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Thobani H, Durrani R, Raymond SL, Shah AA, Islam S, Khan FA. Hepatic resections for pediatric hepatoblastoma: analysis of 30-day outcomes using the National Surgical Quality Improvement Program-Pediatric database. Pediatr Surg Int 2024; 40:230. [PMID: 39154089 DOI: 10.1007/s00383-024-05820-y] [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] [Accepted: 08/10/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Surgical resection remains the cornerstone of treatment for hepatoblastoma in children and offers the best chance of disease-free survival. We aimed to analyze the 30 day outcomes of hepatic resection for hepatoblastoma stratified by extent using the National Surgical Quality Improvement Program-Pediatric (NSQIP-P). METHODS We queried NSQIP-P for children undergoing resection of Hepatoblastoma from 2012 to 2021. Relevant clinical characteristics and outcomes were extracted for multivariate logistic regression to identify predictors of common adverse outcomes. RESULTS We included 458 children with a median age of 1.90 years. Overall complications were rare, and perioperative blood transfusion (64.2%) and postoperative ventilation > 48 h (10.0%) were the only adverse events prevalent in more than 5% of patients. Median transfusion volume was 15.7 ml/kg. On multivariate regression, only patients undergoing Trisectionectomy (aOR = 3.387, 95% C.I. = 1.348-8.510) had higher odds of receiving > 75th percentile blood transfusion. Furthermore, only perioperative transfusion and postoperative ventilation > 48 h were statistically more common in patients undergoing extended versus standard resections. CONCLUSIONS Outcomes following resection of hepatoblastoma are excellent, with low rates of postoperative adverse events. Although children undergoing trisectionectomy likely require greater transfusion volume, extended hepatic resections do not appear to have worse 30 day outcomes despite greater operative complexity and duration.
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Affiliation(s)
- Humza Thobani
- Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
- Division of Pediatric Surgery, Department of Surgery, Stanford Center for Academic Medicine, Lucile Packard Children's Hospital, 453 Quarry Rd, Palo Alto, Stanford, CA, 94304, USA
| | - Rafia Durrani
- Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Steven L Raymond
- Division of Pediatric Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Adil A Shah
- Department of Pediatric Surgery, Children's Hospital and Medical Center, University of Nebraska, Omaha, NE, USA
| | - Saleem Islam
- Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Faraz A Khan
- Division of Pediatric Surgery, Department of Surgery, Stanford Center for Academic Medicine, Lucile Packard Children's Hospital, 453 Quarry Rd, Palo Alto, Stanford, CA, 94304, USA.
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2
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Patel PA, Muñoz FG. Interventional oncology in children: Where are we now? J Med Imaging Radiat Oncol 2024. [PMID: 38874327 DOI: 10.1111/1754-9485.13719] [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: 02/29/2024] [Accepted: 05/22/2024] [Indexed: 06/15/2024]
Abstract
Paediatric Interventional Oncology (IO) lags behind adult IO due to a scarcity of specific outcome data. The suboptimal way to evolve this field is relying heavily on adult experiences. The distinct tumour types prevalent in children, such as extracranial germ cell tumours, sarcomas, and neuroblastoma, differ strongly from those found in adults, presenting a completely different biological behaviour. Compounding this challenge, paediatric interventional radiology often employs adapted or off-label techniques, potentially compromising optimal outcomes. This review outlines the present indications for interventional radiology in paediatric cancer, from biopsy to supportive care, including complication management. It emphasises the role of locoregional approaches, and explores the status of common paediatric oncological diseases, highlighting areas where IO has made progress identifying potential opportunities for future advancements in this evolving field.
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Affiliation(s)
- Premal Amrishkumar Patel
- Interventional Radiology, Radiology Department, Great Ormond Street Hospital for Children, London, UK
- Developmental Biology and Cancer Research & Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Fernando Gómez Muñoz
- Interventional Radiology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
- Interventional Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
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Liu GH, Qiu MK, Wang Y, Zhang TT, Wang LJ, Guan WB, Ou JM, Chen LT. Liver transplantation for advanced-stage primary hepatic yolk sac tumor: A case report and literature review. Medicine (Baltimore) 2023; 102:e35821. [PMID: 38115376 PMCID: PMC10727592 DOI: 10.1097/md.0000000000035821] [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: 07/20/2023] [Accepted: 10/06/2023] [Indexed: 12/21/2023] Open
Abstract
RATIONALE Primary hepatic yolk sac tumors (YSTs) are rare in adults. Liver resection is an acknowledged treatment modality for primary hepatic YST. Liver transplantation may offer a possible cure for unresectable cases. PATIENT CONCERNS We present a case of a 31-year-old woman with an abdominal mass who had abnormally elevated alpha-fetoprotein (AFP) levels (31,132 ng/mL; normal: 0-7 ng/mL). Contrast-enhanced computed tomography (CT) revealed large tumors located in both lobes of the liver, with arterial enhancement and venous washout. Fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/CT indicated increased 18F-FDG uptake (maximum standardized uptake value, 24.4) in the liver tumors and left middle intra-abdominal nodule. DIAGNOSES The diagnosis was primary hepatic YST with metastasis to the greater omentum. INTERVENTIONS The patient underwent orthotopic liver transplantation and intra-abdominal nodule resection after transarterial chemoembolization (TACE) as a bridge. Intraoperatively, an intra-abdominal nodule was confirmed in the greater omentum. Histopathological examination of the liver tumors revealed Schiller-Duval bodies. The tropomyosin receptor kinase (TRK) inhibitor larotrectinib was administered, followed by four cycles of chemotherapy with bleomycin, etoposide, and cisplatin based on the next-generation sequencing results. OUTCOMES The AFP level decreased to within the normal range. No evidence of tumor collapse was observed during the 34-month follow-up period. LESSONS This case suggests that multimodal therapy dominated by liver transplantation, including preoperative TACE, postoperative adjuvant chemotherapy, and TRK inhibitors, is an effective treatment modality for unresectable primary hepatic YST.
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Affiliation(s)
- Guang-Hua Liu
- Department of Interventional and Vascular surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ming-Ke Qiu
- Department of Interventional and Vascular surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yang Wang
- Department of Interventional and Vascular surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ting-Ting Zhang
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li-Jun Wang
- Department of Radiology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wen-Bin Guan
- Department of Pathology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jing-Min Ou
- Department of Interventional and Vascular surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Li-Tian Chen
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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4
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Hampshire J, Dicken BJ, Uruththirakodeeswaran T, Punithakumar K, Noga M. Pediatric patient-specific three-dimensional virtual models for surgical decision making in resection of hepatic and retroperitoneal tumors. Int J Comput Assist Radiol Surg 2023; 18:1941-1949. [PMID: 36905500 DOI: 10.1007/s11548-023-02852-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/08/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE Typically, preoperative imaging is viewed in two dimensions (2D) only, but three-dimensional (3D) virtual models may improve viewers' anatomical perspective by permitting them to interact with the imaging through manipulating it in space. Research into the utility of these models in most surgical specialties is growing rapidly. This study investigates the utility of 3D virtual models of complex pediatric abdominal tumors for clinical decision making, particularly the decision to proceed with surgical resection or not. METHODS 3D virtual models of tumors and adjacent anatomy were created from CT images of pediatric patients scanned for Wilms tumor, neuroblastoma or hepatoblastoma. Pediatric surgeons individually assessed the resectability of the tumors. First, they assessed resectability using the standard protocol of viewing imaging on conventional screens and then reassessed resectability after being presented with the 3D virtual models. Inter-physician agreement on resectability for each patient was analyzed using Krippendorff's alpha. Inter-physician agreement was used as a surrogate for correct interpretation. Participants were also surveyed afterward on the utility and practicality of the 3D virtual models for clinical decision making. RESULTS Inter-physician agreement when using CT imaging alone was "fair" (Krippendorff's alpha α = 0.399), while inter-physician agreement when using 3D virtual models increased to "moderate" (Krippendorff's alpha α = 0.532). When surveyed about model utility, all 5 participants considered them helpful. Two participants felt the models would be practical for clinical use in most cases, while 3 felt they would be practical for select cases only. CONCLUSION This study demonstrates the subjective utility of 3D virtual models of pediatric abdominal tumors for clinical decision making. The models are an adjunct that can be particularly useful in complicated tumors that efface or displace critical structures that may impact resectability. Statistical analysis demonstrates the improved inter-rater agreement with the 3D stereoscopic display over the 2D display. The use of 3D displays of medical images will increase over time, and evaluation of their potential usefulness in various clinical settings is necessary.
