 10.3389/fgene.2023.1170940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Hepatoblastoma (HB) is the most common malignant liver tumor among children. To gain insight into the pathobiology of HB, we performed RNA sequence analysis on 5 patient-derived xenograft lines (HB-243, HB-279, HB-282, HB-284, HB-295) and 1 immortalized cell line (HUH6). Using cultured hepatocytes as a control, we found 2,868 genes that were differentially expressed in all of the HB lines on mRNA level. The most upregulated genes were ODAM, TRIM71, and IGDCC3, and the most downregulated were SAA1, SAA2, and NNMT. Protein-protein interaction analysis identified ubiquitination as a key pathway dysregulated in HB. UBE2C, encoding an E2 ubiquitin ligase often overexpressed in cancer cells, was markedly upregulated in 5 of the 6 HB cell lines. Validation studies confirmed UBE2C immunostaining in 20 of 25 HB tumor specimens versus 1 of 6 normal liver samples. The silencing of UBE2C in two HB cell models resulted in decreased cell viability. RNA sequencing analysis showed alterations in cell cycle regulation after UBE2C knockdown. UBE2C expression in HB correlated with inferior patient survival. We conclude that UBE2C may hold prognostic utility in HB and that the ubiquitin pathway is a potential therapeutic target in this tumor.
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Affiliation(s)
- Ruth Nousiainen
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Katja Eloranta
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Noora Isoaho
- Division of Micro and Nanosystems, School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Stefano Cairo
- Champions Oncology, Hackensack, NJ, United States
- Istituto di Ricerca Pediatrica, Padova, Italy
- XenTech, Evry, France
| | - David B. Wilson
- Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO, United States
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO, United States
| | - Markku Heikinheimo
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children’s Hospital, St. Louis, MO, United States
- Faculty of Medicine and Health Technology, Center for Child, Adolescent and Maternal Health Research, Tampere University, Tampere, Finland
| | - Marjut Pihlajoki
- Pediatric Research Center, Children’s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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11
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Klein SD, DeMarchis M, Linn RL, MacFarland SP, Kalish JM. Occurrence of Hepatoblastomas in Patients with Beckwith-Wiedemann Spectrum (BWSp). Cancers (Basel) 2023; 15:cancers15092548. [PMID: 37174013 PMCID: PMC10177446 DOI: 10.3390/cancers15092548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/18/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
Patients with Beckwith-Wiedemann syndrome (BWS), an epigenetic imprinting disorder involving alterations in genes at the 11p15 chromosomal location, are predisposed to develop hepatoblastomas (HBs), which are rare embryonal liver tumors. Tumors can develop after a BWS diagnosis or, conversely, can be the presenting feature leading to a subsequent diagnosis. While HBs are the cardinal tumors of BWS, not all patients with the BWS spectrum will develop HBs. This observation has led to many hypotheses, including genotype-associated risk, tissue mosaicism, and tumor-specific second hits. To explore these hypotheses, we present the largest cohort of patients with BWS and HBs to date. Our cohort comprised 16 cases, and we broadened our sample size by searching the literature for all cases of BWS with HBs. From these isolated case studies, we amassed another 34 cases, bringing the total number to 50 cases of BWS-HB. We observed that paternal uniparental isodisomy (upd(11)pat) was the most common genotype, representing 38% of cases. The next most common genotype was IC2 LOM, representing 14% of cases. Five patients had clinical BWS without a molecular diagnosis. To investigate the potential mechanism of HBs in BWS, we analyzed normal liver and HB samples from eight cases and isolated tumor samples from another two cases. These samples underwent methylation testing, and 90% of our tumor samples underwent targeted cancer next-generation sequencing (NGS) panels. These matched samples provided novel insights into the oncogenesis of HBs in BWS. We found that 100% of the HBs that underwent NGS panel testing had variants in the CTNNB1 gene. We further identified three distinct groups of BWS-HB patients based on epigenotype. We also demonstrated epigenotype mosaicism, where 11p15 alterations can differ between the blood, HB, and normal liver. In light of this epigenotype mosaicism, tumor risk assessment based on blood profiling may not be accurate. Therefore, universal screening is recommended for all patients with BWS.
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Affiliation(s)
- Steven D Klein
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Madison DeMarchis
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Rebecca L Linn
- Department of Pathology and Lab Medicine, Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Suzanne P MacFarland
- Department of Pediatrics, Perelman School of Medicine, Philadelphia, PA 19104, USA
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Jennifer M Kalish
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Pediatrics, Perelman School of Medicine, Philadelphia, PA 19104, USA
- Center for Childhood Cancer Research, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
- Department of Genetics, Perelman School of Medicine, Philadelphia, PA 19104, USA
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12
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Lin Y, Fang H, Ma C, Zhou J, Ding M, Sun H, Xu Y, Shan Y, Gao H, Yang L, Gu S, Li H. ACLY-β-catenin axis modulates hepatoblastoma cell proliferation. Biochem Biophys Res Commun 2023; 663:104-112. [PMID: 37121120 DOI: 10.1016/j.bbrc.2023.04.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/22/2023] [Indexed: 05/02/2023]
Abstract
HB (hepatoblastoma) is most common in children with liver cancer and few options for treating HB. Thus, it is of great significance to investigate the regulatory mechanism of HB and/or identify new therapeutic targets for clinical treatment of HB. Here, we showed that ACLY (ATP citrate lyase), an important lipometabolic enzyme for de novo biosynthesis of fatty acids and steroids, has a higher expression in HB tissues than noncancerous tissues, and is required for HB cell proliferation. Moreover, knocking down ACLY in HB cells caused severe S-phase arrest and apoptosis. Mechanistically, ACLY knockdown significantly silenced the Wnt signaling pathway and reduced β-catenin expression in HB cells. Conversely, the apoptotic alleviation of HB cells by overexpressing ACLY was blocked by silencing β-catenin, suggesting the modulation of HB cells by ACLY-β-catenin axis. Our results uncovered the role of ACLY in HB cells and presented a theoretical approach for HB targeted therapy in the future.
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Affiliation(s)
- Yanyan Lin
- Key Laboratory of Pediatric Hematology and Oncology Ministry of Health, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Houshun Fang
- Key Laboratory of Pediatric Hematology and Oncology Ministry of Health, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Chunshuang Ma
- Key Laboratory of Pediatric Hematology and Oncology Ministry of Health, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Jiquan Zhou
- Department of General Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Ming Ding
- Key Laboratory of Pediatric Hematology and Oncology Ministry of Health, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Huiying Sun
- Key Laboratory of Pediatric Hematology and Oncology Ministry of Health, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Yan Xu
- Key Laboratory of Pediatric Hematology and Oncology Ministry of Health, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Yuhua Shan
- Department of General Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Hongxiang Gao
- Department of General Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Liyuan Yang
- Department of General Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Song Gu
- Department of General Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China.
| | - Hui Li
- Key Laboratory of Pediatric Hematology and Oncology Ministry of Health, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China; Fujian Children's Hospital, Fujian Branch of Shanghai Children's Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Fujian, China.
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13
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Strategy for hepatoblastoma with major vascular involvement: A guide for surgical decision-making. Surgery 2023; 173:457-463. [PMID: 36473744 DOI: 10.1016/j.surg.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Surgical management of tumor thrombus extending to the major vascular system for children with hepatoblastoma is challenging and insufficiently discussed. METHODS We conducted a retrospective review of hepatoblastoma with tumor thrombus extending to the major vascular system (inferior vena cava, 3 hepatic veins, and portal vein trunk) treated at our center between May 2010 and June 2021. We describe our preoperative assessment, surgical strategies, and outcomes. RESULTS We identified 9 patients (median age at the diagnosis: 3.4 years). All patients received chemotherapy before liver surgery. At the time of the diagnosis, tumor thrombus extended to the portal vein trunk (n = 6), inferior vena cava (n = 3), and 3 hepatic veins (n = 2). Among the 9 patients, 4 underwent liver resection. Liver transplantation was performed in 5 patients. The inferior vena cava wall was circumferentially resected for tumor removal in 1 patient and partially resected in 2 patients. One patient underwent liver transplantation using veno-venous bypass. Patients with tumor thrombus extending to the portal vein trunk were more likely to be managed by liver transplantation in comparison to those with tumor thrombus spreading to the inferior vena cava. The median follow-up period was 5.5 years. One patient underwent transhepatic balloon dilatation for biliary stricture after liver resection. Tumor recurrence was seen in 3 patients (33.3%; lung, n = 2; lymph node and liver, n = 1). No patients died during the follow-up period. CONCLUSION Surgical intervention for pediatric hepatoblastoma with tumor thrombus extending into the major vascular system is safe, feasible, and achieves excellent outcomes.
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14
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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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15
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High-Resolution Magic-Angle-Spinning NMR in Revealing Hepatoblastoma Hallmarks. Biomedicines 2022; 10:biomedicines10123091. [PMID: 36551847 PMCID: PMC9775661 DOI: 10.3390/biomedicines10123091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/02/2022] Open
Abstract
Cancer is one of the leading causes of death in children and adolescents worldwide; among the types of liver cancer, hepatoblastoma (HBL) is the most common in childhood. Although it affects only two to three individuals in a million, it is mostly asymptomatic at diagnosis, so by the time it is detected it has already advanced. There are specific recommendations regarding HBL treatment, and ongoing studies to stratify the risks of HBL, understand the pathology, and predict prognostics and survival rates. Although magnetic resonance imaging spectroscopy is frequently used in diagnostics of HBL, high-resolution magic-angle-spinning (HR-MAS) NMR spectroscopy of HBL tissues is scarce. Using this technique, we studied the alterations among tissue metabolites of ex vivo samples from (a) HBL and non-cancer liver tissues (NCL), (b) HBL and adjacent non-tumor samples, and (c) two regions of the same HBL samples, one more centralized and the other at the edge of the tumor. It was possible to identify metabolites in HBL, then metabolites from the HBL center and the border samples, and link them to altered metabolisms in tumor tissues, highlighting their potential as biochemical markers. Metabolites closely related to liver metabolisms such as some phospholipids, triacylglycerides, fatty acids, glucose, and amino acids showed differences between the tissues.
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16
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Sharma K, Agarwala S, Kandasamy D, Jana M, Sharma R, Dhua A, Jain V, Bhatnagar V. Role of Diffusion Weighted MRI (DW-MR) in Detection of Satellite Lesions Not Detected with Multiphase CT Scans in Hepatoblastoma and Its Implications for Management. Indian J Pediatr 2022; 89:968-974. [PMID: 34997528 DOI: 10.1007/s12098-021-04016-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/18/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To evaluate the role of diffusion-weighted magnetic resonance imaging (DW-MR) in hepatoblastoma as compared to multiphase contrast enhanced computed tomography (CECT) scans for detection of satellite lesions. METHODS In this prospective study on new cases of hepatoblastoma, multiphase CECT scans and DW-MR were performed before initiation of chemotherapy. Results of interpretation were compared for detection of satellite lesions. PRETEXT grouping and risk categorization was done according to SIOPEL based on CECT scan. RESULTS Nine boys and 1 girl with hepatoblastoma, with median age of 11.5 mo were included. All patients were stratified as high-risk group with 2 (20%) in PRETEXT II and 8 (80%) in PRETEXT III. In 2 of 10 (20%) patients, additional satellite lesions were detected on DW-MR, which upgraded their stage. One of the two patients had one satellite lesion identified on CECT, while additional seven satellite lesions were identified on DW-MR imaging. For the other patient, CECT showed no satellite lesion while DW-MR detected six satellite lesions. CONCLUSION MRI has become the gold standard investigation for evaluation of hepatoblastoma. DW-MR, which is a contrast free technique, is a better tool for assessment of satellite lesions which are usually missed on CECT. This would help in proper staging, planning of management and prognostication.
