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Hou JY, Yeh TC, Huang TH, Sheu JC, Liu HC. A retrospective study of clinical features and outcome in patients with refractory or recurrent hepatoblastoma: A single institution experience. Pediatr Neonatol 2021; 62:400-405. [PMID: 33967009 DOI: 10.1016/j.pedneo.2021.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/03/2021] [Accepted: 03/11/2021] [Indexed: 09/30/2022] Open
Abstract
BACKGROUND Hepatoblastoma (HB) is the most common childhood primary hepatic malignancy. The overall survival rate in patients with HB has reached more than 80% over the past decades. The poor prognostic and high-risk HB have been defined, but the treatment and cure of refractory or relapsed HB is still an arduous task. METHODS The complete records of HB in patients under the age of 18 at the MacKay Memorial Hospital between 1990 and 2019 were examined. RESULTS The treatment results for 11 patients with refractory or relapsed HB are presented. The multi-modality treatment records were reviewed and the clinical characteristics associated with poor outcome included multifocal lesions, low α-fetoprotein, great vessel invasion and metastases. Delayed liver tumor surgery was carried out in eight cases. The median duration of follow-up for the 11 patients was 48.6 months (range 1.9 to 316.8 months). The 5-year and 10-year overall survival rate were 62.3% ± 15% (SE) and 49.9% ± 16.4% (SE), respectively. Most treatment-related toxicities were tolerable. The major concern during long term follow-up was irreversible high-frequency hearing loss. CONCLUSION Patients with refractory/relapsed HB are still a thorny issue and more research is needed to improve the outcome.
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Affiliation(s)
- Jen-Yin Hou
- MacKay Medical College, New Taipei City, Taiwan; Division of Pediatric Hematology-Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Division of Pediatric Hematology-Oncology, MacKay Children's Hospital, Taipei, Taiwan
| | - Ting-Chi Yeh
- MacKay Medical College, New Taipei City, Taiwan; Division of Pediatric Hematology-Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Division of Pediatric Hematology-Oncology, MacKay Children's Hospital, Taipei, Taiwan
| | - Ting-Huan Huang
- MacKay Medical College, New Taipei City, Taiwan; Division of Pediatric Hematology-Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Division of Pediatric Hematology-Oncology, MacKay Children's Hospital, Taipei, Taiwan
| | - Jin-Cherng Sheu
- Division of Pediatric Surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Hsi-Che Liu
- MacKay Medical College, New Taipei City, Taiwan; Division of Pediatric Hematology-Oncology, MacKay Memorial Hospital, Taipei, Taiwan; Division of Pediatric Hematology-Oncology, MacKay Children's Hospital, Taipei, Taiwan.
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Disease-specific Hospitalizations Among 5-Year Survivors of Hepatoblastoma: A Nordic Population-based Cohort Study. J Pediatr Hematol Oncol 2019; 41:181-186. [PMID: 30557167 DOI: 10.1097/mph.0000000000001378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The long-term risk of somatic disease in hepatoblastoma survivors has not been thoroughly evaluated in previous studies. In this population-based study of 86 five-year HB survivors, we used inpatient registers to evaluate the risk for a range of somatic diseases. METHODS In total, 86 five-year survivors of hepatoblastoma were identified in the Nordic cancer registries from 1964 to 2008 and 152,231 population comparisons were selected. Study subjects were followed in national hospital registries for somatic disease classified into 12 main diagnostic groups. Standardized hospitalization rate ratios (RRs) and absolute excess risks were calculated. RESULTS After a median follow-up of 11 years, 35 of the 86 five-year hepatoblastoma survivors had been hospitalized with a total of 69 hospitalizations, resulting in an RR of 2.7 (95% confidence interval [CI], 2.2-3.5) and an overall absolute excess risk of 4.2 per 100 person-years. Highest risk was seen for benign neoplasms (RR=16) with 6 hospitalizations for benign neoplasms in the colon and one in rectum. CONCLUSIONS The pattern of hospitalizations found in this first comprehensive follow-up of hepatoblastoma survivors seems reassuring. Less than 50% of the 5-year survivors had been hospitalized and often for diseases that were not severe or life-threatening.