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Affiliation(s)
- Jonathan Hampshire
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Bryan J Dicken
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
- University of Alberta Hospital, 2A2.41 WMC, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | | | | | - Michelle Noga
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
- University of Alberta Hospital, 2A2.41 WMC, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
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Chen M, Qiu M, Liu Y, Zhou W, Xie X, Zhou L. Utility of the pediatric liver contrast-enhanced ultrasound criteria in differentiating malignant and benign multifocal lesions. Pediatr Radiol 2023; 53:2004-2012. [PMID: 37294442 DOI: 10.1007/s00247-023-05694-7] [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: 03/13/2023] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND The pediatric liver contrast-enhanced ultrasound (CEUS) criteria were developed to improve the diagnostic performance of CEUS in differentiating pediatric benign and malignant liver lesions. However, the diagnostic performance of CEUS in the evaluation of multiple focal liver lesions in the pediatric population has not yet been fully evaluated. OBJECTIVE To evaluate the diagnostic performance of the pediatric liver CEUS criteria in differentiating benign and malignant multifocal liver lesions in children. MATERIALS AND METHODS From April 2017 to September 2022, the CEUS characteristics of multifocal liver lesions in patients < 18 years were analyzed. Lesions classified as CEUS-1, CEUS-2 or CEUS-3 were considered benign and lesions classified as CEUS-4 or CEUS-5 were considered malignant. The diagnostic performance of the pediatric liver CEUS criteria (i.e. sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV] and accuracy) was assessed. RESULTS After exclusion, 21 patients (median age, 36.0 months; range, 1.0-204 months; 7 boys) were included. There were significant differences in the serum alpha fetoprotein level (P= 0.039) and the presence of washout (P < 0.001) between children with malignant and benign lesions. The sensitivity, specificity, PPV, NPV and accuracy of the pediatric liver CEUS criteria were 100.0% (10/10), 90.9% (10/11), 90.9% (10/11), 100.0% (10/10) and 95.2% (20/21), respectively. CONCLUSION The pediatric liver CEUS criteria had excellent diagnostic performance in differentiating benign and malignant multifocal liver lesions in children.
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Affiliation(s)
- Meixi Chen
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated Hospital, Sun Yat-Sen University, No 58, Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Meng Qiu
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated Hospital, Sun Yat-Sen University, No 58, Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Yingxin Liu
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated Hospital, Sun Yat-Sen University, No 58, Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Wenying Zhou
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated Hospital, Sun Yat-Sen University, No 58, Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated Hospital, Sun Yat-Sen University, No 58, Zhongshan Er Road, Guangzhou, 510080, People's Republic of China
| | - Luyao Zhou
- Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, the First Affiliated Hospital, Sun Yat-Sen University, No 58, Zhongshan Er Road, Guangzhou, 510080, People's Republic of China.
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Nissen TN, Rechnitzer C, Albertsen BK, Borgwardt L, Christensen VB, Fallentin E, Hasle H, Johansen LS, Maroun LL, Nissen KB, Rasmussen A, Rathe M, Rosthøj S, Schultz NA, Wehner PS, Jørgensen MH, Brok J. Epidemiological Study of Malignant Paediatric Liver Tumours in Denmark 1985-2020. Cancers (Basel) 2023; 15:3355. [PMID: 37444465 DOI: 10.3390/cancers15133355] [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: 05/23/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Malignant liver tumours in children are rare and national outcomes for this tumour entity are rarely published. This study mapped paediatric liver tumours in Denmark over 35 years and reported on the incidence, outcomes and long-term adverse events. METHODS We identified all liver tumours from the Danish Childhood Cancer Registry and reviewed the case records for patient and tumour characteristics, treatment and clinical outcome. RESULTS We included 79 patients in the analyses. Overall crude incidence was ~2.29 per 1 million children (<15 yr) per year, with 61 hepatoblastomas (HB), 9 hepatocellular carcinomas and 9 other hepatic tumours. Overall 5-year survival was 84%, 78% and 44%, respectively. Nine patients had underlying liver disease or predisposition syndrome. Seventeen children underwent liver transplantation, with two late complications, biliary stenosis and liver fibrosis. For HB, age ≥ 8 years and diagnosis prior to 2000 were significant predictors of a poorer outcome. Adverse events included reduced renal function in 10%, reduced cardiac function in 6% and impaired hearing function in 60% (19% needed hearing aids). Behavioural conditions requiring additional support in school were registered in 10 children. CONCLUSIONS In Denmark, incidences of malignant liver tumours during the last four decades have been increasing, as reported in the literature. HB survival has improved since the year 2000 and is comparable with international results. Reduced hearing is the major treatment-related side effect and affects approximately 60% of patients.
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Affiliation(s)
- Thomas N Nissen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Catherine Rechnitzer
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Birgitte K Albertsen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
- Department of Clinical Medicine, Faculty of Health, Aarhus University, 8200 Aarhus, Denmark
| | - Lotte Borgwardt
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Vibeke B Christensen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Eva Fallentin
- Department of Radiology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Henrik Hasle
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Lars S Johansen
- Department of Paediatric Surgery, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Lisa L Maroun
- Department of Pathology, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Karin B Nissen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, 8200 Aarhus, Denmark
| | - Allan Rasmussen
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Mathias Rathe
- Department of Paediatric Haematology and Oncology, H. C. Andersen Children's Hospital, Odense University Hospital, 5000 Odense, Denmark
| | - Steen Rosthøj
- Department of Paediatrics and Adolescent Medicine, Aalborg University Hospital, 9000 Aalborg, Denmark
| | - Nicolai A Schultz
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Peder S Wehner
- Department of Paediatric Haematology and Oncology, H. C. Andersen Children's Hospital, Odense University Hospital, 5000 Odense, Denmark
| | - Marianne H Jørgensen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
| | - Jesper Brok
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen University Hospital, 2100 Copenhagen, Denmark
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Schooler GR, Infante JC, Acord M, Alazraki A, Chavhan GB, Davis JC, Khanna G, Morani AC, Morin CE, Nguyen HN, Rees MA, Shaikh R, Srinivasan A, Squires JH, Tang E, Thacker PG, Towbin AJ. Imaging of pediatric liver tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29965. [PMID: 36102690 PMCID: PMC10641897 DOI: 10.1002/pbc.29965] [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: 08/05/2022] [Accepted: 08/16/2022] [Indexed: 11/11/2022]
Abstract
Primary hepatic malignancies are relatively rare in the pediatric population, accounting for approximately 1%-2% of all pediatric tumors. Hepatoblastoma and hepatocellular carcinoma are the most common primary liver malignancies in children under the age of 5 years and over the age of 10 years, respectively. This paper provides consensus-based imaging recommendations for evaluation of patients with primary hepatic malignancies at diagnosis and follow-up during and after therapy.
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Affiliation(s)
- Gary R. Schooler
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Juan C. Infante
- Department of Radiology, Nemours Children’s Health, Orlando, FL
| | - Michael Acord
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Adina Alazraki
- Department of Radiology and Imaging Sciences, Emory University, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Govind B. Chavhan
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical Imaging, University of Toronto, ON Canada
| | | | - Geetika Khanna
- Department of Radiology and Imaging Sciences, Emory University, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Ajaykumar C. Morani
- Singleton Department of Radiology, Texas Children’s Hospital and Department of Radiology, Baylor College of Medicine, Houston, TX
| | - Cara E. Morin
- Department of Radiology, Cincinnati Children’s Hospital, Cincinnati, OH
| | - HaiThuy N. Nguyen
- Singleton Department of Radiology, Texas Children’s Hospital and Department of Radiology, Baylor College of Medicine, Houston, TX
| | - Mitchell A. Rees
- Department of Radiology, Nationwide Children’s Hospital, Columbus, OH
| | - Raja Shaikh
- Department of Radiology, Boston Children’s Hospital, Boston, MA
| | - Abhay Srinivasan
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Judy H. Squires
- Department of Radiology, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Elizabeth Tang
- Department of Radiology, Seattle Children’s Hospital, Seattle, WA
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Brown A, Pan Q, Fan L, Indersie E, Tian C, Timchenko N, Li L, Hansen BS, Tan H, Lu M, Peng J, Pruett-Miller SM, Yu J, Cairo S, Zhu L. Ribonucleotide reductase subunit switching in hepatoblastoma drug response and relapse. Commun Biol 2023; 6:249. [PMID: 36882565 PMCID: PMC9992519 DOI: 10.1038/s42003-023-04630-7] [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: 08/05/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
Prognosis of children with high-risk hepatoblastoma (HB), the most common pediatric liver cancer, remains poor. In this study, we found ribonucleotide reductase (RNR) subunit M2 (RRM2) was one of the key genes supporting cell proliferation in high-risk HB. While standard chemotherapies could effectively suppress RRM2 in HB cells, they induced a significant upregulation of the other RNR M2 subunit, RRM2B. Computational analysis revealed distinct signaling networks RRM2 and RRM2B were involved in HB patient tumors, with RRM2 supporting cell proliferation and RRM2B participating heavily in stress response pathways. Indeed, RRM2B upregulation in chemotherapy-treated HB cells promoted cell survival and subsequent relapse, during which RRM2B was gradually replaced back by RRM2. Combining an RRM2 inhibitor with chemotherapy showed an effective delaying of HB tumor relapse in vivo. Overall, our study revealed the distinct roles of the two RNR M2 subunits and their dynamic switching during HB cell proliferation and stress response.