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Affiliation(s)
- Kanika Sharma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.,Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | | | - Manisha Jana
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Raju Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Dhua
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Vishesh Jain
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Veereshwar Bhatnagar
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, 110029, India.,Department of Pediatric Surgery, Sharda University, School of Medical Sciences & Research, Greater Noida, Uttar Pradesh, India
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17
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Kahla JA, Siegel DA, Dai S, Lupo PJ, Foster JH, Scheurer ME, Heczey AA. Incidence and 5-year survival of children and adolescents with hepatoblastoma in the United States. Pediatr Blood Cancer 2022; 69:e29763. [PMID: 35591805 PMCID: PMC9658228 DOI: 10.1002/pbc.29763] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Hepatoblastoma (HB) is the most common pediatric primary malignant liver tumor, its incidence has been increasing worldwide, but recent changes in incidence and outcomes with high population coverage are not well characterized. METHODS We defined the incidence of HB diagnosed during 2003-2017 from United States Cancer Statistics (USCS) database, and survival during 2001-2016 from the National Program of Cancer Registries (NPCR). Data were stratified by sex, race/ethnicity, age, tumor stage, county population, and diagnosis year. Incidence trends were assessed by calculating average annual percent change (AAPC) using Joinpoint regression. Differences in overall 5-year survival were estimated using Cox regression analysis. RESULTS 2178 HB cases with an annual incidence rate of 1.76 per million persons were identified and incidence increased over time (AAPC = 2.2, 95% confidence interval [CI], 0.9-3.6). The 5-year relative survival was 76.9% (95% CI: 74.9-78.8) and the risk of death was lower for cases diagnosed after 2009 (hazard ratio [HR] = 0.77, 95% CI: 0.63-0.94), higher for ages 3-7 years and 8-19 years compared to 0-2 years (HR = 1.38, 95% CI: 1.10-1.76 and 1.83, 95% CI: 1.31-2.70, respectively), for distant compared to locoregional stage (HR = 2.77, 95% CI: 2.27-3.36), and for non-Hispanic Black compared to non-Hispanic White cases (HR = 1.39, 95% CI: 1.02-1.84). CONCLUSIONS HB incidence increased, and survival improved over the study period. Disparities in survival exist by age, race or ethnicity, and stage. Further studies could identify factors affecting increases in HB cases, inform future interventions, and address disparities in outcomes.
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Affiliation(s)
- Justin A Kahla
- Baylor College of Medicine, School of Medicine, Houston, Texas, USA
| | - David A Siegel
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shifan Dai
- Cyberdata Technologies, Inc., Herndon, Virginia, USA
| | - Philip J Lupo
- Section Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
| | - Jennifer H Foster
- Section Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
| | - Michael E Scheurer
- Section Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Center for Epidemiology and Population Health, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
| | - Andras A Heczey
- Section Pediatric Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
- Cancer and Hematology Centers, Texas Children's Hospital, Houston, Texas, USA
- Advanced Innate Cell Therapy Center, Baylor College of Medicine, Houston, Texas, USA
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18
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Fukazawa T, Tanimoto K, Yamaoka E, Kojima M, Kanawa M, Hirohashi N, Hiyama E. Oncogenic Role of ADAM32 in Hepatoblastoma: A Potential Molecular Target for Therapy. Cancers (Basel) 2022; 14:cancers14194732. [PMID: 36230656 PMCID: PMC9562177 DOI: 10.3390/cancers14194732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Outcomes of pediatric hepatoblastoma (HBL) have improved, but refractory cases still occur. More effective and safer drugs are needed that are based on molecular mechanisms. A disintegrin and metalloproteases (ADAMs) are expressed with high frequency in various human carcinomas and play an important role in cancer progression. In this study, we analyzed expression of ADAMs in HBL with a cDNA microarray dataset and found that the expression level of ADAM32 is particularly high. To investigate the role of ADAM32 in cancer, forced expression or knockdown experiments were conducted with HepG2 and HBL primary cells. Colony formation, cell migration and invasion, and cell viability were increased in HepG2 expressing ADAM32, whereas knockdown of ADAM32 induced a decrease in these cellular functions. Quantitative RT-PCR demonstrated an association between ADAM32 expression and the expression of genes related to cancer stem cells and epithelial–mesenchymal transition (EMT), suggesting a role of ADAM32 in cancer stemness and EMT. Furthermore, knockdown of ADAM32 increased cisplatin-induced apoptosis, and this effect was attenuated by a caspase-8 inhibitor, suggesting that ADAM32 plays a role in extrinsic apoptosis signaling. We conclude that ADAM32 plays a crucial role in progression of HBL, so it might be a promising molecular target in anticancer therapy.
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Affiliation(s)
- Takahiro Fukazawa
- Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima 734-8553, Japan
| | - Keiji Tanimoto
- Department of Radiation Disaster Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8553, Japan
- Correspondence: (K.T.); (E.H.); Tel.: +81-(0)82-257-5841 (K.T.); +81-(0)82-257-5555 (E.H.)
| | - Emi Yamaoka
- Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima 734-8553, Japan
| | - Masato Kojima
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8553, Japan
| | - Masami Kanawa
- Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima 734-8553, Japan
| | - Nobuyuki Hirohashi
- Department of Radiation Disaster Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima 734-8553, Japan
| | - Eiso Hiyama
- Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima 734-8553, Japan
- Correspondence: (K.T.); (E.H.); Tel.: +81-(0)82-257-5841 (K.T.); +81-(0)82-257-5555 (E.H.)
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19
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Shen Y, Zheng M, Li J, Tan T, Yang J, Pan J, Hu C, Zou Y, Yang T. Clinical Application of Indocyanine Green Fluorescence Imaging in the Resection of Hepatoblastoma: A Single Institution's Experiences. Front Surg 2022; 9:932721. [PMID: 35846968 PMCID: PMC9280053 DOI: 10.3389/fsurg.2022.932721] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/06/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose Indocyanine green (ICG) fluorescence imaging is becoming increasingly popular in adult oncologic surgery, but remains relatively uncommon in pediatric oncologic surgery. Herein, we report our experience with the use of ICG fluorescence imaging in the resection of hepatoblastoma (HB). Patients and Methods Hepatoblastoma patients who underwent liver resection with ICG fluorescence imaging between January 2020 and March 2021 were included in this study. Patients’ demographic data, clinical information, and detailed information of the use of ICG fluorescence imaging were retrospectively reviewed. Results Sixteen HB patients underwent ICG fluorescence imaging-guided liver resection. There were 11 males and 5 females, age ranged from 8 to 134 months. The initial alpha-fetoprotein ranged from 436 to 528,390 ng/ml. There were one pre-treatment extent of tumor stage I, nine stage II, four stage III, and two stage IV. Three patients underwent up-front hepatectomy, 13 patients received 2–8 cycles of platinum-based neoadjuvant chemotherapy and underwent delayed hepatectomy. ICG (0.5 mg/kg) was given intravenously 48–72 h prior to surgery. The operative time ranged from 180 to 400 min. All patients achieved negative surgical margins. In two patients, ICG identify additional lesions which were not detected in preoperative imaging. Conclusion ICG fluorescence imaging is useful in the resection of HB and may detect small lesions not shown in preoperative imaging.
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Affiliation(s)
| | | | | | | | | | | | | | - Yan Zou
- Correspondence: Yan Zou Tianyou Yang
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20
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D’Souza AM, Gnanamony M, Thomas M, Hanley P, Kanabar D, de Alarcon P, Muth A, Timchenko N. Second Generation Small Molecule Inhibitors of Gankyrin for the Treatment of Pediatric Liver Cancer. Cancers (Basel) 2022; 14:3068. [PMID: 35804840 PMCID: PMC9265042 DOI: 10.3390/cancers14133068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/03/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Gankyrin, a member of the 26S proteasome, is an overexpressed oncoprotein in hepatoblastoma (HBL) and hepatocellular carcinoma (HCC). Cjoc42 was the first small molecule inhibitor of Gankyrin developed; however, the IC50 values of >50 μM made them unattractive for clinical use. Second-generation inhibitors demonstrate a stronger affinity toward Gankyrin and increased cytotoxicity. The aim of this study was to characterize the in vitro effects of three cjoc42 derivatives. Methods: Experiments were performed on the HepG2 (HBL) and Hep3B (pediatric HCC) cell lines. We evaluated the expression of TSPs, cell cycle markers, and stem cell markers by Western blotting and/or real-time quantitative reverse transcription PCR. We also performed apoptotic, synergy, and methylation assays. Results: The treatment with cjoc42 derivatives led to an increase in TSPs and a dose-dependent decrease in the stem cell phenotype in both cell lines. An increase in apoptosis was only seen with AFM-1 and -2 in Hep3B cells. Drug synergy was seen with doxorubicin, and antagonism was seen with cisplatin. In the presence of cjoc42 derivatives, the 20S subunit of the 26S proteasome was more available to transport doxorubicin to the nucleus, leading to synergy. Conclusion: Small-molecule inhibitors for Gankyrin are a promising therapeutic strategy, especially in combination with doxorubicin.
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Affiliation(s)
- Amber M. D’Souza
- Department of Pediatrics, University of Illinois College of Medicine Peoria, 1 Illini Drive, Peoria, IL 61605, USA; (M.G.); (M.T.); (P.H.); (P.d.A.)
| | - Manu Gnanamony
- Department of Pediatrics, University of Illinois College of Medicine Peoria, 1 Illini Drive, Peoria, IL 61605, USA; (M.G.); (M.T.); (P.H.); (P.d.A.)
| | - Maria Thomas
- Department of Pediatrics, University of Illinois College of Medicine Peoria, 1 Illini Drive, Peoria, IL 61605, USA; (M.G.); (M.T.); (P.H.); (P.d.A.)
| | - Peter Hanley
- Department of Pediatrics, University of Illinois College of Medicine Peoria, 1 Illini Drive, Peoria, IL 61605, USA; (M.G.); (M.T.); (P.H.); (P.d.A.)
| | - Dipti Kanabar
- Department of Pharmaceutical Sciences, St. John’s University, 8000 Utopia Pkwy, Jamaica, NY 11439, USA; (D.K.); (A.M.)
| | - Pedro de Alarcon
- Department of Pediatrics, University of Illinois College of Medicine Peoria, 1 Illini Drive, Peoria, IL 61605, USA; (M.G.); (M.T.); (P.H.); (P.d.A.)
| | - Aaron Muth
- Department of Pharmaceutical Sciences, St. John’s University, 8000 Utopia Pkwy, Jamaica, NY 11439, USA; (D.K.); (A.M.)
| | - Nikolai Timchenko
- Division of Pediatric Surgery, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA;
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21
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Falqueto LE, Vilar PR, Campos HG, Schulz C, Mattos E Silva EDE. Primary Malignant Liver Tumors: eight-year experience in a Pediatric Hospital in Brazil. A cross-sectional study. Rev Col Bras Cir 2022; 49:e20223273. [PMID: 35703678 PMCID: PMC10578837 DOI: 10.1590/0100-6991e-20223273-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/22/2022] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION liver tumors are rare neoplasms in childhood (1-2%), and about 2/3 are malignant. Hepatoblastoma (HB) is the most frequent, followed by hepatocellular carcinoma (HCC). In both, the main treatment is surgical resection. Currently, chemotherapy and liver transplantation have improved outcomes. OBJECTIVE study of the epidemiological profile and evolution of liver cancer cases in a referral pediatric hospital. METHODOLOGY a retrospective survey of medical records of patients aged up to 18 years with a diagnosis of primary malignant hepatic neoplasm between 2012 and 2020, carried out in the largest exclusively pediatric hospital in Brazil. RESULTS a total of 13 patients with malignant liver tumors (HB 12, HCC 1) were treated. Of the HB cases, 66,7% were male, with a mean age of 2 years and the main alteration in the palpable abdominal mass. Tumors involved an average of 3 liver segments, more in the right lobe (54%). Only one patient was treated with surgery without neoadjuvant therapy, another one underwent transplantation like the first treatment, and another 2 required liver transplantation as a rescue. The middle follow-up time of patients with HB was 39 months and only 1 case died due to febrile neutropenia. The 5-year overall and disease-free survival was 91.7% and 81.5%, respectively. CONCLUSION Advanced staging at the time of diagnosis has always been a poor prognostic factor in patients with primary malignant liver tumors. However, the results and survival have improved with the advancement of chemotherapy, surgical technique, and liver transplantation.