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Sunil BJ, Palaniappan R, Venkitaraman B, Ranganathan R. Surgical Resection for Hepatoblastoma—Updated Survival Outcomes. J Gastrointest Cancer 2017; 49:493-496. [DOI: 10.1007/s12029-017-0005-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Hou JY, Liu HC, Yeh TC, Sheu JC, Chen KH, Chang CY, Liang DC. Treatment Results of Extracranial Malignant Germ Cell Tumor with Regimens of Cisplatin, Vinblastine, Bleomycin or Carboplatin, Etoposide, and Bleomycin with Special Emphasis on the Sites of Vagina and Testis. Pediatr Neonatol 2015; 56:301-6. [PMID: 25769700 DOI: 10.1016/j.pedneo.2014.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 12/01/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The survival of children with malignant germ cell tumor (GCT) increased over the past 2 decades with platinum-based chemotherapy. This report has three objectives: (1) comparison of PVB (cisplatin, vinblastine, and bleomycin) with JEB (carboplatin, etoposide, and bleomycin) regimens; (2) treatment modality of vaginal GCT; and (3) management of stage I testicular yolk sac tumor (YST) in boys under 2 years old. METHODS From January 1, 1987 to December 31, 2010, 81 patients with malignant extracranial GCT were treated. Two consecutive protocols, PVB followed by JEB, were used. Girls with vaginal YST received minimal surgery and chemotherapy. Boys under 2 years old with Stage I testicular YST received surgery with or without chemotherapy. RESULTS As of June 30, 2012, the 10-year overall survival (OS) was 95 ± 3% (standard error) and the event-free survival (EFS) was 88 ± 4%. With PVB, 35 patients had 10-year OS of 91 ± 5% and EFS of 89 ± 5%. With JEB, 25 patients had 7-year OS of 96 ± 5% and EFS of 96 ± 5%. All five girls with vaginal YST were cured with vagina-preserved strategy. In 32 boys age under 2 years old with stage I YST, 16 with light chemotherapy were all in EFS, whereas two of 16 patients without chemotherapy relapsed. After PVB, six patients developed nephrotoxicity and one had pulmonary fibrosis. CONCLUSION Girls with vaginal YST who received minimal surgery and chemotherapy had excellent prognosis and sexual organs were preservable. Light chemotherapy after surgery is a treatment option for boys under 2 years old with stage I YST to decrease relapse rate. Both JEB and PVB are effective. JEB resulted in more myelosuppression but otherwise less serious long-term toxicity than PVB.
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Affiliation(s)
- Jen-Yin Hou
- Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan; Division of Pediatric Hematology-Oncology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Hsi-Che Liu
- Division of Pediatric Hematology-Oncology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Ting-Chi Yeh
- Division of Pediatric Hematology-Oncology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Jin-Cherng Sheu
- Division of Pediatric Surgery, Mackay Memorial Hospital, Taipei, Taiwan
| | - Kuan-Hao Chen
- Division of Pediatric Hematology-Oncology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Ching-Yi Chang
- Division of Pediatric Hematology-Oncology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Der-Cherng Liang
- Division of Pediatric Hematology-Oncology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
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Miura Y, Saito J, Shimanuki Y, Takeyama J, Murotsuki J. Diagnosis and Treatment of a Preterm Infant With Inoperable Congenital Hepatoblastoma--A Case Report. J Pediatr Hematol Oncol 2015; 37:e188-90. [PMID: 24942027 DOI: 10.1097/mph.0000000000000200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reports of hepatoblastoma (HB) in preterm infants are quite rare. Herein, we report the clinical management of a preterm infant with inoperable congenital HB. A female fetus that had been diagnosed with a large liver tumor consistent with hemangioma was delivered by emergency cesarean section at 33 weeks of gestation because of fetal distress. Effective antitumor therapy could not be performed, resulting in rapid deterioration and death. The postmortem histopathologic analysis confirmed the tumor as a HB. This report demonstrates the difficulties inherent in both the image diagnosis of HB and in providing efficacious treatments for preterm infants with HB.