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Affiliation(s)
- Anthony Brown
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Qingfei Pan
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Li Fan
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Cheng Tian
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nikolai Timchenko
- Department of Surgery, Cincinnati Children's Hospital Medical Center and Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
| | - Liyuan Li
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Baranda S Hansen
- Department of Cell and Molecular Biology and Center for Advanced Genome Engineering, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Haiyan Tan
- Center for Proteomics and Metabolomics, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Meifen Lu
- Center for Comparative Pathology Core, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Junmin Peng
- Departments of Structural Biology and Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Shondra M Pruett-Miller
- Department of Cell and Molecular Biology and Center for Advanced Genome Engineering, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jiyang Yu
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | | | - Liqin Zhu
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, TN, USA.
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9
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Brown A, Pan Q, Fan L, Indersie E, Tian C, Timchenko N, Li L, Hansen BS, Tan H, Lu M, Peng J, Pruett-Miller SM, Yu J, Cairo S, Zhu L. Ribonucleotide Reductase Subunit Switching in Hepatoblastoma Drug Response and Relapse. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023. [PMID: 36747774 PMCID: PMC9900781 DOI: 10.1101/2023.01.24.525404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Prognosis of children with high-risk hepatoblastoma (HB), the most common pediatric liver cancer, remains poor. In this study, we found ribonucleotide reductase (RNR) subunit M2 ( RRM2 ) was one of the key genes supporting cell proliferation in high-risk HB. While standard chemotherapies could effectively suppress RRM2 in HB cells, they induced a significant upregulation of the other RNR M2 subunit, RRM2B . Computational analysis revealed distinct signaling networks RRM2 and RRM2B were involved in HB patient tumors, with RRM2 supporting cell proliferation and RRM2B participating heavily in stress response pathways. Indeed, RRM2B upregulation in chemotherapy-treated HB cells promoted cell survival and subsequent relapse, during which RRM2B was gradually replaced back by RRM2. Combining an RRM2 inhibitor with chemotherapy showed an effective delaying of HB tumor relapse in vivo. Overall, our study revealed the distinct roles of the two RNR M2 subunits and their dynamic switching during HB cell proliferation and stress response.
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10
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Li P, Kong Y, Guo J, Ji X, Han X, Zhang B. Incidence and trends of hepatic cancer among children and adolescents in the United States from 2000 to 2017: Evidence from the Surveillance, Epidemiology, and End Results registry data. Cancer Causes Control 2023; 34:69-79. [PMID: 36244051 DOI: 10.1007/s10552-022-01640-4] [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: 12/22/2021] [Accepted: 10/03/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Primary liver tumors are rare pediatric malignancies. Knowledge of the epidemiology of pediatric liver tumors is limited. This study aims to present the national incidence trends of pediatric liver tumors over 18 years, according to sociodemographic and histological subtype variation. METHODS The Surveillance, Epidemiology, and End Results registry was queried from 2000 to 2017 for 1,099 patients between ages 0 and 19 with liver tumors. Age-standardized incidence rates by age, sex, and race/ethnicity were examined among histological subtypes. Annual percentage change (APC) was calculated via joinpoint regression for various sociodemographic and histotype subgroups. RESULTS An increase of age-adjusted incidence rate of pediatric hepatic cancers was observed between 2000 and 2017 (APC, 1.7% [95% confidence interval or CI: 0.6%-2.8%], p-value = 0.006), which may likely attribute to the increasing incidence of hepatoblastoma and mesenchymal tumors (APC, 2.5% [95% CI: 1.1%-3.8%], p-value = 0.001). The incidence trend of hepatocellular carcinoma remained stable in the study period. The non-Hispanic Asian/Pacific Islander children and adolescents had a higher risk of hepatic tumors (incidence rate ratio or IRR, 1.42 [95% CI: 1.16-1.72], p-value = 0.0007) when compared with the non-Hispanic white subgroup, while a non-Hispanic black child was associated with a lower incidence rate (IRR, 0.64 [95% CI: 0.50-0.80], p-value < 0.0001). Significantly lower hepatic tumor incidence occurred in females than males, with an incidence rate ratio of 0.69 (95% CI: 0.61-0.78; p-value < 0.0001). Hepatic tumor incidence was also significantly lower in those aged 1-4 years (IRR, 0.47 [95% CI: 0.40-0.54]; p-value < 0.001) and 5-19 years (IRR, 0.09 [95% CI: 0.08-0.10]; p-value < 0.001) when compared with the youngest age group aged less than 1 year. These significant differences were also detected for the subgroup of hepatoblastoma and mesenchymal liver tumors but less among hepatocellular carcinomas (all p-values less than 0.0001). CONCLUSION Continued increasing incidence of pediatric hepatoblastoma and mesenchymal liver tumors was discovered and warranted further investigation. Additional findings include a lower incidence of hepatic cancer among non-Hispanic black individuals and higher incidence of hepatic cancer in non-Hispanic Asian/Pacific Islander, male, and aged 1-4-year children and adolescents.
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Affiliation(s)
- Peiyi Li
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yujia Kong
- Department of Public Health, Weifang Medical University, Weifang, Shandong, China
| | - Jing Guo
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
| | - Xu Ji
- Department of Pediatrics, Emory University School of Medicine/Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, GA, USA
| | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA. .,Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
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11
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Alannan M, Seidah NG, Merched AJ. PCSK9 in Liver Cancers at the Crossroads between Lipid Metabolism and Immunity. Cells 2022; 11:cells11244132. [PMID: 36552895 PMCID: PMC9777286 DOI: 10.3390/cells11244132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
Metabolic rewiring and defective immune responses are considered to be the main driving forces sustaining cell growth and oncogenesis in many cancers. The atypical enzyme, proprotein convertase subtilisin/kexin type 9 (PCSK9), is produced by the liver in large amounts and plays a major role in lipid metabolism via the control of the low density lipoprotein receptor (LDLR) and other cell surface receptors. In this context, many clinical studies have clearly demonstrated the high efficacy of PCSK9 inhibitors in treating hyperlipidemia and cardiovascular diseases. Recent data implicated PCSK9 in the degradation of major histocompatibility complex I (MHC-I) receptors and the immune system as well as in other physiological activities. This review highlights the complex crosstalk between PCSK9, lipid metabolism and immunosuppression and underlines the latest advances in understanding the involvement of this convertase in other critical functions. We present a comprehensive assessment of the different strategies targeting PCSK9 and show how these approaches could be extended to future therapeutic options to treat cancers with a main focus on the liver.
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Affiliation(s)
- Malak Alannan
- Bordeaux Institute of Oncology (BRIC), INSERM U1312, University of Bordeaux, F-33000 Bordeaux, France
| | - Nabil G. Seidah
- Laboratory of Biochemical Neuroendocrinology, Montreal Clinical Research Institute, IRCM, University of Montreal, Montreal, QC H2W 1R7, Canada
| | - Aksam J. Merched
- Bordeaux Institute of Oncology (BRIC), INSERM U1312, University of Bordeaux, F-33000 Bordeaux, France
- Correspondence:
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12
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Grimaldi C, de Ville de Goyet J, Bici K, Cianci MC, Callea F, Morabito A. The role of liver transplantation in the care of primary hepatic vascular tumours in children. Front Oncol 2022; 12:1026232. [PMID: 36505841 PMCID: PMC9730342 DOI: 10.3389/fonc.2022.1026232] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Liver transplantation (LT) is the standard of care for many liver conditions, such as end-stage liver diseases, inherited metabolic disorders, and primary liver malignancies. In the latter group, indications of LT for hepatoblastoma and hepatocellular carcinoma evolved and are currently available for many non-resectable cases. However, selection criteria apply, as the absence of active metastases. Evidence of good long-term outcomes has validated the LT approach for managing these malignancies in the context of specialist and multidisciplinary approach. Nevertheless, LT's role in treating primary vascular tumours of the liver in children, both benign and malignant, remains somewhat controversial. The rarity of the different diseases and the heterogeneity of pathological definitions contribute to the controversy and make evaluating the benefit/risk ratio and outcomes quite difficult. In this narrative review, we give an overview of primary vascular tumours of the liver in children, the possible indications and the outcomes of LT.