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Affiliation(s)
| | - Paula Rubio Vilar
- - Hospital Pequeno Príncipe, Cirurgia Pediátrica - Curitiba - PR - Brasil
| | | | - Claudio Schulz
- - Hospital Pequeno Príncipe, Cirurgia Pediátrica - Curitiba - PR - Brasil
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22
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Lak NSM, van der Kooi EJ, Enciso-Martinez A, Lozano-Andrés E, Otto C, Wauben MHM, Tytgat GAM. Extracellular Vesicles: A New Source of Biomarkers in Pediatric Solid Tumors? A Systematic Review. Front Oncol 2022; 12:887210. [PMID: 35686092 PMCID: PMC9173703 DOI: 10.3389/fonc.2022.887210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/12/2022] [Indexed: 12/12/2022] Open
Abstract
Virtually every cell in the body releases extracellular vesicles (EVs), the contents of which can provide a "fingerprint" of their cellular origin. EVs are present in all bodily fluids and can be obtained using minimally invasive techniques. Thus, EVs can provide a promising source of diagnostic, prognostic, and predictive biomarkers, particularly in the context of cancer. Despite advances using EVs as biomarkers in adult cancers, little is known regarding their use in pediatric cancers. In this review, we provide an overview of published clinical and in vitro studies in order to assess the potential of using EV-derived biomarkers in pediatric solid tumors. We performed a systematic literature search, which yielded studies regarding desmoplastic small round cell tumor, hepatoblastoma, neuroblastoma, osteosarcoma, and rhabdomyosarcoma. We then determined the extent to which the in vivo findings are supported by in vitro data, and vice versa. We also critically evaluated the clinical studies using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) system, and we evaluated the purification and characterization of EVs in both the in vivo and in vitro studies in accordance with MISEV guidelines, yielding EV-TRACK and PedEV scores. We found that several studies identified similar miRNAs in overlapping and distinct tumor entities, indicating the potential for EV-derived biomarkers. However, most studies regarding EV-based biomarkers in pediatric solid tumors lack a standardized system of reporting their EV purification and characterization methods, as well as validation in an independent cohort, which are needed in order to bring EV-based biomarkers to the clinic.
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Affiliation(s)
- Nathalie S M Lak
- Research Department, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
| | - Elvera J van der Kooi
- Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
| | | | - Estefanía Lozano-Andrés
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Cees Otto
- Medical Cell Biophysics Group, University of Twente, Enschede, Netherlands
| | - Marca H M Wauben
- Department of Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Netherlands
| | - Godelieve A M Tytgat
- Research Department, Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands.,Department of Experimental Immunohematology, Sanquin Research, Amsterdam, Netherlands
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23
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Short SS, Kastenberg ZJ, Wei G, Bondoc A, Dasgupta R, Tiao GM, Watters E, Heaton TE, Lotakis D, La Quaglia MP, Murphy AJ, Davidoff AM, Mansfield SA, Langham MR, Lautz TB, Superina RA, Ott KC, Malek MM, Morgan KM, Kim ES, Zamora A, Lascano D, Roach J, Murphy JT, Rothstein DH, Vasudevan SA, Whitlock R, Lal DR, Hallis B, Bütter A, Baertschiger RM, Lapidus-Krol E, Putra J, Tracy ER, Aldrink JH, Apfeld J, Le HD, Park KY, Rich BS, Glick RD, Fialkowski EA, Utria AF, Meyers RL, Riehle KJ. Histologic type predicts disparate outcomes in pediatric hepatocellular neoplasms: A Pediatric Surgical Oncology Research Collaborative study. Cancer 2022; 128:2786-2795. [PMID: 35561331 DOI: 10.1002/cncr.34256] [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: 11/16/2021] [Revised: 02/06/2022] [Accepted: 03/10/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a rare cancer in children, with various histologic subtypes and a paucity of data to guide clinical management and predict prognosis. METHODS A multi-institutional review of children with hepatocellular neoplasms was performed, including demographic, staging, treatment, and outcomes data. Patients were categorized as having conventional HCC (cHCC) with or without underlying liver disease, fibrolamellar carcinoma (FLC), and hepatoblastoma with HCC features (HB-HCC). Univariate and multivariate analyses identified predictors of mortality and relapse. RESULTS In total, 262 children were identified; and an institutional histologic review revealed 110 cHCCs (42%; 69 normal background liver, 34 inflammatory/cirrhotic, 7 unknown), 119 FLCs (45%), and 33 HB-HCCs (12%). The authors observed notable differences in presentation and behavior among tumor subtypes, including increased lymph node involvement in FLC and higher stage in cHCC. Factors associated with mortality included cHCC (hazard ratio [HR], 1.63; P = .038), elevated α-fetoprotein (HR, 3.1; P = .014), multifocality (HR, 2.4; P < .001), and PRETEXT (pretreatment extent of disease) stage IV (HR, 5.76; P < .001). Multivariate analysis identified increased mortality in cHCC versus FLC (HR, 2.2; P = .004) and in unresectable tumors (HR, 3.4; P < .001). Disease-free status at any point predicted survival. CONCLUSIONS This multi-institutional, detailed data set allowed a comprehensive analysis of outcomes for children with these rare hepatocellular neoplasms. The current data demonstrated that pediatric HCC subtypes are not equivalent entities because FLC and cHCC have distinct anatomic patterns and outcomes in concert with their known molecular differences. This data set will be further used to elucidate the impact of histology on specific treatment responses, with the goal of designing risk-stratified algorithms for children with HCC. LAY SUMMARY This is the largest reported granular data set on children with hepatocellular carcinoma. The study evaluates different subtypes of hepatocellular carcinoma and identifies key differences between subtypes. This information is pivotal in improving understanding of these rare cancers and may be used to improve clinical management and subsequent outcome in children with these rare malignancies.
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Affiliation(s)
- Scott S Short
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Zachary J Kastenberg
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Guo Wei
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Alex Bondoc
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Roshni Dasgupta
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Greg M Tiao
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Erin Watters
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Todd E Heaton
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Dimitra Lotakis
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael P La Quaglia
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andrew J Murphy
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Andrew M Davidoff
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Sara A Mansfield
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Max R Langham
- Department of Surgery, St Jude Children's Research Hospital, Memphis, Tennessee
| | - Timothy B Lautz
- Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Riccardo A Superina
- Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Katherine C Ott
- Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Marcus M Malek
- Division of Pediatric Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Katrina M Morgan
- Division of Pediatric Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eugene S Kim
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Abigail Zamora
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Danny Lascano
- Division of Pediatric Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jonathan Roach
- Department of Pediatric Surgery, Children's Hospital of Colorado, Denver, Colorado
| | - Joseph T Murphy
- Division of Pediatric Surgery, Children's Medical Center, University of Texas Southwestern, Dallas, Texas
| | - David H Rothstein
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
| | - Sanjeev A Vasudevan
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Richard Whitlock
- Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Dave R Lal
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Brian Hallis
- Division of Pediatric Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Andreana Bütter
- Division of Pediatric Surgery, Children's Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Reto M Baertschiger
- Department of General and Pediatric Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eveline Lapidus-Krol
- Department of General and Pediatric Surgery, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Juan Putra
- Division of Pediatric Pathology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elisabeth R Tracy
- Division of Pediatric Surgery, Duke University Medical Center, Durham, North Carolina
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Jordan Apfeld
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Hau D Le
- Division of Pediatric Surgery, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Keon Y Park
- Division of Pediatric Surgery, American Family Children's Hospital, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, New Hyde Park, New York
| | - Richard D Glick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Northwell/Hofstra, New Hyde Park, New York
| | - Elizabeth A Fialkowski
- Division of Pediatric Surgery, Oregon Health and Science University Doernbecher Children's Hospital, Portland, Oregon
| | - Alan F Utria
- Division of Pediatric Surgery, Oregon Health and Science University Doernbecher Children's Hospital, Portland, Oregon
| | - Rebecka L Meyers
- Division of Pediatric Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Kimberly J Riehle
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington
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Özçay F, Balci Sezer O, Sarialioğlu F, Boyvat F, Coşkun M, Haberal Reyhan N, Haberal M. Seventeen Years of Pediatric Liver Transplantation Experience for Cirrhosis and Hepatocellular Carcinoma. EXP CLIN TRANSPLANT 2022. [PMID: 35297328 DOI: 10.6002/ect.2021.0469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This was a retrospective analysis of liver transplant for pediatric patients with liver cirrhosis and hepatocellular carcinoma. MATERIALS AND METHODS Fourteen pediatric patients with chronic liver disease and hepatocellular carcinoma underwent liver transplant from 2004 to 2021. Preexisting diseases were tyrosinemia (n = 6), progressive familial intrahepatic cholestasis type 2 (n = 2) and type 3 (n = 3), cryptogenic cirrhosis (n = 2), hepatitis B and D (n = 1), and biliary atresia (n = 1). RESULTS Mean age was 9.43 ± 4.9 years (range, 13 months to 16 years). Three patients had 1 tumor, 4 had 2 tumors, and 7 had multiple (≥3) lesions. Six patients were classified as Pretreatment Extent of Disease Staging System for Hepatoblastoma (PRETEXT) stage IV, 3 as stage II, and 5 as stage I. Some patients received systemic chemotherapy before (n = 4) or after transplant (n = 3) or transarterial chemoembolization and microwave ablation pretransplant (n = 1). Hepatocellular carcinoma posttransplant recurrence was observed at 23, 47, and 108 months in 3 patients (21%). Recurrence sites were omentum (n = 1) and liver graft (n = 2). One patient was treated with hepatic resection, radiofrequency ablation, and radiotherapy, while the other received radiofrequency ablation and chemotherapy for graft tumor recurrence. Relapse-free patient survival rates were 92%, 82.5%, and 72.2% at 2, 4, and 10 years, respectively. Four recipients (28.5%) died; posttransplant cause of death was infection at 19 (n = 1) and 188 months (n = 1) or hepatocellular carcinoma recurrence at 79 (n = 1) and 165 months (n = 1). Median follow-up was 178 months (range, 13-204 months). Mean estimated survival was 171.25 ± 16.6 months. Overall patient posttransplant survival was 100%, 92.3%, 92.3%, 83%, and 72% at 1, 2, 5, 10, and 15 years, respectively. CONCLUSIONS Hepatocellular carcinoma was mainly associated with inherited liver diseases in our pediatric series. Liver transplant provided a long-term survival advantage to pediatric patients with preexisting cirrhosis and hepatocellular carcinoma.
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Affiliation(s)
- Figen Özçay
- From the Department of Pediatric Gastroenterology, Başkent University, Ankara, Turkey
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25
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Balli HT, Aikimbaev K, Guney IB, Piskin FC, Yagci-Kupeli B, Kupeli S, Kanmaz T. Trans-Arterial Radioembolization with Yttrium-90 of Unresectable and Systemic Chemotherapy Resistant Hepatoblastoma in Three Toddlers. Cardiovasc Intervent Radiol 2022; 45:344-348. [PMID: 35034139 DOI: 10.1007/s00270-021-03026-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 11/16/2021] [Indexed: 02/07/2023]
Abstract
The aim of this short communication was to report the results of transarterial radioembolization (TARE) with Yttrium-90 (Y90) loaded resin microspheres in three toddlers with unresectable and systemic chemotherapy-resistant HB hepatoblastoma (HB). Six TARE procedures were performed on the patients. The dose required for treatment was calculated using partition model. Administered doses of Y90 were 1.369, 0.851, and 1.147 GBq. Complete radiological response in two patients and partial response enabling liver resection in one patient were achieved. Neither life-threatening nor minor complications developed after the treatment. These results demonstrates that HB is a radiosensitive neoplasm, and TARE-Y90 can be used as the primary, neoadjuvant and palliative treatment method in patients with unresectable and systemic chemotherapy-resistant HBs. However, studies with higher number of patients and long-term results are required.