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Affiliation(s)
- Yuichiro Miura
- Departments of *Neonatology †Radiology ‡Clinical Pathology §Maternal and Fetal Medicine, Miyagi Children's Hospital ∥Department of Maternal and Fetal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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Trobaugh-Lotrario AD, Chaiyachati BH, Meyers RL, Häberle B, Tomlinson GE, Katzenstein HM, Malogolowkin MH, von Schweinitz D, Krailo M, Feusner JH. Outcomes for patients with congenital hepatoblastoma. Pediatr Blood Cancer 2013; 60:1817-25. [PMID: 23798361 DOI: 10.1002/pbc.24655] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 05/20/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Congenital hepatoblastoma, diagnosed in the first month of life, has been reported to have a poor prognosis; however, a comprehensive evaluation of this entity is lacking. PROCEDURE We retrospectively reviewed two patients from the senior authors' personal series and 25 cases identified in the databases of several multicenter group studies (INT-0098, P9645, 881, P9346, HB 89, HB94, and HB 99). We compared this series with cases of congenital hepatoblastoma previously published in the literature. RESULTS The 3-year survival in our case series was 86% (18/21) with a follow-up of 44-230 months (median 85.5 months). Presentation and treatment were not substantially different from hepatoblastoma cohorts unselected for age. Survival was comparable to the reported disease free survival for a similar cohort of hepatoblastoma patients unselected for age between 1986 and 2002 (82.5%) [von Schweinitz et al., Eur J Cancer 1997; 33:1243-1249]. The 2-year survival of cases reported in the literature was 0% (0/9) and 42% (10/24) for patients reported before and after 1990, respectively. CONCLUSIONS Congenital hepatoblastoma does not appear to confer a worse prognosis. The improved survival of our current series of patients, collected from the past 20 years of German and American multicenter trials and personal series, suggests that the outcome of hepatoblastoma at this young age is much better than has been historically reported. More rigorous analysis should be conducted in future multicenter trials. It is possible that congenital hepatoblastoma should be treated like all other patients with hepatoblastoma provided that the child is stable enough to proceed with surgery and chemotherapy.
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Tsay PK, Lai JY, Yang CP, Hung IJ, Hsueh C, Tsai MH, Jaing TH. Treatment outcomes for hepatoblastoma: experience of 35 cases at a single institution. J Formos Med Assoc 2011; 110:322-5. [PMID: 21621153 DOI: 10.1016/s0929-6646(11)60048-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 05/29/2010] [Accepted: 05/31/2010] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/PURPOSE Hepatoblastoma is the most common malignant liver tumor in children. Comparative studies have elucidated the optimal pre- or postoperative chemotherapeutic regimens. The aim of this study was to investigate the prognostic significance of baseline tumor characteristics for overall survival and disease-free survival in children with hepatoblastoma. METHODS There were 19 male and 16 female children with a median age of 19 months at diagnosis (range: 1-169 months) in our institution between February 1990 and June 2009. We reviewed the clinical presentation, serum α-fetoprotein level at diagnosis, histological subtype, treatment, and outcomes. RESULTS Twenty-seven patients (78%) underwent neoadjuvant chemotherapy. The majority of patients subsequently underwent either hemihepatectomy (56%) or bisegmentectomy (16%). Only six patients underwent extended hepatic resection, and one of them required rescue liver transplantation. During follow-up, six patients died of progressive disease and two of perioperative mortality. Four of the six who died had pulmonary metastases at the time of diagnosis or follow-up. The median survival time was 28 months (range: 1-181 months). Five-year overall survival was 67.7% (95% confidence interval: 52.0-87.8%) and disease-free survival was 60.2% (95% confidence interval: 41.9-86.5%). CONCLUSION The potential down-staging effect of neoadjuvant chemotherapy on hepatoblastoma might facilitate remission and convert unresectable tumors into operable ones.