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Affiliation(s)
- Chiara Grimaldi
- Department of Pediatric Surgery, Meyer Children’s Hospital, University of Florence, Florence, Italy,*Correspondence: Chiara Grimaldi,
| | - Jean de Ville de Goyet
- Department of Pediatrics, IRCCS-Istituto Mediterraneo per i Trapianti e Terapie ad altra specializzazione (ISMETT) (Institute for Scientific-Based Care and Research-Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Kejd Bici
- Department of Pediatric Surgery, Meyer Children’s Hospital, University of Florence, Florence, Italy
| | - Maria Chiara Cianci
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Francesco Callea
- Department of Histopathology, Bugando Medical Centre, Catholic University of Healthy Allied Sciences, Mwanza, Tanzania
| | - Antonino Morabito
- Department of Neuroscience, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
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13
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Fan L, Pan Q, Yang W, Koo SC, Tian C, Li L, Lu M, Brown A, Ju B, Easton J, Ranganathan S, Shin S, Bondoc A, Yang JJ, Yu J, Zhu L. A developmentally prometastatic niche to hepatoblastoma in neonatal liver mediated by the Cxcl1/Cxcr2 axis. Hepatology 2022; 76:1275-1290. [PMID: 35179799 PMCID: PMC9385889 DOI: 10.1002/hep.32412] [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: 10/28/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 12/08/2022]
Abstract
BACKGROUND AND AIMS Hepatoblastoma (HB) is the most common pediatric liver cancer. Its predominant occurrence in very young children led us to investigate whether the neonatal liver provides a protumorigenic niche to HB development. APPROACH AND RESULTS HB development was compared between orthotopic transplantation models established in postnatal day 5 (P5) and 60 (P60) mice (P5Tx and P60Tx models). Single-cell RNA-sequencing (sc-RNAseq) was performed using tumor and liver tissues from both models and the top candidate cell types and genes identified are investigated for their roles in HB cell growth, migration, and survival. CONCLUSIONS We found that various HB cell lines including HepG2 cells were consistently and considerably more tumorigenic and metastatic in the P5Tx model than in the P60Tx models. Sc-RNAseq of the P5Tx and P60Tx HepG2 models revealed that the P5Tx tumor was more hypoxic and had a larger number of activated hepatic stellate cells (aHSCs) in the tumor-surrounding liver that express significantly higher levels of Cxcl1 than those from the P60Tx model. We found these differences were developmentally present in normal P5 and P60 liver. We showed that the Cxcl1/Cxcr2 axis mediated HB cell migration and was critical to HB cell survival under hypoxia. Treating HepG2 P60Tx model with recombinant CXCL1 protein induced intrahepatic and pulmonary metastasis and CXCR2 knockout (KO) in HepG2 cells abolished their metastatic potential in the P5Tx model. Lastly, we showed that in tumors from patients with metastatic HB, there was a similar larger population of aHSCs in the tumor-surrounding liver than in localized tumors, and tumor hypoxia was uniquely associated with prognosis of patients with HB among pediatric cancers. We demonstrated that the neonatal liver provides a prometastatic niche to HB development through the Cxcl1/Cxcr2 axis.
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Affiliation(s)
- Li Fan
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States
| | - Qingfei Pan
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States
| | - Wentao Yang
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States
| | - Selene C. Koo
- Department of Pathology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States
| | - Cheng Tian
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States
| | - Liyuan Li
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States
| | - Meifen Lu
- Veterinary Pathology Core, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States
| | - Anthony Brown
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States
| | - Bensheng Ju
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States
| | - John Easton
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States
| | - Sarangarajan Ranganathan
- Department of Pathology and Laboratory Medicine, Cincinnati Children’s Hospital, Cincinnati, Ohio, United States
| | - Soona Shin
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Alexander Bondoc
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Jun J. Yang
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States
| | - Jiyang Yu
- Department of Computational Biology, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States
| | - Liqin Zhu
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee, United States
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14
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Moreira-Silva H, Amorim J, Santos-Silva E. Incidental Liver Lesions in children: A practical and evidence-based approach. Clin Res Hepatol Gastroenterol 2022; 46:101904. [PMID: 35318140 DOI: 10.1016/j.clinre.2022.101904] [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: 07/04/2021] [Revised: 02/19/2022] [Accepted: 02/24/2022] [Indexed: 02/04/2023]
Abstract
Incidental liver lesions are increasingly being discovered in the context of the increased use of ultrasound studies and the majority are benign. In children, although individually rare, the differential diagnosis is broad and therefore a systematic approach is of utmost importance to reduce the radiological and disease burden in children and their families. This review article collected current evidence and provides fundamental information for the clinician regarding specific differential diagnoses and unique imaging features of benign liver lesions in children. Ultimately, we propose a practical stepwise approach mainly involving clinical and radiological workup. Laboratory tests and histopathological examination may be necessary in the presence of red flags or in indeterminate lesions.
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Affiliation(s)
- Helena Moreira-Silva
- Pediatric Gastroenterology Unit, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Largo da Maternidade de Júlio Dinis 45, Porto 4050-651, Portugal.
| | - João Amorim
- Radiology Department, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ermelinda Santos-Silva
- Pediatric Gastroenterology Unit, Centro Materno Infantil do Norte, Centro Hospitalar Universitário do Porto, Largo da Maternidade de Júlio Dinis 45, Porto 4050-651, Portugal
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15
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Tsvetkova V, Magro G, Broggi G, Luchini C, Cappello F, Caporalini C, Buccoliero AM, Santoro L. New insights in gastrointestinal "pediatric" neoplasms in adult patients: pancreatoblastoma, hepatoblastoma and embryonal sarcoma of the liver. A practical approach by GIPPI-GIPAD Groups. Pathologica 2022; 114:64-78. [PMID: 35212317 PMCID: PMC9040550 DOI: 10.32074/1591-951x-559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 12/11/2022] Open
Abstract
Pediatric solid neoplasms are rare and very different from those observed in adults. The majority of them are referred to as embryonal because they arise as a result of alterations in the processes of organogenesis or normal growth and are characterized by proliferation of primitive cells, reproducing the corresponding tissue at various stages of embryonic development. This review will focus on embryonal gastrointestinal pediatric neoplasms in adult patients, including pancreatoblastoma, hepatoblastoma, and embryonal sarcoma of the liver. Although they are classically considered pediatric neoplasms, they may (rarely) occur in adult patients. Hepatoblastoma represents the most frequent liver neoplasm in the pediatric population, followed by hepatocellular carcinoma and embryonal sarcoma of the liver; while pancreatoblastoma is the most common malignant pancreatic tumor in childhood. Both in children and adults, the mainstay of treatment is complete surgical resection, either up front or following neoadjuvant chemotherapy. Unresectable and/or metastatic neoplasms may be amenable to complete delayed surgery after neoadjuvant chemotherapy. However, these neoplasms display a more aggressive behavior and overall poorer prognosis in adults than in children, probably because they are diagnosed in later stages of diseases.