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Affiliation(s)
- Huseyin Tugsan Balli
- Department of Radiology, Cukurova University Medical School, Balcali Hospital, Adana, Turkey
| | - Kairgeldy Aikimbaev
- Department of Radiology, Cukurova University Medical School, Balcali Hospital, Adana, Turkey
| | - Isa Burak Guney
- Department of Nuclear Medicine, Cukurova University Medical School, Balcali Hospital, Adana, Turkey
| | - Ferhat Can Piskin
- Department of Radiology, Cukurova University Medical School, Balcali Hospital, Adana, Turkey.
| | - Begul Yagci-Kupeli
- Department of Pediatric Hematology and Oncology, University of Health Sciences, Adana Education and Research Center, Adana, Turkey
| | - Serhan Kupeli
- Department of Pediatric Oncology, Cukurova University Medical School, Balcali Hospital, Adana, Turkey
| | - Turan Kanmaz
- Department of Pediatric Surgery, Organ Transplantation Center, Koc University Hospital, Istanbul, Turkey
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26
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Katzenstein HM, Malogolowkin MH, Krailo MD, Piao J, Towbin AJ, McCarville MB, Tiao GM, Dunn SP, Langham MR, McGahren ED, Finegold MJ, Ranganathan S, Weldon CB, Thompson PA, Trobaugh-Lotrario AD, O’Neill AF, Furman WL, Chung N, Randazzo J, Rodriguez-Galindo C, Meyers RL. Doxorubicin in combination with cisplatin, 5-flourouracil, and vincristine is feasible and effective in unresectable hepatoblastoma: A Children's Oncology Group study. Cancer 2022; 128:1057-1065. [PMID: 34762296 PMCID: PMC9066555 DOI: 10.1002/cncr.34014] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/01/2021] [Accepted: 10/07/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The Children's Oncology Group (COG) adopted cisplatin, 5-flourouracil, and vincristine (C5V) as standard therapy after the INT-0098 legacy study showed statistically equivalent survival but less toxicity in comparison with cisplatin and doxorubicin. Subsequent experience demonstrated doxorubicin to be effective in patients with recurrent disease after C5V, and this suggested that it could be incorporated to intensify therapy for patients with advanced disease. METHODS In this nonrandomized, phase 3 COG trial, the primary aim was to explore the feasibility and toxicity of a novel therapeutic cisplatin, 5-flourouracil, vincristine, and doxorubicin (C5VD) regimen with the addition of doxorubicin to C5V for patients considered to be at intermediate risk. Patients were eligible if they had unresectable, nonmetastatic disease. Patients with a complete resection at diagnosis and local pathologic evidence of small cell undifferentiated histology were also eligible for an assessment of feasibility. RESULTS One hundred two evaluable patients enrolled between September 14, 2009, and March 12, 2012. Delivery of C5VD was feasible and tolerable: the mean percentages of the target doses delivered were 96% (95% CI, 94%-97%) for cisplatin, 96% (95% CI, 94%-97%) for 5-fluorouracil, 95% (95% CI, 93%-97%) for doxorubicin, and 90% (95% CI, 87%-93%) for vincristine. Toxicity was within expectations, with death as a first event in 1 patient. The most common adverse events were febrile neutropenia (n = 55 [54%]), infection (n = 48 [47%]), mucositis (n = 31 [30%]), hypokalemia (n = 39 [38%]), and elevated aspartate aminotransferase (n = 28 [27%]). The 5-year event-free and overall survival rates for the 93 patients who did not have complete resection at diagnosis were 88% (95% CI, 79%-93%) and 95% (95% CI, 87%-98%), respectively. CONCLUSIONS The addition of doxorubicin to the previous standard regimen of C5V is feasible, tolerable, and efficacious, and this suggests that C5VD is a good regimen for future clinical trials.
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Affiliation(s)
- Howard M Katzenstein
- Nemours Children’s Specialty Care and Wolfson Children’s Hospital, Jacksonville, FL
| | | | - Mark D Krailo
- University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Jin Piao
- University of Southern California Keck School of Medicine, Los Angeles, CA
| | | | - M Beth McCarville
- University of Tennessee Health Science Center and St Jude Children’s Research Hospital, Memphis, TN
| | - Gregory M Tiao
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | - Max R Langham
- University of Tennessee Health Science Center and St Jude Children’s Research Hospital, Memphis, TN
| | | | | | | | | | | | | | - Allison F O’Neill
- Dana-Farber Cancer Institute, and Boston Children’s Hospital, Boston, MA
| | - Wayne L Furman
- University of Tennessee Health Science Center and St Jude Children’s Research Hospital, Memphis, TN
| | | | | | - Carlos Rodriguez-Galindo
- University of Tennessee Health Science Center and St Jude Children’s Research Hospital, Memphis, TN
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27
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Diagnosis and Follow-up of Incidental Liver Lesions in Children. J Pediatr Gastroenterol Nutr 2022; 74:320-327. [PMID: 34984985 DOI: 10.1097/mpg.0000000000003377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Incidental liver lesions are identified in children without underlying liver disease or increased risk of hepatic malignancy in childhood. Clinical and imaging evaluation of incidental liver lesions can be complex and may require a multidisciplinary approach. This review aims to summarize the diagnostic process and follow-up of incidental liver lesions based on review of the literature, use of state-of-the-art imaging, and our institutional experience. Age at presentation, gender, alpha fetoprotein levels, tumor size, and imaging characteristics should all be taken into consideration to optimize diagnosis process. Some lesions, such as simple liver cyst, infantile hemangioma, focal nodular hyperplasia (FNH), and focal fatty lesions, have specific imaging characteristics. Recently, contrast-enhanced ultrasound (CEUS) was Food and Drug Administration (FDA)-approved for the evaluation of pediatric liver lesions. CEUS is most specific in lesions smaller than 3 cm and is most useful in the diagnosis of infantile hemangioma, FNH, and focal fatty lesions. The use of hepatobiliary contrast in MRI increases specificity in the diagnosis of FNH. Recently, lesion characteristics in MRI were found to correlate with subtypes of hepatocellular adenomas and associated risk for hemorrhage and malignant transformation. Biopsy should be considered when there are no specific imaging characteristics of a benign lesion. Surveillance with imaging and alpha fetoprotein (AFP) should be performed to confirm the stability of lesions when the diagnosis cannot be determined, and whenever biopsy is not feasible.
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Bahador A, Forooghi M, Shahriarirad R, Geramizadeh B, Ataollahi M, Kamran H. A large undifferentiated sarcoma of the liver in a 13-year-old girl treated with anatomical resection: a case report and review of the literature. BMC Gastroenterol 2022; 22:2. [PMID: 34979950 PMCID: PMC8722022 DOI: 10.1186/s12876-021-02076-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Undifferentiated embryonal sarcoma of the liver (UESL) is a rare liver tumor accounting for 6–13% of primary liver tumors. Accurate preoperative diagnosis is difficult, with a rather high misdiagnosis rate. Herein, we reported a very large UESL treated with anatomical resection. Our case is amongst the largest pediatric UESLs in the literature. Case presentation Herein, we report a 13-year-old girl presenting with right upper quadrant abdominal pain, postprandial vomiting, and abdominal distention, in which radiographic imaging demonstrated a huge UESL (28 × 20 × 12 cm). The patient was treated with partial hepatectomy and the 5 kg tumor was removed. The patient was discharged in good condition, with no significant complaints in her follow-up. Conclusions Although different treatment strategies have been reported for UESL cases, anatomical resection is still the main treatment approach, especially for large tumors.
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Affiliation(s)
- Ali Bahador
- Department of Pediatric Surgery, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Forooghi
- Department of Pediatric Surgery, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bita Geramizadeh
- Shiraz Transplant Research Center (STRC), Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Ataollahi
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. .,Nemazee Hospital, Zand Street, Nemazee Square, 71936-13311, Shiraz, Iran.
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FALQUETO LORAINEENTRINGER, VILAR PAULARUBIO, CAMPOS HELDERGROENWOLD, SCHULZ CLAUDIO, MATTOS E SILVA ELISANGELADE. Neoplasias Malignas Primárias do Fígado: experiência de oito anos de um Hospital Pediátrico no Brasil. Estudo transversal. Rev Col Bras Cir 2022. [DOI: 10.1590/0100-6991e-20223273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Introdução: tumores hepáticos são neoplasias raras na infância (1-2%), sendo que cerca de 2/3 são malignos. O hepatoblastoma (HB) é o mais frequente, seguido do carcinoma hepatocelular (CHC). Em ambos, o principal tratamento é a ressecção cirúrgica completa. Atualmente, a quimioterapia e o transplante hepático têm melhorado os resultados. Objetivo: estudo do perfil epidemiológico e evolução dos casos de cânceres hepáticos em um hospital pediátrico de referência. Método: Levantamento retrospectivo de prontuários de pacientes até 18 anos com diagnóstico de neoplasia maligna primária hepática entre 2012 e 2020 realizado no maior hospital exclusivamente pediátrico do Brasil. Resultados: foram atendidos 13 pacientes com tumores malignos hepáticos (HB 12, CHC 1). Dos casos de HB, 66,7% eram do sexo masculino, com idade média de 2 anos e a principal alteração foi massa abdominal palpável. Os tumores envolviam em média 3 segmentos hepáticos, mais em lobo direito (54%). Um paciente foi tratado com cirurgia sem neoadjuvância, um foi submetido a transplante inicialmente e outros 2 necessitaram de transplante hepático como resgate. O tempo de seguimento dos pacientes com HB foi de 39 meses e apenas 1 caso foi a óbito por neutropenia febril. A sobrevida geral e livre de doença em 5 anos foi de 91,7% e 81,5% respectivamente. Conclusão: o estadiamento avançado no momento do diagnóstico sempre foi um fator de mau prognóstico em pacientes com tumores hepáticos malignos primários. Entretanto, os resultados e a sobrevida têm melhorado significativamente com o avanço da quimioterapia, da técnica cirúrgica e do transplante hepático.
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Feng J, Qin H, Yang W, Cheng H, Xu J, Han J, Mou J, Wang H, Ni X. Tumor-Background Ratio is an effective method to identify tumors and false-positive nodules in indocyanine-green navigation surgery for pediatric liver cancer. Front Pediatr 2022; 10:875688. [PMID: 35967548 PMCID: PMC9363659 DOI: 10.3389/fped.2022.875688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Indocyanine green (ICG) navigation surgery has been used for hepatoblastoma (HB) in children but the technique has been reported for using in other childhood liver cancers were rare. This article summarizes the application experience of ICG in HB and other childhood liver cancers in children and explores the role of fluorescence intensity measurement in identifying tumors. METHODS To summarize the clinical experience of children with liver cancer treated by ICG navigation surgery. The tumor and its surrounding tissue were photographed by near infrared during the operation. The fluorescence intensity of tumors, ICG (+) lesions and the normal liver was measured, and the Tumor-Background Ratio (TBR) was calculated. RESULTS A total of 11 children with liver cancer were injected intravenously with ICG 1 day before operation. With the help of ICG fluorescence navigation, there was no residual tumor at the surgical margin for all the children. Total fluorescence was seen in 2 cases, rim fluorescence in 2 cases, and partial fluorescence in 7 cases. 19 ICG false-positive nodules were found on the resection stump or residual liver tissue in 5 cases, and the TBR value of tumors was higher than that of false- positive nodules. 10 children have survived without disease. CONCLUSION ICG navigation surgery is safe and feasible for liver cancer in children, which can enhance the visualization of the tumor during operation and provide more information about the location and boundaries of the tumor. This technique also has limitations, which can be affected by chemotherapy, tumor location, ICG administration regimen, and equipment. TBR is an effective method to identify tumor and non-cancerous lesions.