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Affiliation(s)
- Pei-Kwei Tsay
- Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Li YC, Deng YH, Guo ZH, Zhang MM, Zhu J, Pu CL, Xiang CP, Guo CB. Prognostic value of hedgehog signal component expressions in hepatoblastoma patients. Eur J Med Res 2011; 15:468-74. [PMID: 21159571 PMCID: PMC3352655 DOI: 10.1186/2047-783x-15-11-468] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Activation of hedgehog (Hh) pathway has been implicated in the development of human malignancies. Hh as well as related downstream target genes has been extensively studied in many kinds of malignant tumours for clinical diagnostic or prognostic utilities. This study aimed at investigating whether Hh molecules provides a molecular marker of hepatoblastoma malignancy. METHODS We obtained tissue sections from 32 patients with hepatoblastoma as well as cholestasis and normal control. Immunohistochemical analysis were performed to determine Hh signal components in human hepatoblastoma. The prognostic significance of single expression of Hh signal components were evaluated using Cox proportional hazards regression models and Kaplan-Meier survival analysis for statistical analysis. RESULTS Expression of Hh signal components showed an increase in hepatoblastoma compared with cholestasis and normal tissues. There was a positive correlation between Smo or Gli1 expression and tumor clinicopathological features, such as histological type, tumor grade, tumor size and clinical stage. Both Smo or Gli1 protein high expression was significantly associated with poor prognosis by univariate analyses and multivariate analyses. CONCLUSIONS Abnormal Hh signaling activation plays important roles in the malignant potential of hepatoblastoma. Gli1 expression is an independent prognostic marker.
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Affiliation(s)
- Ying-Cun Li
- Department of Hepatobiliary Surgery, Children's Hospital of Chongqing Medical University, 22 Zhongshan Rd., Chongqing, 400014, PR China
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Malek MM, Shah SR, Atri P, Paredes JL, DiCicco LA, Sindhi R, Soltys KA, Mazariegos GV, Kane TD. Review of outcomes of primary liver cancers in children: our institutional experience with resection and transplantation. Surgery 2010; 148:778-82; discussion 782-4. [PMID: 20728194 DOI: 10.1016/j.surg.2010.07.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 07/12/2010] [Indexed: 02/06/2023]
Abstract
BACKGROUND Operative intervention plays an important role in the management of primary liver cancers in children. Recent improvements in diagnostic modalities, pre- and postoperative chemotherapy, and operative technique have all led to improved survival in these patients. Both hepatic resection and orthotopic liver transplantation are effective operations for pediatric liver tumors; which intervention is pursued is based on preoperative extent of disease. This is a review of our institution's experience with operative management of pediatric liver cancer over an 18-year period. METHODS A retrospective chart review from 1990 to 2007 identified patients who were ≤18 years old who underwent operative intervention for primary liver cancer. Demographics, type of operation, intraoperative details, pre- and postoperative management, as well as outcomes were recorded for all patients. RESULTS Fifty-four patients underwent 57 operations for primary liver cancer, 30 of whom underwent resection; the remaining 27 underwent orthotopic liver transplantation. The mean age at diagnosis was 41 months. Twenty patients had stage 1 or 2 disease and 34 patients had stage 3 or 4 disease. Forty-eight (89%) patients received preoperative chemotherapy. Postoperative chemotherapy was given to 92% of patients. Mean overall and intensive care unit duration of stay were 18 and 6 days, respectively. About 45% of patients had a postoperative complication, including hepatic artery thrombosis (n = 8), line sepsis (n = 6), mild acute rejection (n = 3), biliary stricture (n = 2), pneumothorax (n = 2), incarcerated omentum (n = 1), Horner's syndrome (n = 1), and urosepsis (n = 1). Only 6 patients had a recurrence of their cancer, 5 after liver resection, 3 of whom later received a transplant. There was only 1 recurrence after liver transplantation. There was 1 perioperative mortality from cardiac arrest. Overall survival was 93%. CONCLUSION Operative intervention plays a critical role in the management of primary liver cancer in the pediatric population. Neoadjuvant chemotherapy can be given if the tumor seems unresectable at diagnosis. If chemotherapy is unable to sufficiently downstage the tumor, orthotopic liver transplantation becomes the patient's best option. Our institution has had considerable experience with both resection and liver transplantation in the treatment of pediatric primary liver cancer, with good long-term outcomes.
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Affiliation(s)
- Marcus M Malek
- Division of Pediatric General and Thoracic Surgery, University of Pittsburgh Medical Center, Children's Hospital of UPMC, Pittsburgh, PA 15224, USA
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