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Affiliation(s)
- Vassilena Tsvetkova
- Department of Diagnostics and Public Health, Section of Pathology, Verona University and Hospital Trust; Verona, Italy
| | - Gaetano Magro
- Department of Medical and Surgical Sciences and Advanced Technologies "G. F. Ingrassia", Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Giuseppe Broggi
- Department of Medical and Surgical Sciences and Advanced Technologies "G. F. Ingrassia", Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, Verona University and Hospital Trust; Verona, Italy
| | - Filippo Cappello
- Department of Pathology, Azienda Ospedaliera Universitaria di Padova, Padova, Italy
| | | | | | - Luisa Santoro
- Department of Pathology, Azienda Ospedaliera Universitaria di Padova, Padova, Italy
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16
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Sex Difference and Benzene Exposure: Does It Matter? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042339. [PMID: 35206525 PMCID: PMC8872447 DOI: 10.3390/ijerph19042339] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 11/16/2022]
Abstract
Sex-related biological differences might lead to different effects in women and men when they are exposed to risk factors. A scoping review was carried out to understand if sex could be a discriminant in health outcomes due to benzene. Studies on both animals and humans were collected. In vivo surveys, focusing on genotoxicity, hematotoxicity and effects on metabolism suggested a higher involvement of male animals (mice or rats) in adverse health effects. Conversely, the studies on humans, focused on the alteration of blood parameters, myeloid leukemia incidence and biomarker rates, highlighted that, overall, women had significantly higher risk for blood system effects and a metabolization of benzene 23-26% higher than men, considering a similar exposure situation. This opposite trend highlights that the extrapolation of in vivo findings to human risk assessment should be taken with caution. However, it is clear that sex is a physiological parameter to consider in benzene exposure and its health effects. The topic of sex difference linked to benzene in human exposure needs further research, with more numerous samples, to obtain a higher strength of data and more indicative findings. Sex factor, and gender, could have significant impacts on occupational exposures and their health effects, even if there are still uncertainties and gaps that need to be filled.
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17
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Wu WK, Ziogas IA, Matsuoka LK, Izzy M, Pai AK, Benedetti DJ, Alexopoulos SP. Waitlist mortality and post-liver transplant outcomes of pediatric patients with hepatocellular carcinoma and hepatoblastoma in the United States. Pediatr Blood Cancer 2022; 69:e29425. [PMID: 34736292 DOI: 10.1002/pbc.29425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/21/2021] [Accepted: 10/10/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Liver transplantation (LT) is offered in cases of advanced disease for both pediatric patients with hepatoblastoma (HBL) and those with hepatocellular carcinoma (HCC). Current United States organ allocation priorities differ between the two groups. METHODS We retrospectively examined the waitlist and posttransplant outcomes of pediatric LT candidates with HBL and HCC using the United Network for Organ Sharing registry (February 2002 to September 2020). RESULTS Six hundred sixty-eight children with HBL and 95 children with HCC listed for first LT were identified. Patients with HBL were younger (p < .001), had lower laboratory Model for End-stage Liver Disease (MELD)/Pediatric End-stage Liver Disease (PELD) scores (p < .001), and had lesser proportion with encephalopathy (p = .01). Patients with HCC had an increased risk of waitlist mortality in univariable (unadjusted subdistribution hazard ratio [sHR] = 4.37, 95% confidence interval [CI], 2.01-9.51, p < .001) and multivariable competing risk regression (adjusted sHR = 3.08, 95% CI 1.13-8.37, p = .03) accounting for age and laboratory MELD/PELD score. Five hundred ninety-five children underwent LT for HBL and 76 for HCC. Patients transplanted for HBL had a significantly higher proportion with status 1B exception (71.3% vs. 7.9%, p < .001). No difference was observed in patient (unadjusted log-rank test, p = .52; adjusted hazard ratio [HR] = 0.77, 95% CI, 0.40-1.48, p = .43) or graft survival (unadjusted log-rank test, p = .93; adjusted HR = 0.74, 95% CI 0.42-1.33, p = .32) between HCC and HBL recipients. CONCLUSION Waitlist mortality for pediatric LT candidates with HCC is significantly higher than for HBL, while posttransplant patient and graft survival are similar. This highlights an opportunity to improve equitable prioritization for children with HCC who may have reduced access to size-appropriate deceased donor organs and less effective bridge-to-transplant therapies.
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Affiliation(s)
- W Kelly Wu
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ioannis A Ziogas
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lea K Matsuoka
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Manhal Izzy
- Department of Medicine, Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Anita K Pai
- Department of Pediatrics, D. Brent Polk Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Daniel J Benedetti
- Department of Pediatrics, Division of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sophoclis P Alexopoulos
- Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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18
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Torres A, Koskinen SK, Gjertsen H, Fischler B. Contrast-enhanced ultrasound is useful for the evaluation of focal liver lesions in children. Australas J Ultrasound Med 2021; 24:143-150. [PMID: 34765424 PMCID: PMC8409441 DOI: 10.1002/ajum.12279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Contrast‐enhanced ultrasound (CEUS) is a widely used diagnostic method. In adults, it has been proven to be a useful alternative to CT and MRI for the characterisation of focal liver lesions (FLLs). However, since there is no official paediatric licensing for any ultrasound contrast agents in Europe, its use has been restricted. Purpose To retrospectively outline our experience with CEUS as a tool for the characterisation of FLLs in paediatric patients. Methods An eleven‐year retrospective single‐centre study. During this period, we identified 287 CEUS examinations performed on children, of these 36 were relevant first‐time examinations with the aim of characterising a focal liver lesion. Clinical and radiological data were collected from the hospital chart. Results The overall agreement between the CEUS diagnosis and the reference diagnosis for benign versus malignant differentiation was 75%. When analysing conclusive CEUS examinations only, the overall agreement was 96%. The specificity for correctly characterising a lesion as benign was 96%, and the negative predictive value was 100%. No side effects from CEUS were detected. Conclusions Our study reinforces that CEUS can be useful in the medical workup for the identification and classification of focal liver lesions in children.
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Affiliation(s)
- Alvaro Torres
- Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institute Alfred Nobels alle 8 Huddinge 141 52 Sweden.,Division of Radiology Karolinska University Hospital C1:46 Huddinge Sweden
| | - Seppo K Koskinen
- Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institute Alfred Nobels alle 8 Huddinge 141 52 Sweden
| | - Henrik Gjertsen
- Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institute Alfred Nobels alle 8 Huddinge 141 52 Sweden.,Division of Transplantation Surgery Karolinska University Hospital Huddinge Stockholm 141 86 Sweden
| | - Björn Fischler
- Department of Clinical Science, Intervention and Technology (CLINTEC) Karolinska Institute Alfred Nobels alle 8 Huddinge 141 52 Sweden.,Division of Paediatrics Karolinska University Hospital, Novum Blickagången 6a Huddinge 141 57 Sweden
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19
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Moosburner S, Schmelzle M, Schöning W, Kästner A, Seika P, Globke B, Dziodzio T, Pratschke J, Öllinger R, Gül-Klein S. Liver Transplantation Is Highly Effective in Children with Irresectable Hepatoblastoma. MEDICINA-LITHUANIA 2021; 57:medicina57080819. [PMID: 34441025 PMCID: PMC8399470 DOI: 10.3390/medicina57080819] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 01/19/2023]
Abstract
Background and Objectives: In children, hepatoblastoma preferentially is managed by liver resection (LR). However, in irresectable cases, liver transplantation (LT) is required. The aim of our study was to compare short- and long-term results after LR and LT for the curative treatment of hepatoblastoma. Materials and Methods: Retrospective analysis of all patients treated surgically for hepatoblastoma from January 2000 until December 2019 was performed. Demographic and clinical data were collected before and after surgery. The primary endpoints were disease free survival and patient survival. Results: In total, 38 patients were included into our analysis (n = 28 for LR, n = 10 for LT) with a median follow-up of 5 years. 36 patients received chemotherapy prior to surgery. Total hospital stay and intensive care unit (ICU) stay were significantly longer within the LT vs. the LR group (ICU 23 vs. 4 days, hospital stay 34 vs. 16 days, respectively; p < 0.001). Surgical complications (≤Clavien–Dindo 3a) were equally distributed in both groups (60% vs. 57%; p = 1.00). Severe complications (≥Clavien–Dindo 3a) were more frequent after LT (50% vs. 21.4%; p = 0.11). Recurrence rates were 10.7% for LR and 0% for LT at 5 years after resection or transplantation (p = 0.94). Overall, 5-year survival was 90% for LT and 96% for LR (p = 0.44). Conclusions: In irresectable cases, liver transplantation reveals excellent outcomes in children with hepatoblastoma with an acceptable number of perioperative complications.
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Affiliation(s)
- Simon Moosburner
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
- BIH Charité (Digital) Clinician Scientist Program, Berlin Institute of Health, 10178 Berlin, Germany
- Correspondence: (S.M.); (S.G.-K.); Tel.: +01-76-3452-1755 (S.M.); +49-17-0740-2409 (S.G.-K.)
| | - Moritz Schmelzle
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
| | - Wenzel Schöning
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
| | - Anika Kästner
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
| | - Philippa Seika
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
| | - Brigitta Globke
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
- BIH Charité (Digital) Clinician Scientist Program, Berlin Institute of Health, 10178 Berlin, Germany
| | - Tomasz Dziodzio
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
| | - Johann Pratschke
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
| | - Robert Öllinger
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
| | - Safak Gül-Klein
- Deparment of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (M.S.); (W.S.); (A.K.); (P.S.); (B.G.); (T.D.); (J.P.); (R.Ö.)