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Affiliation(s)
- Jun Feng
- Department of Surgical Oncology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Hong Qin
- Department of Surgical Oncology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Wei Yang
- Department of Surgical Oncology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Haiyan Cheng
- Department of Surgical Oncology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jiatong Xu
- Department of Pathology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jianyu Han
- Department of Surgical Oncology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Jianing Mou
- Department of Surgical Oncology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Huanmin Wang
- Department of Surgical Oncology, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xin Ni
- National Center for Pediatric Cancer Surveillance, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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31
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Pire A, Tambucci R, De Magnée C, Sokal E, Stephenne X, Scheers I, Zech F, Gurevich M, Brichard B, Reding R. Living donor liver transplantation for hepatic malignancies in children. Pediatr Transplant 2021; 25:e14047. [PMID: 34076944 DOI: 10.1111/petr.14047] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Living donor liver transplantation is a treatment option for unresectable hepatic tumors in children. METHODS We enrolled 45 living donor transplantations performed between 1993 and 2018 for liver malignacies, which included hepatoblastoma (n = 33), hepatocellular carcinoma (n = 10), hepatic angiosarcoma (n = 1), and rhabdomyosarcoma (n = 1). RESULTS No mortality or major morbidities were encountered in any donor, and the complication rate was 9%. In the hepatoblastoma group, 5-year overall and event-free survival rate in recipients was 87.4% and 75.8%, respectively, and mortality was significantly higher in patients after rescue transplantation (p = .001). Inferior vena cava replacement in these recipients appeared to be associated with reduced mortality (p = .034), but this was not confirmed when rescue patients were excluded (p = .629). In hepatocellular carcinoma group, both 5-year overall and event-free survival rates were 75.4% each, and invasion of hepatic veins was significantly associated with increased risk of recurrence and death (p = .028). The patient with rhabdomyosarcoma died from EBV-induced lymphoma 2 months after transplantation. The patient with angiosarcoma was in complete remission at the last follow-up. Overall, 5-year graft survival rate was 81.3%, and one patient underwent re-transplantation due to chronic rejection. CONCLUSIONS Pediatric oncological liver transplantation has become a key player in the management of malignancies with cancer cure in 84% of patients in this series. Living donor liver transplantation for pediatric recipients with unresectable tumors might be a beneficial surgical option, which is technically safe for donors and recipients, thus, allowing timely planning according to chemotherapy protocols.
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Affiliation(s)
- Aurore Pire
- Pediatric and Transplantation Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Roberto Tambucci
- Pediatric and Transplantation Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Catherine De Magnée
- Pediatric and Transplantation Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Etienne Sokal
- Pediatric Hepatology and Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Xavier Stephenne
- Pediatric Hepatology and Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Isabelle Scheers
- Pediatric Hepatology and Gastroenterology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Francis Zech
- Institute of Experimental and Clinical Research, Université Catholique de Louvain, Brussels, Belgium
| | - Micheal Gurevich
- Organ Transplantation Division, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Bénédicte Brichard
- Pediatric Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Raymond Reding
- Pediatric and Transplantation Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Nagae G, Yamamoto S, Fujita M, Fujita T, Nonaka A, Umeda T, Fukuda S, Tatsuno K, Maejima K, Hayashi A, Kurihara S, Kojima M, Hishiki T, Watanabe K, Ida K, Yano M, Hiyama Y, Tanaka Y, Inoue T, Ueda H, Nakagawa H, Aburatani H, Hiyama E. Genetic and epigenetic basis of hepatoblastoma diversity. Nat Commun 2021; 12:5423. [PMID: 34538872 PMCID: PMC8450290 DOI: 10.1038/s41467-021-25430-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 08/06/2021] [Indexed: 02/08/2023] Open
Abstract
Hepatoblastoma (HB) is the most common pediatric liver malignancy; however, hereditary predisposition and acquired molecular aberrations related to HB clinicopathological diversity are not well understood. Here, we perform an integrative genomic profiling of 163 pediatric liver tumors (154 HBs and nine hepatocellular carcinomas) based on the data acquired from a cohort study (JPLT-2). The total number of somatic mutations is precious low (0.52/Mb on exonic regions) but correlated with age at diagnosis. Telomerase reverse transcriptase (TERT) promoter mutations are prevalent in the tween HBs, selective in the transitional liver cell tumor (TLCT, > 8 years old). DNA methylation profiling reveals that classical HBs are characterized by the specific hypomethylated enhancers, which are enriched with binding sites for ASCL2, a regulatory transcription factor for definitive endoderm in Wnt-pathway. Prolonged upregulation of ASCL2, as well as fetal-liver-like methylation patterns of IGF2 promoters, suggests their "cell of origin" derived from the premature hepatoblast, similar to intestinal epithelial cells, which are highly proliferative. Systematic molecular profiling of HB is a promising approach for understanding the epigenetic drivers of hepatoblast carcinogenesis and deriving clues for risk stratification.
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Affiliation(s)
- Genta Nagae
- grid.26999.3d0000 0001 2151 536XGenome Science Laboratory, Research Center for Advanced Science and Technology (RCAST), the University of Tokyo, Tokyo, Japan
| | - Shogo Yamamoto
- grid.26999.3d0000 0001 2151 536XGenome Science Laboratory, Research Center for Advanced Science and Technology (RCAST), the University of Tokyo, Tokyo, Japan
| | - Masashi Fujita
- grid.509459.40000 0004 0472 0267Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Takanori Fujita
- grid.26999.3d0000 0001 2151 536XGenome Science Laboratory, Research Center for Advanced Science and Technology (RCAST), the University of Tokyo, Tokyo, Japan
| | - Aya Nonaka
- grid.26999.3d0000 0001 2151 536XGenome Science Laboratory, Research Center for Advanced Science and Technology (RCAST), the University of Tokyo, Tokyo, Japan
| | - Takayoshi Umeda
- grid.26999.3d0000 0001 2151 536XGenome Science Laboratory, Research Center for Advanced Science and Technology (RCAST), the University of Tokyo, Tokyo, Japan
| | - Shiro Fukuda
- grid.26999.3d0000 0001 2151 536XGenome Science Laboratory, Research Center for Advanced Science and Technology (RCAST), the University of Tokyo, Tokyo, Japan
| | - Kenji Tatsuno
- grid.26999.3d0000 0001 2151 536XGenome Science Laboratory, Research Center for Advanced Science and Technology (RCAST), the University of Tokyo, Tokyo, Japan
| | - Kazuhiro Maejima
- grid.509459.40000 0004 0472 0267Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Akimasa Hayashi
- grid.26999.3d0000 0001 2151 536XGenome Science Laboratory, Research Center for Advanced Science and Technology (RCAST), the University of Tokyo, Tokyo, Japan ,grid.411205.30000 0000 9340 2869Department of Pathology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Sho Kurihara
- grid.470097.d0000 0004 0618 7953Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Masato Kojima
- grid.470097.d0000 0004 0618 7953Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomoro Hishiki
- grid.136304.30000 0004 0370 1101Chiba University Graduate School of Medicine, Chiba, Japan
| | - Kenichiro Watanabe
- grid.415798.60000 0004 0378 1551Shizuoka Children’s Hospital, Shizuoka, Japan
| | - Kohmei Ida
- grid.412305.10000 0004 1769 1397Department of Pediatrics, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Michihiro Yano
- grid.411403.30000 0004 0631 7850Department of Pediatrics, Akita University Hospital, Akita, Japan
| | - Yoko Hiyama
- grid.257022.00000 0000 8711 3200Department of Biomedical Science, Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima, Japan 734-8551, 1-2-3, Kasumi, Minami-ku, Hiroshima
| | - Yukichi Tanaka
- grid.414947.b0000 0004 0377 7528Department of Pathology, Kanagawa Children’s Medical Center, Yokohama, Japan
| | - Takeshi Inoue
- grid.416948.60000 0004 1764 9308Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Hiroki Ueda
- grid.26999.3d0000 0001 2151 536XGenome Science Laboratory, Research Center for Advanced Science and Technology (RCAST), the University of Tokyo, Tokyo, Japan
| | - Hidewaki Nakagawa
- grid.509459.40000 0004 0472 0267Laboratory for Cancer Genomics, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Hiroyuki Aburatani
- grid.26999.3d0000 0001 2151 536XGenome Science Laboratory, Research Center for Advanced Science and Technology (RCAST), the University of Tokyo, Tokyo, Japan
| | - Eiso Hiyama
- grid.470097.d0000 0004 0618 7953Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan ,grid.257022.00000 0000 8711 3200Department of Biomedical Science, Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima, Japan 734-8551, 1-2-3, Kasumi, Minami-ku, Hiroshima
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Fuchs J, Hoffmann K, Murtha-Lemekhova A, Kessler M, Günther P, Frongia G, Probst P, Mehrabi A. Establishing a Standardized Measure of Quality in Pediatric Liver Surgery: Definition and Validation of Textbook Outcome With Associated Predictors. Front Surg 2021; 8:708351. [PMID: 34368218 PMCID: PMC8333609 DOI: 10.3389/fsurg.2021.708351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 06/25/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose: To establish comparable reporting of surgical results in pediatric liver surgery, the recently introduced composite outcome measures Textbook Outcome (TO) and Comprehensive Complication Index (CCI) are applied and validated in a pediatric surgery context for the first time. In a representative cohort of pediatric patients undergoing liver resection, predictive factors for TO and CCI are investigated, and outcomes are compared to available literature on surgical outcomes of pediatric liver resection. Methods: All liver resections for patients under 21 years of age performed at the Department of General, Visceral, Transplantation and Pediatric Surgery of the University of Heidelberg between 2009 and 2020 were included in the analysis. Criteria for TO were defined prior to the analysis. Univariate and Multivariate regression was applied to identify factors associated with TO and CCI. Results: Fifty-three pediatric patients underwent liver resections during the observation period. No 30- or 90-day mortality occurred. Twenty-three patients (43.4%) had a TO. CCI and TO showed highly significant correlation (b = −30.33, 95% CI [−37.44; −23.22], p < 0.001). Multivariate analyses revealed significant association between intraoperative blood loss (adjusted for circulating blood volume) and CCI (b = 0.70, 95%CI [0.22; 1.32], p = 0.008) and failure to achieve TO (OR = 0.85, 95%CI [0.69; 0.97], p = 0.048). Conclusion: TO and CCI are suited outcome measures in pediatric surgical studies and offer objective comparability of results. Their application in clinical studies will be a major step forward to establish evidence-based therapies in pediatric surgery. Systematic utilization of TO and CCI can aid in generating comparable studies on surgical techniques and outcomes in pediatric liver resection.
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Affiliation(s)
- Juri Fuchs
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Katrin Hoffmann
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Anastasia Murtha-Lemekhova
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Markus Kessler
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Patrick Günther
- Division of Pediatric Surgery, Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Giovanni Frongia
- Department of General, Visceral, Thorax, Pediatric and Endocrine Surgery, Johannes Wesling Hospital Minden, Heidelberg, Germany
| | - Pascal Probst
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
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Bellantoni AJ, Wagner LM. Pursuing Precision: Receptor Tyrosine Kinase Inhibitors for Treatment of Pediatric Solid Tumors. Cancers (Basel) 2021; 13:3531. [PMID: 34298746 PMCID: PMC8303693 DOI: 10.3390/cancers13143531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 02/06/2023] Open
Abstract
Receptor tyrosine kinases are critical for the growth and proliferation of many different cancers and therefore represent a potential vulnerability that can be therapeutically exploited with small molecule inhibitors. Over forty small molecule inhibitors are currently approved for the treatment of adult solid tumors. Their use has been more limited in pediatric solid tumors, although an increasing number of single-agent and combination studies are now being performed. These agents have been quite successful in certain clinical contexts, such as the treatment of pediatric tumors driven by kinase fusions or activating mutations. By contrast, only modest activity has been observed when inhibitors are used as single agents for solid tumors that do not have genetically defined alterations in the target genes. The absence of predictive biomarkers has limited the wider applicability of these drugs and much work remains to define the appropriate patient population and clinical situation in which receptor tyrosine kinase inhibitors are most beneficial. In this manuscript, we discuss these issues by highlighting past trials and identifying future strategies that may help add precision to the use of these agents for pediatric extracranial solid tumors.