- Correspondence: (S.M.); (S.G.-K.); Tel.: +01-76-3452-1755 (S.M.); +49-17-0740-2409 (S.G.-K.)
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20
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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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Pang C, Miao H, Zuo Y, Guo N, Sun D, Li B. C/EBPβ enhances efficacy of sorafenib in hepatoblastoma. Cell Biol Int 2021; 45:1897-1905. [PMID: 33945665 DOI: 10.1002/cbin.11624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/23/2021] [Accepted: 05/01/2021] [Indexed: 12/29/2022]
Abstract
Hepatoblastoma (HB) is the predominant hepatic neoplasm in infants and young children. Sorafenib has been used to treat adult and pediatric hepatocellular carcinoma. However, efficacy of monotherapy of sorafenib in HB is not sustained. In this study, we tested a possible combinatory therapy of sorafenib with the CCAAT/enhancer-binding proteins (C/EBP) overexpression in HB cell line. Firstly, we evaluated the expression level of C/EBPβ in the patients with HB by analyzing The Cancer Genome Atlas data. Lower level of C/EBPβ was observed in tumor tissues in comparison with matched normal tissues. Next, we observed that combination of sorafenib and C/EBPβ overexpression led to dramatic growth and migration inhibition of live tumor cells which implied promising probability for clinical trial. Mechanistically, C/EBPβ which can be downregulated by Ras v12, augmented messenger RNA and protein levels of p53. These data suggested that a combination of sorafenib and C/EBPβ overexpression inhibited tumor growth synergistically and provided a promising approach to treat HB.
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Affiliation(s)
- Chong Pang
- Departments of Pharmacology, Chengde Medical University, Chengde, Hebei, China
| | - Hao Miao
- Functional Experiment Center, Chengde Medical University, Chengde, Hebei, China
| | - Yanzhen Zuo
- Departments of Pharmacology, Chengde Medical University, Chengde, Hebei, China
| | - Nana Guo
- Departments of Pharmacology, Chengde Medical University, Chengde, Hebei, China
| | - Dayong Sun
- Tumor Radiation and Chemotherapy Center, Chengde Central Hospital, Chengde, Hebei, China
| | - Baoqun Li
- Departments of Pharmacology, Chengde Medical University, Chengde, Hebei, China
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22
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Shaikh R, Munoz FG. Endovascular approaches in pediatric interventional oncology. CVIR Endovasc 2021; 4:2. [PMID: 33387076 PMCID: PMC7778666 DOI: 10.1186/s42155-020-00190-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
The demand for interventional oncological (IO) treatment of pediatric cancers is becoming increasingly common, at least at several tertiary care institutions. The data and techniques used in pediatric IO are largely extrapolated from experience in adult patients. The management of pediatric tumors differs from that in adults in several categories, such as, the curative intent of treatment, wide use of general anesthesia, aggressive pain management, potentially longer hospital stay, variation in chemotherapy dosing etc. Additionally, pediatric cancers are managed by protocols directed by national and international oncology groups such as the Children’s Oncology Group (COG). Consequently, the translation and adoption of these techniques is gradual, but there is a noticeable uptrend due to the growing need. This review will update the current endovascular IO treatments for common pediatric liver, renal, bone and soft tissue tumors.
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Affiliation(s)
- Raja Shaikh
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood, Boston, MA-02115, USA.
| | - Fernando Gomez Munoz
- Hospital Clinic-Hospital Sant Joan de Deu, C/ Villarroel 170, Passeig de Sant Joan de Déu, 2, Esplugues del Llobregat, 08950, Barcelona, Spain
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23
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Karalexi MA, Servitzoglou M, Moschovi M, Moiseenko R, Bouka P, Ntzani E, Kachanov D, Petridou ET. Survival and prognostic factors for childhood malignant liver tumors: analysis of harmonized clinical data. Cancer Epidemiol 2020; 70:101850. [PMID: 33220637 DOI: 10.1016/j.canep.2020.101850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/16/2020] [Accepted: 10/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite overall striking advances in survival of childhood liver tumors, outcomes remain poor for specific patient segments. We aimed to assess overall survival (OS) of this rare disease and evaluate the generalizability of prognostic variables included in international collaborative systems using, for the first time, harmonized clinical data from two geographically different cohorts (Greece and Moscow). METHODS Data for children (0-14 years) with liver tumors were retrieved from two Southern-Eastern European areas (Greece; 2001-2019 and Moscow; 2012-2019). Kaplan-Meier curves were constructed, and OS values were derived from Cox proportional models controlling for study variables. RESULTS A total of 171 newly diagnosed cases (54.4% males) were included. The OS5-year exceeded 80% in patients <5 years, reaching 85% among 133 patients with hepatoblastoma (HBL). By contrast, children with other than HBL histology, especially hepatocellular carcinoma (HCC) had significantly worse prognosis (hazard ratio [HR] HCC: 7.09, 95% confidence intervals [CI]: 2.56-19.65; HR other liver tumors: 5.18; 95%CI: 2.15-12.49). The OS5-year was poorer (40%-60%) in patients with extensive local, metastatic or relapsed disease. By contrast, a significantly lower risk of death was shown in case of microscopically margin-negative resection (HR: 0.06, 95%CI: 0.02-0.17) and liver transplantation (HR: 0.12, 95% CI: 0.02-0.63) compared to the non- operated group. CONCLUSIONS Outcomes of patients with liver tumors registered in two SEE areas were comparable to those reported by major collaborative trials. Ongoing clinical cancer registration could facilitate comparison of outcomes between different study groups in order to shape state of the art of treatment.
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Affiliation(s)
- Maria A Karalexi
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marina Servitzoglou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Moschovi
- Pediatric Hematology/Oncology Unit, First Department of Pediatrics, National and Kapodistrian University of Athens, "Agia Sofia" Children's Hospital, Athens, Greece
| | - Roman Moiseenko
- Department of Clinical Oncology, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Panagiota Bouka
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Ntzani
- Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, Greece; Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, RI, USA
| | - Denis Kachanov
- Department of Clinical Oncology, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
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MacDonell-Yilmaz R, Anderson K, DeNardo B, Sprinz P, Padula WV. Cost-effectiveness Analysis of Screening Extremely Low Birth Weight Children for Hepatoblastoma Using Serum Alpha-fetoprotein. J Pediatr 2020; 225:80-89.e4. [PMID: 32470475 PMCID: PMC8855955 DOI: 10.1016/j.jpeds.2020.05.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/04/2020] [Accepted: 05/20/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To evaluate the cost-effectiveness of screening children born at extremely low birth weight (ELBW) for hepatoblastoma using serial serum alpha-fetoprotein measurements. STUDY DESIGN We created a decision tree to evaluate the cost effectiveness of screening children born at ELBW between 3 and 48 months of age compared with current standard of care (no screening). Our model used discounted lifetime costs and monetary benefits in 2018 US dollars, based on estimates in the published literature. The effects of uncertainty in model parameters were also assessed using univariate sensitivity analyses, in which we changed the values for one parameter at a time to assess the effect on the estimated incremental cost-effectiveness ratio. RESULTS For the estimated 55 699 children born at ELBW in the US each year, this screening is associated with 77.7 additional quality-adjusted life-years (QALYs) at a cost of $8.7 million. This results in an incremental cost-effectiveness ratio of about $112 000/QALY, which is considered cost effective from a US societal perspective. For children diagnosed with hepatoblastoma, our model finds that the screening regimen is associated with a 10.1% increase in survival, a 4.18% increase in expected QALYs, and a $245 184 decrease in expected cost. CONCLUSIONS Screening ELBW children for hepatoblastoma between 3 and 48 months of age dominates the alternative and is cost effective from a societal perspective.
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Affiliation(s)
| | - Kelly Anderson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | - William V. Padula
- Department of Pharmaceutical & Health Economics, School of Pharmacy,Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, CA
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Morris MW, Berch B, Westmoreland T, Sawaya DE, Blewett CJ. Resection of a Giant Hepatic Adenoma in an Eight-year-old Girl. Am Surg 2020. [DOI: 10.1177/000313481307900922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hepatic adenomas are benign tumors typically diagnosed in women of reproductive age, however, these tumors occur in the pediatric population although rare. We present the case of a giant hepatic adenoma in an 8-year-old female without established risk factors with progressive abdominal pain, and po intolerance, biliary obstruction, anemia, and fever. Right trisegmentectomy afforded extirpation of the 16 3 14.5 3 8.5 cm mass. The postoperative course was complicated by transient encephalopathy and a bile leak which resolved with appropriate care. The patient is well over 1 year from resection. She demonstrates age appropriate mental and physical function without disease recurrence or complication.
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Affiliation(s)
- Michael W. Morris
- Department of Surgery, Division of Pediatric Surgery, University of Mississippi School of Medicine, Jackson, Mississippi
| | - Barry Berch
- Department of Surgery, Division of Pediatric Surgery, University of Mississippi School of Medicine, Jackson, Mississippi
| | - Tammy Westmoreland
- Department of Surgery, Division of Pediatric Surgery, University of Mississippi School of Medicine, Jackson, Mississippi
| | - David E. Sawaya
- Department of Surgery, Division of Pediatric Surgery, University of Mississippi School of Medicine, Jackson, Mississippi
| | - Christopher J. Blewett
- Department of Surgery, Division of Pediatric Surgery, University of Mississippi School of Medicine, Jackson, Mississippi
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26
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Tyraskis A, Deganello A, Sellars M, De Vito C, Thompson R, Quaglia A, Heaton N, Davenport M. Portal venous deprivation in patients with portosystemic shunts and its effect on liver tumors. J Pediatr Surg 2020; 55:651-654. [PMID: 31279480 DOI: 10.1016/j.jpedsurg.2019.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 11/18/2022]
Abstract
AIMS To outline the use of radiological investigations in patients with congenital portosystemic shunts (CPS) and to assess the degree of portal venous deprivation in relation to the development of liver tumors. METHODS Single center retrospective cohort study of all patients with CPS referred from 1990 to 2016. Radiological investigations were reviewed for the presence of intrahepatic portal veins. Two groups were defined: Group 1 - without evidence of preservation of an intrahepatic portal venous system and, Group 2 - with evidence of intrahepatic portal venous flow. These groups were compared for the development of liver tumors, serum ammonia, and nature of subsequent surgical intervention. The ratio of infraceliac to supraceliac aortic diameter and hepatic enhancement in biphasic CT scans were also used to infer hepatic arterial in-flow and compared to age matched controls. Nonparametric tests were used throughout. A P value of 0.05 was considered significant. Data are quoted as median (IQR). RESULTS 45 patients (Group 1, n = 12: Group 2, n = 33) were investigated for CPS at a median age of 8 months (1 month-14 years). Liver tumors were more common in Group 1 than Group 2 [11/12 (92%) versus 10/33 (29%); P < 0.001]. Aortic ratio was significantly lower in patients with CPS compared to control (0.82 versus 0.96; P < 0.001), but there was no difference between patients with or without tumors (0.82 versus 0.82; P = 0.52). Enhancement of the liver parenchyma was greater in portal venous rather than arterial phases by a median difference of 28 (15-50) Hounsfield units in controls, compared to 15 (8.5-23.5) in CPS patients (P = 0.04). A single stage closure was possible in 2/6 (33%) operated patients in Group 1 and 14/20 (70%) in Group 2 (P = 0.32). CONCLUSIONS Patients without radiological evidence of intrahepatic portal venous flow were significantly more likely to have associated hepatic tumors with a relative risk 3.1. LEVELS OF EVIDENCE This manuscript includes data that are III and IV Levels-of-Evidence.
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Affiliation(s)
| | | | - Maria Sellars
- Department of Radiology, King's College Hospital, London, UK
| | - Claudio De Vito
- Division of Clinical Pathology, Geneva University Hospital, Geneva, Switzerland
| | | | - Alberto Quaglia
- Liver Histopathology Department, King's College Hospital, London, UK
| | - Nigel Heaton
- Institute of Liver Studies, King's College London, London, UK
| | - Mark Davenport
- Department of Paediatric Surgery, King's College Hospital, London, UK.
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27
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Wang J, Jin S, Zhang Y. A Report of 21 Cases of Laparoscopic Liver Resection in Children. J Laparoendosc Adv Surg Tech A 2020; 30:581-585. [PMID: 32213130 DOI: 10.1089/lap.2019.0376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective: To summarize and analyze the technique and experience of laparoscopic liver resection (LLR) in children. Methods: From Dec 2015 to Dec 2018, surgical outcomes were evaluated in 30 pediatric patients with liver tumors. LLR was performed in 21 patients, including 15 males and 6 females with a mean age of 7.6 ± 3.8 years (range, 2-13 years) and a mean liver tumor diameter of 7.2 ± 2.0 cm (range, 4-10 cm). During the same period, 9 cases of traditional open liver resection were selected as controls, including 6 males and 3 females with a mean age of 7.0 ± 3.7 years (range, 2-13 years) and a mean liver tumor diameter of 7.5 ± 2.2 cm (range, 4.4-10.0 cm). Results: The mean operation time and mean hepatic inflow occlusion time were longer in the laparoscopic group, with values of 182.3 ± 66.1 minutes and 83.2 ± 38.2 minutes, respectively, than in the open group, with values of 120.0 ± 54.3 minutes and 49.6 ± 26.5 minutes, respectively. There were no significant differences between the two groups in blood loss (164.4 ± 107.4 mL versus 133.8 ± 87.1 mL), blood transfusion volume (102.2 ± 100.2 mL versus 69.2 ± 81.8 mL), and alanine aminotransferase levels 24 hours after surgery (212.0 ± 101.4 IU/L versus 173.3 ± 97.2 IU/L) and 72 hours after surgery (74.0 ± 32.5 IU/L versus 81.7 ± 57.3 IU/L). The average hospital stay in the laparoscopic group (6.2 ± 1.6 days) was significantly shorter than that in the open group (8.2 ± 2.0 days). The children in both groups recovered well after surgery without serious complications. Conclusion: LLR contributes to improved recovery of patients after surgery without increasing the incidence of complication, therefore, LLR is a safe option for liver tumors in children.
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Affiliation(s)
- Junxiang Wang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shuguang Jin
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Yimao Zhang
- Department of Pediatric Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China
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Paapsi K, Baburin A, Mikkel S, Mägi M, Saks K, Innos K. Childhood cancer incidence and survival trends in Estonia (1970-2016): a nationwide population-based study. BMC Cancer 2020; 20:30. [PMID: 31924184 PMCID: PMC6954517 DOI: 10.1186/s12885-019-6510-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 12/30/2019] [Indexed: 12/19/2022] Open
Abstract
Background Childhood cancers represent a small proportion of all cancers but are still a major public health problem. The study analysed long-term trends in childhood cancer incidence and survival in Estonia in relation to societal and health care transition. Methods Data on all malignant tumours, diagnosed in children aged 0–14 during 1970–2016, were derived from the Estonian Cancer Registry. Age-standardised (World standard) incidence rates were calculated by ICCC-3 site groups and joinpoint regression was used to estimate annual percentage change (APC) for incidence trends. Cohort and period approach were used to estimate 5-year survival. Internal age standardisation was applied. Results A total of 1628 incident cancer cases were diagnosed during the study period and overall incidence increased significantly at a rate of 0.5% per year. Significant increases were seen for neuroblastoma and germ cell tumours, for lymphoid leukemias and some CNS sub-sites. At the same time, decline in incidence was seen in almost all subgroups of unspecified neoplasms. The overall 5-year survival improved from 24% in 1970–1979 to 73% in 2010–2016, with the largest changes occurring in the 1990s and 2000s. For many sites, survival increase thereafter has been marginal. Conclusion In this first comprehensive population-based study of childhood cancer incidence and survival in Estonia, long-term trends are shown in the context of societal and health care changes. Even though the increasing incidence of some sites may, at least partially, be explained by improved diagnostics reflected in the decreased incidence of unspecified neoplasms, the overall cancer incidence in children seems to be rising. Rapid progress in diagnosis and care have improved childhood cancer survival immensely, but deficit in Estonia persists compared to other European countries. Results of the study accentuate the need for a more in-depth analysis of clinical data, but also for the prioritization of childhood cancer in Estonia, to ensure access to standard care and innovative treatments.