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Affiliation(s)
| | - Lars M. Wagner
- Division of Pediatric Hematology/Oncology, Duke University, Durham, NC 27710, USA;
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Ho HT, Mai TH, Nguyen TX, Nguyen KHT, Pham NH, Nguyen HS. Central Hepatectomy in a 6-Month-Old Child with Hepatoblastoma following Chemotherapy. Case Rep Oncol 2021; 14:874-880. [PMID: 34267635 PMCID: PMC8261264 DOI: 10.1159/000516800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022] Open
Abstract
A hepatoblastoma in a 6-month-old child was initially considered unresectable because of diffuse liver involvement. The patient received 4 courses of cisplatin with an interval time of 2 weeks. A computed tomography scan after 4 courses of chemotherapy showed shrinking of the tumor, which made it resectable, and the tumor was removed by central hepatectomy. The patient was able to eat a regular diet on the fourth day and was sent home on the seventh day, after the operation. The pediatric oncologist followed the patient with liver ultrasonography and alpha-fetoprotein and administered 2 more cycles of cisplatin.
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Affiliation(s)
- Huu Thien Ho
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue City, Vietnam
| | - Trung Hieu Mai
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue City, Vietnam
| | - Thanh Xuan Nguyen
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue City, Vietnam
| | | | - Nhu Hien Pham
- Department of Abdominal Emergency and Pediatric Surgery, Hue Central Hospital, Hue City, Vietnam
| | - Huu Son Nguyen
- Pediatric Center, Hue Central Hospital, Hue City, Vietnam
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36
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[Imaging of hepatic tumors in children and adolescents]. Radiologe 2021; 61:629-638. [PMID: 34061213 PMCID: PMC8257542 DOI: 10.1007/s00117-021-00851-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pediatric liver tumors are relatively rare, but thorough knowledge of their imaging features is still important. OBJECTIVES Frequency and imaging features of benign and malignant liver masses during childhood and adolescence. MATERIALS AND METHODS Discussion of relevant original articles, review manuscripts and expert recommendations concerning imaging of childhood liver tumors. RESULTS The most common malignant tumors of the liver are hepatoblastoma, which usually occur in younger children, as well as in some regions hepatocellular carcinoma. In contrast to most benign masses, such as focal nodular hyperplasia, simple cysts or fatty liver infiltrations, their imaging morphology is not very characteristic. Radiologically, sonography and magnetic resonance imaging (MRI) are used for assessment. Both methods benefit from intravenous contrast agent administration. CONCLUSIONS Childhood liver tumors show a broad spectrum of morphological manifestations. Some entities can be characterized using standard imaging, some require multimodal imaging or histological assessment. In addition to morphological imaging criteria, age and the medical history as well as laboratory data play an important role in establishing the correct diagnosis.
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Abstract
The most recent advance in the care of children diagnosed with hepatoblastoma and hepatocellular carcinoma is the Pediatric Hepatic International Tumor Trial, which opened to international enrollment in 2018. It is being conducted as a collaborative effort by the pediatric multicenter trial groups in North America, Europe, and the Far East. This international effort was catalyzed by a new unified global risk stratification system for hepatoblastoma, an international histopathologic consensus classification for pediatric liver tumors, and a revised 2017 collaborative update of the PRE-Treatment EXTent of disease radiographic based staging system.
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Affiliation(s)
- Rebecka Meyers
- Division Pediatric Surgery, University of Utah, Primary Children's Hospital, 100 North Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84113, USA.
| | - Eiso Hiyama
- Department of Pediatric Surgery, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-Ku, Hiroshima 734-8551, Japan
| | - Piotr Czauderna
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Marii Skłodowskiej-Curie 3a, 80-210 Gdańsk, Poland
| | - Greg M Tiao
- Division Pediatric Surgery, Cincinnati Children's Hospital and Medical Center, 3333 Burnet Ave, Cincinnati, Ohio 45229, USA
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39
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D'Souza AM, Cast A, Kumbaji M, Rivas M, Gulati R, Johnston M, Smithrud D, Geller J, Timchenko N. Small Molecule Cjoc42 Improves Chemo-Sensitivity and Increases Levels of Tumor Suppressor Proteins in Hepatoblastoma Cells and in Mice by Inhibiting Oncogene Gankyrin. Front Pharmacol 2021; 12:580722. [PMID: 33746747 PMCID: PMC7969996 DOI: 10.3389/fphar.2021.580722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 01/18/2021] [Indexed: 12/31/2022] Open
Abstract
Objective: Relapsed hepatoblastoma (HBL) and upfront hepatocellular carcinoma (HCC) are notoriously chemoresistant tumors associated with poor outcomes. Gankyrin (Gank) is a known oncogene that is overexpressed in pediatric liver cancer and implicated in chemo-resistance. The goal of this study was to evaluate if the Gank-tumor suppressor axis is activated in chemoresistant hepatoblastoma patients and examine if an inhibitor of Gank, Cjoc42, might improve the chemosensitivity of cancer cells. Methods: Expression of Gank and its downstream targets were examined in fresh human HBL samples using immunostaining, QRT-PCR, and Western Blot. Cancer cells, Huh6 (human HBL) and Hepa1c1c7 (mouse HCC) were treated with Cjoc42 and with Cjoc42 in combination with cisplatin or doxorubicin. Cell proliferation, apoptosis, and chemoresistance were examined. To examine activities of Cjoc42 in vivo, mice were treated with different doses of Cjoc42, and biological activities of Gank and cytotoxicity of Cjoc42 were tested. Results: Elevation of Gank and Gank-mediated elimination of TSPs are observed in patients with minimal necrosis after chemotherapy and relapsed disease. The treatment of Huh6 and Hepa1c1c7 with Cjoc42 was not cytotoxic; however, in combination with cisplatin or doxorubicin, Cjoc42 caused a significant increase in cytotoxicity compared to chemotherapy alone with increased apoptosis. Examination of Cjoc42 in WT mice showed that Cjoc42 is well tolerated without systemic toxicity, and levels of tumor suppressors CUGBP1, Rb, p53, C/EBPα, and HNF4α are increased by blocking their Gank-dependent degradation. Conclusions: Our work shows that Cjoc42 might be a promising adjunct to chemotherapy for the treatment of severe pediatric liver cancer and presents mechanisms by which Cjoc42 increases chemo-sensitivity.
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Affiliation(s)
- Amber M D'Souza
- Departments of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, Hematology and Oncology, University of Illinois College of Medicine, Peoria, IL, United States
| | - Ashley Cast
- Departments of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Meenasri Kumbaji
- Departments of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Maria Rivas
- Departments of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Ruhi Gulati
- Departments of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Michael Johnston
- Departments of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - David Smithrud
- Department of Chemistry, University of Cincinnati, Cincinnati, OH, United States
| | - James Geller
- Departments of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Nikolai Timchenko
- Departments of Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Surgery, University of Cincinnati, Cincinnati, OH, United States
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Liver Transplantation in Locally Unresectable, Undifferentiated Embryonal Cell Sarcoma. Transplant Direct 2021; 7:e654. [PMID: 33490379 PMCID: PMC7817332 DOI: 10.1097/txd.0000000000001106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/26/2020] [Accepted: 11/11/2020] [Indexed: 12/14/2022] Open
Abstract
Background. Undifferentiated embryonal cell sarcoma (UESL) of the liver is the third most common malignant liver disease of childhood presenting as a rapidly enlarging intraabdominal mass. This systematic review explores the practicality of liver transplantation as a viable option in the treatment armamentarium for locally advanced undifferentiated embryonal cell sarcoma. Methods. A systematic review of the literature was performed using Medline and Embase, from inception of databases to December 31, 2018. Keywords and MeSH headings used were embryonal sarcoma, mesenchymal sarcoma, and liver transplant. Reviews and manuscripts with incomplete data were excluded. Results. Twenty-eight patients had orthotopic liver transplantation (OLT) as a curative treatment option. The median age at presentation was 8 and 27 years in the pediatric and adult population, respectively, with a similar male to female ratio. A majority of the patients presented with abdominal pain, palpable mass, and a normal alpha-feto-protein. The median tumor size was 15 cm mainly affecting the right lobe (62%) of the liver. Eighty-two percent of the patients underwent primary OLT and 5 patients had salvage OLT. One death (3.6%) was due to initial misdiagnosis and management for hepatoblastoma. Recurrence was noted in 7.1% of the population. The median follow-up was noted to be 28.5 months. The documented survival rate post-liver transplant for UESL was 96%. Conclusions. Based on available data and the very positive results therein, liver transplantation is a practical and justifiable use of a scarce resource as a treatment option for locally unresectable, undifferentiated embryonal cell sarcoma. The authors propose (accepting existence of different proposals) neoadjuvant therapy before curative resection, and if not achievable, then liver transplantation followed by adjuvant chemotherapy is an option for suitable candidates. For recurrent tumors after surgical resection, adjuvant therapy with salvage liver transplantation is an option.
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41
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Eloranta K, Nousiainen R, Cairo S, Pakarinen MP, Wilson DB, Pihlajoki M, Heikinheimo M. Neuropilin-2 Is Associated With Increased Hepatoblastoma Cell Viability and Motility. Front Pediatr 2021; 9:660482. [PMID: 34239847 PMCID: PMC8257959 DOI: 10.3389/fped.2021.660482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/27/2021] [Indexed: 12/29/2022] Open
Abstract
The neuropilins NRP1 and NRP2 are multifunctional glycoproteins that have been implicated in several cancer-related processes including cell survival, migration, and invasion in various tumor types. Here, we examine the role of neuropilins in hepatoblastoma (HB), the most common pediatric liver malignancy. Using a combination of immunohistochemistry, RNA analysis and western blotting, we observed high level expression of NRP1 and NRP2 in 19 of 20 HB specimens and in a majority of human HB cell lines (HUH6 and five cell lines established from patient-derived xenografts) studied but not in normal hepatocytes. Silencing of NRP2 expression in HUH6 and HB-282 HB cells resulted in decreased cell viability, impaired cytoskeleton remodeling, and reduced cell motility, suggesting that NRP2 contributes to the malignant phenotype. We propose that neuropilins warrant further investigation as biomarkers of HB and potential therapeutic targets.
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Affiliation(s)
- Katja Eloranta
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Ruth Nousiainen
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Stefano Cairo
- XenTech, Evry, France.,Istituto di Ricerca Pediatrica, Padova, Italy
| | - Mikko P Pakarinen
- Pediatric Surgery, and Pediatric Liver and Gut Research Group, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - David B Wilson
- Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, United States.,Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO, United States
| | - Marjut Pihlajoki
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Markku Heikinheimo
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.,Department of Pediatrics, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, United States
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42
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Xu H, Zhou Y, Sun R, Liu X, Diao M, Ren X, Li L. A narrative review of the challenges and countermeasures in hepatoblastoma management during COVID-19 epidemic. Transl Pediatr 2020; 9:840-848. [PMID: 33457307 PMCID: PMC7804479 DOI: 10.21037/tp-20-143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/22/2020] [Indexed: 11/27/2022] Open
Abstract
An infectious disease named "coronavirus disease 2019" (COVID-19) currently has brought a threat to global health security and trends to be more and more severe in many countries. It also has introduced great challenges to the diagnosis and management of children with hepatoblastoma (HB). During the COVID-19 pandemic, pediatric surgeons should not only develop personalized treatment plans for HB therapy, but also emphasize the diagnosis, prevention, and treatment of this virus. Children with both HB and COVID-19 are recommended to undertake multidisciplinary assessment. Anti-SARS-CoV-2 therapy may be a preferred treatment for the infected without presenting a surgical emergency. However, emergent operation may be necessary for HB children with concurrent COVID-19 who developed a life-threatening surgical emergency condition. Otherwise, for children with negative virus examination results, treatment advice should be based on the impact of the epidemic and regional economic considerations. A "wait and see" strategy is recommended for children with resectable tumors after new adjuvant chemotherapy treatment (NACT). Assessment of liver transplantation is recommended for children with HB whose tumors cannot be resected after NACT. Children with HB with pulmonary metastasis may have abnormal findings on chest imaging due to COVID-19. Besides, the detailed therapeutic regimens may vary for children with HB with or without an emergency presentation. Based on previous consensus, current research, and the experiences of our hospital, we aim to offer available management plans for the above-mentioned concerns.
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Affiliation(s)
- Hang Xu
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Yan Zhou
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Rui Sun
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuelai Liu
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xianghai Ren
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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43
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Di Giuseppe G, Youlden DR, Aitken JF, Pole JD. Pediatric hepatic cancer incidence and survival: 30-year trends in Ontario, Canada; the United States; and Australia. Cancer 2020; 127:769-776. [PMID: 33197043 DOI: 10.1002/cncr.33319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 10/02/2020] [Accepted: 10/21/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND Pediatric hepatic cancer is a rare malignancy, comprising only approximately 2% of all cancers diagnosed in children aged <15 years. The authors sought to describe trends in pediatric hepatic cancer incidence and survival in Ontario, Canada; the United States; and Australia. METHODS Children aged <15 years who were diagnosed with hepatic cancer from 1985 through 2013 were ascertained through population-based registries and followed from the time of diagnosis until December 31, 2015. Age-standardized incidence and 5-year relative survival were calculated for each jurisdiction. Multivariable flexible parametric survival models were used to explore predictors of hepatic cancer mortality. RESULTS A total of 794 children were identified in Ontario (148 children), the United States (400 children), and Australia (246 children). The average annual incidence increased by 2.2% (95% CI, 0.5%-4.0%) in Australia, 2.1% (95% CI, 0.9%-3.3%) in the United States, and 1.3% (95% CI, -0.4% to 3.0%) in Ontario. The 5-year relative survival rate improved from 60% to 82% (P = .08) in Ontario and 62% to 78% (P = .02) in the United States between the diagnostic periods 1985 through 1994 and 2005 through 2013, whereas in Australia the rate remained constant (between 74% and 77%) during the study period. On multivariable analysis, there was no significant difference noted with regard to the hazard of death between jurisdictions (P = .06). Older age, the presence of metastatic disease, and being diagnosed with hepatocellular carcinoma were found to be associated with mortality. CONCLUSIONS The incidence of hepatic cancer in children appears to have increased over the last 30 years in Australia and North America. Survival differences between Australia; Ontario, Canada; and the United States observed in the 1980s and 1990s were no longer apparent and only marginal geographical differences in the hazard of mortality were observed.
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Affiliation(s)
- Giancarlo Di Giuseppe
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Danny R Youlden
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Joanne F Aitken
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Jason D Pole
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
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44
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Grice A, Tennermann N, Hagi R, Ward VL. Pediatric Hepatoblastoma: What the Sonographer Needs to Know for the Sonographic Evaluation of Complications After Treatment and After Liver Transplantation. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479320935390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hepatoblastoma (HB) is a common primary pediatric liver tumor, and its typical presentation is a palpable, nontender abdominal mass that is detected through sonographic imaging. The current treatment standard for HB includes chemotherapy followed by liver resection or transplantation. Throughout the management of HB, high-quality sonographic images inform diagnosis, treatment interventions, and detection of surgical treatment complications. It is important that sonographers be familiar with the presentation and complications of HB on imaging examinations. The authors review sonographic detection, evaluation of HB at presentation, and common complications after liver resection and transplantation.
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Affiliation(s)
- Amanda Grice
- Department of Radiology, Boston Children’s Hospital, Boston, MA, USA
| | - Nikki Tennermann
- Office of Health Equity and Inclusion, Boston Children’s Hospital, Boston, MA, USA
| | - Ramla Hagi
- Office of Health Equity and Inclusion, Boston Children’s Hospital, Boston, MA, USA
- Summer Program to Advance Research Careers through Dana-Farber/Harvard Cancer Center and University of Massachusetts Boston, Boston, MA, USA
| | - Valerie L. Ward
- Department of Radiology, Boston Children’s Hospital, Boston, MA, USA
- Office of Health Equity and Inclusion, Boston Children’s Hospital, Boston, MA, USA
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45
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Moreno F, Rose A, Chaplin MA, Cipolla MC, García Lombardi M, Nana M, Cervio G, Halac E, Viso M, Ayarzabal V, Bosaleh A, Liberto D, Sarabia E, Rizzi A, Morici M, Streitenberger P, de Dávila MTG. Childhood liver tumors in Argentina: Incidence trend and survival by treatment center. A report from the national pediatric cancer registry, ROHA network 2000-2015. Pediatr Blood Cancer 2020; 67:e28583. [PMID: 32737960 DOI: 10.1002/pbc.28583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 06/19/2020] [Accepted: 06/29/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Information on the epidemiology of pediatric liver tumors in Latin America is limited. PURPOSE To describe the incidence of liver tumors in a pediatric registry in Argentina according to geographic region, national trends over 16 years, and survival related to stage, age, sex, and care center. METHODS Newly diagnosed liver tumors cases are registered in the Argentine Pediatric Oncology Hospital Registry (ROHA) with an estimated coverage of 91% of national cases. Age-standardized incidence rate per millon (ASR) was calculated based on the National Vital Statistics Reports. Five-year overall survival (OS) was estimated using the Kaplan-Meier method. The log-rank test was used to compare subgroup survival. RESULTS Two hundred seven cases of hepatoblastoma (HB) and 73 of hepatocellular carcinoma (HCC) were identified. ASR of liver tumors was 1.8/million (95% confidence Interval [CI], 1.6-2.0) per year. ASR was 1.4 (1.2-1.6) for HB and 0.4 (0.3-0.5) for HCC. For HB, the highest incidence was found in the northwest region including the Altiplano. OS was 60.4% (53.4-66.8) for HB and 36.1% (25.2-47.2) for HCC. Five-year survival rate of children with metastatic HB treated at liver transplant hospitals (LTH) was 54.2% (30.3-73.0) compared to 13.3% (2.2-34.6) for those seen at other hospitals (OH) (P = .02), while for HCC this rate was 46.3% (30.7-60.6) at LTH compared to 17.5% (3.1-41.9) at OH (P = .01). CONCLUSIONS The incidence rate of pediatric liver tumors was stable over the 16-year study period. Patients may benefit if at treatment initiation they are evaluated jointly with LTH specialists to define treatment strategies.
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Affiliation(s)
- Florencia Moreno
- Argentinian Pediatric Oncology Registry, Ministry of Health, National Cancer Institute, Buenos Aires, Argentina
| | - Adriana Rose
- Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | - M Agustina Chaplin
- Argentinian Pediatric Oncology Registry, Ministry of Health, National Cancer Institute, Buenos Aires, Argentina
| | - M Cristina Cipolla
- Nacional Department of Maternity, Childhood, and Adolescence, Ministry of Health, Buenos Aires, Argentina
| | | | - Mariana Nana
- Ricardo Gutiérrez Children's Hospital, Buenos Aires, Argentina
| | | | - Esteban Halac
- Garrahan Pediatric Hospital, Buenos Aires, Argentina
| | | | | | | | | | - Elena Sarabia
- Dr Humberto J. Notti Children's Hospital, Mendoza, Argentina
| | - Ana Rizzi
- Garrahan Pediatric Hospital, Buenos Aires, Argentina
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Haeberle B, Rangaswami A, Krailo M, Czauderna P, Hiyama E, Maibach R, Lopez-Terrada D, Aronson DC, Alaggio R, Ansari M, Malogolowkin MH, Perilongo G, O'Neill AF, Trobaugh-Lotrario AD, Watanabe K, Schmid I, von Schweinitz D, Ranganathan S, Yoshimura K, Hishiki T, Tanaka Y, Piao J, Feng Y, Rinaldi E, Saraceno D, Derosa M, Meyers RL. The importance of age as prognostic factor for the outcome of patients with hepatoblastoma: Analysis from the Children's Hepatic tumors International Collaboration (CHIC) database. Pediatr Blood Cancer 2020; 67:e28350. [PMID: 32383794 DOI: 10.1002/pbc.28350] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE Treatment outcomes for hepatoblastoma have improved markedly in the contemporary treatment era, principally due to therapy intensification, with overall survival increasing from 35% in the 1970s to 90% at present. Unfortunately, these advancements are accompanied by an increased incidence of toxicities. A detailed analysis of age as a prognostic factor may support individualized risk-based therapy stratification. METHODS We evaluated 1605 patients with hepatoblastoma included in the CHIC database to assess the relationship between event-free survival (EFS) and age at diagnosis. Further analysis included the age distribution of additional risk factors and the interaction of age with other known prognostic factors. RESULTS Risk for an event increases progressively with increasing age at diagnosis. This pattern could not be attributed to the differential distribution of other known risk factors across age. Newborns and infants are not at increased risk of treatment failure. The interaction between age and other adverse risk factors demonstrates an attenuation of prognostic relevance with increasing age in the following categories: metastatic disease, AFP < 100 ng/mL, and tumor rupture. CONCLUSION Risk for an event increased with advancing age at diagnosis. Increased age attenuates the prognostic influence of metastatic disease, low AFP, and tumor rupture. Age could be used to modify recommended chemotherapy intensity.
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Affiliation(s)
- Beate Haeberle
- Division of Pediatric Surgery, University of Munich, Munich, Germany
| | - Arun Rangaswami
- Division of Pediatric Hematology and Oncology, University of California San Francisco, San Francisco, California
| | - Mark Krailo
- Department of Preventive Medicine, University of Southern California, California, Los Angeles
| | - Piotr Czauderna
- Department of Surgery for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
| | - Eiso Hiyama
- Department of Pediatric Surgery, Hiroshima University, Hiroshima, Japan
| | | | | | - Daniel C Aronson
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Rita Alaggio
- Department of Pathology, Bambino Gesu Pediatric Hospital, Roma, Italy
| | - Marc Ansari
- Pediatric Department, Onco-Hematology Unit, Geneva University Hospital, Geneva, Switzerland
| | - Marcio H Malogolowkin
- Division of Pediatric Hematology Oncology, University of California Davis Comprehensive Cancer Center, California, Sacramento
| | | | - Allison F O'Neill
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Angela D Trobaugh-Lotrario
- Department of Pediatric Hematology/Oncology, Providence Sacred Heart Children's Hospital Spokane, Washington
| | - Kenichiro Watanabe
- Department of Hematology and Oncology, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Irene Schmid
- Department of Pediatric Hematology and Oncology, University of Munich, Munich, Germany
| | | | - Sarangarajan Ranganathan
- Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Mediacla Center, Cincinnati, Ohio
| | - Kenichi Yoshimura
- Innovative Clinical Research Center (iCREK), Kanazawa University Hospital, Japan
| | - Tomoro Hishiki
- Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yukichi Tanaka
- Department of Pathology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Jin Piao
- Department of Preventive Medicine, University of Southern California, California, Los Angeles
| | - Yurong Feng
- Children's Oncology Group, Los Angeles, California
| | | | | | | | - Rebecka L Meyers
- Division of Pediatric Surgery, University of Utah School of Medicine, Utah, Salt Lake City
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Surgical Therapy for Pediatric Hepatoblastoma in the USA over the Last Decade: Analysis of the National Cancer Database. J Gastrointest Cancer 2020; 52:547-556. [PMID: 32458263 DOI: 10.1007/s12029-020-00421-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Hepatoblastoma (HB) is a rare childhood malignancy with hepatic resection (HR) or liver transplantation (LT) providing the best chance of cure. In this study, we analyze the National Cancer Database lacks (NCDB) to compare outcomes following HR and LT for HB. METHODS Review of the US experience with surgical (HR and LT) management of pediatric (< 18 years) HB over the last decade (2004-2014) using data extracted from the NCDB. RESULTS A total of 628 children underwent surgical treatment for HB during the study period: HR in 525 (83.6%) and LT in 103 (16.4%). The two groups were comparable for age, sex, race, tumor size, and metastatic disease at initial diagnosis. LT group had significantly higher number of patients with bilobar disease (40 vs 21%; p < 0.001), longer median time from diagnosis to surgery (120 vs 78 days; p < 0.001), and longer post-operative length of stay (LOS) (14 vs 6 days; p < 0.001). There were no differences in rates of 30-day readmission and 30- or 90-day mortality between groups. Both groups had comparable 5-year overall survival (OS) (84.1% HR vs 80.0% LT; p = 0.4). Univariate analysis identified metastatic disease at initial presentation (HR 2.56, CI 1.51-4.35) and age ≥ 4 years (HR 2.68, CI 1.5-4.7) as risk factors for worse overall 5-yr OS, while administration of adjuvant chemotherapy was associated with improved 5-yr OS (92.3% with chemo vs 85.4% without chemo; HR 0.51, CI 0.31-0.84). CONCLUSION The outcome of HB has improved compared with historical controls. Age at presentation, metastatic disease, and post-operative chemotherapy impact outcomes.
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Hiyama E, Hishiki T, Watanabe K, Ida K, Ueda Y, Kurihara S, Yano M, Hoshino K, Yokoi A, Takama Y, Nogami Y, Taguchi T, Mori M, Kihira K, Miyazaki O, Fuji H, Honda S, Iehara T, Kazama T, Fujimura J, Tanaka Y, Inoue T, Tajiri T, Kondo S, Oue T, Yoshimura K. Outcome and Late Complications of Hepatoblastomas Treated Using the Japanese Study Group for Pediatric Liver Tumor 2 Protocol. J Clin Oncol 2020; 38:2488-2498. [PMID: 32421442 DOI: 10.1200/jco.19.01067] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE We report here the outcomes and late effects of the Japanese Study Group for Pediatric Liver Tumors (JPLT)-2 protocol, on the basis of cisplatin-tetrahydropyranyl-adriamycin (CITA) with risk stratification according to the pretreatment extent of disease (PRETEXT) classification for hepatoblastoma (HB). PATIENTS AND METHODS From 1999 to 2012, 361 patients with untreated HB were enrolled. PRETEXT I/II patients were treated with up-front resection, followed by low-dose CITA (stratum 1) or received low-dose CITA, followed by surgery and postoperative chemotherapy (stratum 2). In the remaining patients, after 2 cycles of CITA, responders received the CITA regimen before resection (stratum 3), and nonresponders were switched to ifosfamide, pirarubicin, etoposide, and carboplatin (ITEC; stratum 4). Intensified chemotherapeutic regimens with autologous hematopoietic stem-cell transplantation (SCT) after resection were an optional treatment for patients with refractory/metastatic disease. RESULTS The 5-year event-free and overall survival rates of HB patients were 74.2% and 89.9%, respectively, for stratum 1, 84.8% and 90.8%%, respectively, for stratum 2, 71.6% and 85.9%%, respectively, for stratum 3, and 59.1% and 67.3%%, respectively, for stratum 4. The outcomes for CITA responders were significantly better than those for nonresponders, whose outcomes remained poor despite salvage therapy with a second-line ITEC regimen or SCT. The late effects, ototoxicity, cardiotoxicity, and delayed growth, occurred in 61, 18, and 47 patients, respectively. Thirteen secondary malignant neoplasms (SMNs), including 10 leukemia, occurred, correlating with higher exposure to pirarubicin and younger age at diagnosis. CONCLUSION The JPLT-2 protocol achieved up-front resectability in PRETEXT I/II patients with no annotation factors, and satisfactory survival in patients who were CITA responders in the remaining patients. However, outcomes for CITA nonresponders were unsatisfactory, despite therapy intensification with ITEC regimens and SCT. JPLT-2 had a relatively low incidence of cardiotoxicity but high rates of SMNs.
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Affiliation(s)
- Eiso Hiyama
- Natural Science Center for Basic Research and Development, Hiroshima University, Hiroshima, Japan.,Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomoro Hishiki
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan.,National Cancer Center Hospital, Tokyo, Japan
| | | | - Kohmei Ida
- Department of Pediatrics, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
| | - Yuka Ueda
- Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Sho Kurihara
- Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, Japan
| | - Michihiro Yano
- Department of Pediatrics, Akita University School of Medicine, Akita, Japan
| | - Ken Hoshino
- School of Medicine, Keio University, Tokyo, Japan
| | - Akiko Yokoi
- Department of Pediatric Surgery, Kobe Children's Hospital, Kobe, Hyogo, Japan
| | - Yuichi Takama
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Nogami
- National Cancer Center Hospital, Tokyo, Japan
| | - Tomoaki Taguchi
- Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Makiko Mori
- Departments of Hematology/Oncology, Saitama Children's Medical Center, Saitama, Japan
| | - Kentaro Kihira
- Department of Pediatrics, Mie University Graduate School of Medicine, Mie, Japan
| | - Osamu Miyazaki
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Hiroshi Fuji
- Children's Cancer Center, National Center for Child Health and Development, Tokyo, Japan
| | - Shohei Honda
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tomoko Iehara
- Department of Pediatrics, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Takuro Kazama
- Department of Pediatric Surgery, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Junya Fujimura
- Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan
| | - Yukichi Tanaka
- Department of Pathology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Takeshi Inoue
- Department of Pathology, Osaka City General Hospital, Osaka, Japan
| | - Tatsuro Tajiri
- Department of Pediatric Surgery, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Satoshi Kondo
- Division of Pediatric Surgery and Transplant Surgery, Nagoya City University Medical School, Nagoya, Japan
| | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Kenichi Yoshimura
- Center for Integrated Medical Research, Hiroshima University Hospital, Hiroshima, Japan
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Yang W, Chen Y, Huang Y, Wang H. Analysis of factors related to recurrence of paediatric hepatoblastoma - a single Centre retrospective study. BMC Pediatr 2019; 19:485. [PMID: 31822277 PMCID: PMC6902323 DOI: 10.1186/s12887-019-1870-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/03/2019] [Indexed: 01/10/2023] Open
Abstract
Background This study was performed to identify risk factors associated with recurrence of hepatoblastoma. Methods A retrospective study was conducted on 56 patients with hepatoblastoma from 2012 to 2015 in Beijing Children’s Hospital. Pretreatment extension stage (PRETEXT), serum alpha fetoprotein (AFP) value, change trend of tumors after treatment and some other clinical characteristics were collected and analyzed. The comparison of independent variables that were not distributed normally was performed with the log-rank test. Results Twenty-eight patients with tumour recurrence and 28 patients without recurrence were included in this study, and the median age at presentation was 46.5 (26, 71.5) months. There was a significant difference in the 3-year recurrence-free survival (RFS) probability between patients aged over 54 months and those younger than 54 months (p = 0.007). After neoadjuvant chemotherapy, the chance of recurrence in partial response (PR) patients was significantly lower than that in stable disease (SD) patients (p = 0.004). The 3-year RFS rate of patients with a reduction in AFP of more than 60% after neoadjuvant chemotherapy was significantly higher than that of patients with a reduction of less than 60% (p = 0.005). The postoperative follow-up revealed that patients whose postoperative AFP fell to normal levels within 6 months of the start of treatment had a 3-year RFS rate of 68.6%, which is higher than that of patients whose AFP fell below the normal range after 6 months (p = 0.0005). Finally, the multivariate analysis by Cox regression showed that AFP decreased by less than 60% and tumour size decreased by less than 50% after neoadjuvant chemotherapy were significant independent prognostic risk factors for the 3-year RFS rate. The other clinical features were not significantly associated with tumour recurrence in this study. Conclusions Through this study, we concluded that the prognosis of childhood HB is related to the age at presentation and the response of chemotherapy. The results of the multivariate analysis showed that AFP decreased by less than 60% and tumour size decreased by less than 50% after neoadjuvant chemotherapy were significant independent prognostic risk factors. These findings can be helpful to evaluate therapeutic effects and predict prognosis.
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Affiliation(s)
- Wei Yang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, No.56 Nanlishi road, Beijing, China
| | - Yiwei Chen
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, No.56 Nanlishi road, Beijing, China
| | - Yijin Huang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, No.56 Nanlishi road, Beijing, China
| | - Huanmin Wang
- Department of Surgical Oncology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 100045, No.56 Nanlishi road, Beijing, China.
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Quintero Escobar M, Maschietto M, Krepischi ACV, Avramovic N, Tasic L. Insights into the Chemical Biology of Childhood Embryonal Solid Tumors by NMR-Based Metabolomics. Biomolecules 2019; 9:biom9120843. [PMID: 31817982 PMCID: PMC6995504 DOI: 10.3390/biom9120843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/30/2019] [Accepted: 12/02/2019] [Indexed: 01/19/2023] Open
Abstract
Most childhood cancers occur as isolated cases and show very different biological behavior when compared with cancers in adults. There are some solid tumors that occur almost exclusively in children among which stand out the embryonal solid tumors. These cancers main types are neuroblastoma, nephroblastoma (Wilms tumors), retinoblastoma and hepatoblastomas and tumors of the central nervous system (CNS). Embryonal solid tumors represent a heterogeneous group of cancers supposedly derived from undifferentiated cells, with histological features that resemble tissues of origin during embryogenesis. This key observation suggests that tumorigenesis might begin during early fetal or child life due to the errors in growth or pathways differentiation. There are not many literature data on genomic, transcriptomic, epigenetic, proteomic, or metabolomic differences in these types of cancers when compared to the omics- used in adult cancer research. Still, metabolomics by nuclear magnetic resonance (NMR) in childhood embryonal solid tumors research can contribute greatly to understand better metabolic pathways alterations and biology of the embryonal solid tumors and potential to be used in clinical applications. Different types of samples, such as tissues, cells, biofluids, mostly blood plasma and serum, can be analyzed by NMR to detect and identify cancer metabolic signatures and validated biomarkers using enlarged group of samples. The literature search for biomarkers points to around 20-30 compounds that could be associated with pediatric cancer as well as metastasis.
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Affiliation(s)
- Melissa Quintero Escobar
- Biological Chemistry Group, Department of Organic Chemistry, Institute of Chemistry, University of Campinas (UNICAMP), Campinas 13083-970, Brazil;
- Laboratory of Blood Coagulation, Department of Medical Physiopathology, Hemocentro, University of Campinas (UNICAMP), Campinas 13083-878, Brazil
| | - Mariana Maschietto
- Research Center, Boldrini Children’s Hospital, Campinas 13083-884, Brazil;
| | - Ana C. V. Krepischi
- Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of Sao Paulo (USP), Sao Paulo 05508-0970, Brazil;
| | - Natasa Avramovic
- Institute of Medical Chemistry, Faculty of Medicine, University of Belgrade, Belgrade 11000, Serbia;
| | - Ljubica Tasic
- Biological Chemistry Group, Department of Organic Chemistry, Institute of Chemistry, University of Campinas (UNICAMP), Campinas 13083-970, Brazil;
- Correspondence: ; Tel.: +55-19-3521-1106
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