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Affiliation(s)
- Keiu Paapsi
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia.
| | - Aleksei Baburin
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia
| | - Sirje Mikkel
- Clinic of Haematology and Oncology, Tartu University Hospital, Tartu, Estonia
| | - Margit Mägi
- Estonian Cancer Registry, National Institute for Health Development, Tallin, Estonia
| | - Kadri Saks
- Department of Oncology and Haematology, Clinic of Paediatrics, Tallinn Children's Hospital, Tallinn, Estonia
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619, Tallinn, Estonia
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29
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Feng J, Polychronidis G, Heger U, Frongia G, Mehrabi A, Hoffmann K. Incidence trends and survival prediction of hepatoblastoma in children: a population-based study. Cancer Commun (Lond) 2019; 39:62. [PMID: 31651371 PMCID: PMC6813130 DOI: 10.1186/s40880-019-0411-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/16/2019] [Indexed: 12/21/2022] Open
Abstract
Background Hepatoblastoma is a rare disease that nevertheless accounts for the majority of liver malignancies in children. Due to limited epidemiological data, therapy for hepatoblastoma tends to be individualized. This study aimed to evaluate incidence trends of hepatoblastoma and to develop a nomogram to predict the survival of children with newly diagnosed hepatoblastoma on a population-based level. Methods Individuals up to 18 years of age with hepatoblastoma recorded in 18 registries of the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2015 were examined. Joinpoint regression analyses were applied to assess incidence trends in annual percentage change (APC). Multivariable Cox regression was used to identify factors associated with overall survival (OS). A nomogram was constructed to predict OS in individual cases based on independent predictors. Concordance index (C-index) and calibration curves were used to evaluate predictive performance. Results Between 2004 and 2015, hepatoblastoma incidence increased significantly (APC, 2.2%; 95% confidence interval [CI] 0.5% to 3.8%, P < 0.05). In particular, this increase was observed among 2- to 4-year-old patients, males, and African–Americans. The 5- and 10-year OS rates were 81.5% and 81.0%, respectively. Age of 2 to 4 years, African–American ethnicity, and no surgery were independent predictors for short OS. Distant disease at presentation was found not to be an independent factor of survival. The nomogram had a C-index of 0.79 (95% CI 0.74–0.84) with appropriate calibration curve fitting. Conclusions We constructed a nomogram that integrates common factors associated with survival for hepatoblastoma patients. It provides accurate prognostic prediction for children with hepatoblastoma.
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Affiliation(s)
- Jincheng Feng
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Georgios Polychronidis
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Ulrike Heger
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Giovanni Frongia
- Department of Pediatric Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Arianeb Mehrabi
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Katrin Hoffmann
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Contrast-enhanced ultrasound of liver lesions in children. Pediatr Radiol 2019; 49:1422-1432. [PMID: 31620843 DOI: 10.1007/s00247-019-04361-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/14/2019] [Accepted: 02/14/2019] [Indexed: 12/13/2022]
Abstract
Initial pediatric imaging of the liver heavily relies on ultrasonography (US) because it is free of ionizing radiation, easily portable and readily available. Although conventional US (gray-scale and color Doppler) is often an excellent screening tool, its relative low specificity compared to CT/MRI limits liver lesion characterization. The United States Food and Drug Administration's recent approval of an intravenous US contrast agent for pediatric liver lesion characterization (sulfur hexafluoride lipid-type A microspheres) and its excellent safety profile have spurred increased interest in contrast-enhanced US for definitive diagnosis of pediatric liver lesions. This review focuses on the safety of contrast-enhanced US, role of contrast-enhanced US in the evaluation of focal liver lesions, basic contrast-enhanced US technique for liver imaging, and interpretation principles. The authors review common focal liver lesions, with special attention to the role of contrast-enhanced US in the pediatric oncology population.
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Sade D, Shaham-Niv S, Arnon ZA, Tavassoly O, Gazit E. Seeding of proteins into amyloid structures by metabolite assemblies may clarify certain unexplained epidemiological associations. Open Biol 2019; 8:rsob.170229. [PMID: 29367352 PMCID: PMC5795054 DOI: 10.1098/rsob.170229] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 01/03/2018] [Indexed: 12/20/2022] Open
Abstract
The accumulation of various metabolites appears to be associated with diverse human diseases. However, the aetiological link between metabolic alteration and the observed diseases is still elusive. This includes the correlation between the abnormally high levels of homocysteine and quinolinic acid in Alzheimer's disease, as well as the accumulation of oncometabolites in malignant processes. Here, we suggest and discuss a possible mechanistic insight into metabolite accumulation in conditions such as neurodegenerative diseases and cancer. Our hypothesis is based on the demonstrated ability of metabolites to form amyloid-like structures in inborn error of metabolism disorders and the potential of such metabolite amyloids to promote protein aggregation. This notion can provide a new paradigm for neurodegeneration and cancer, as both conditions were linked to loss of function due to protein aggregation. Similar to the well-established observation of amyloid formation in many degenerative disorders, the formation of amyloids by tumour-suppressor proteins, including p53, was demonstrated in malignant states. Moreover, this new paradigm could fill the gap in understanding the high occurrence of specific types of cancer among genetic error of metabolism patients. This hypothesis offers a fresh view on the aetiology of some of the most abundant human maladies and may redirect the efforts towards new therapeutic developments.
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Affiliation(s)
- Dorin Sade
- Department of Molecular Microbiology and Biotechnology, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shira Shaham-Niv
- Department of Molecular Microbiology and Biotechnology, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Zohar A Arnon
- Department of Molecular Microbiology and Biotechnology, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Omid Tavassoly
- Department of Chemistry, Simon Fraser University, Burnaby, British Columbia, Canada V5A 1S6
| | - Ehud Gazit
- Department of Molecular Microbiology and Biotechnology, Tel Aviv University, Tel Aviv 6997801, Israel .,Sagol Interdisciplinary School of Neurosciences, Tel Aviv University, Tel Aviv 6997801, Israel.,Blavatnik Center for Drug Discovery, Tel Aviv University, Tel Aviv 6997801, Israel
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Mussa A, Duffy KA, Carli D, Ferrero GB, Kalish JM. Defining an optimal time window to screen for hepatoblastoma in children with Beckwith-Wiedemann syndrome. Pediatr Blood Cancer 2019; 66:e27492. [PMID: 30270492 PMCID: PMC7955797 DOI: 10.1002/pbc.27492] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/18/2018] [Indexed: 12/15/2022]
Abstract
Patients with Beckwith-Wiedemann spectrum (BWSp) undergo quarterly alpha-fetoprotein measurement for hepatoblastoma (HB) screening up to 4 years of age, paralleling the epidemiology of nonsyndromic HB. However, specific data on the timing of HB development in BWSp are lacking. Here we compare the timing of presentation of HBs in BWSp with a control cohort of consecutive HB cases, demonstrating that halving screening duration of screening procedures in BWSp likely will not impact its effectiveness.
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Affiliation(s)
- Alessandro Mussa
- Neonatal Intensive Care Unit, Department of Obstetrics and Gynecology, Città della Salute e della Scienza di Torino, Torino, Italy,Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - Kelly A. Duffy
- Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Diana Carli
- Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | | | - Jennifer M. Kalish
- Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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33
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Marchese S, Sorice A, Ariano A, Florio S, Budillon A, Costantini S, Severino L. Evaluation of Aflatoxin M1 Effects on the Metabolomic and Cytokinomic Profiling of a Hepatoblastoma Cell Line. Toxins (Basel) 2018; 10:E436. [PMID: 30373285 PMCID: PMC6265880 DOI: 10.3390/toxins10110436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 12/20/2022] Open
Abstract
Hepatoblastoma incidence has been associated with different environmental factors even if no data are reported about a correlation between aflatoxin exposure and hepatoblastoma initiation. Considering that hepatoblastoma develops in infants and children and aflatoxin M1 (AFM1), the aflatoxin B1 (AFB1) hydroxylated metabolite, can be present in mothers' milk and in marketed milk products, in this study we decided to test the effects of AFM1 on a hepatoblastoma cell line (HepG2). Firstly, we evaluated the effects of AFM1 on the cell viability, apoptosis, cell cycle, and metabolomic and cytokinomic profile of HepG2 cells after treatment. AFM1 induced: (1) a decrease of HepG2 cell viability, reaching IC50 at 9 µM; (2) the blocking of the cell cycle in the G0/G1 phase; (3) the decrease of formiate levels and incremented level of some amino acids and metabolites in HepG2 cells after treatment; and (4) the increase of the concentration of three pro-inflammatory cytokines, IL-6, IL-8, and TNF-α, and the decrease of the anti-inflammatory interleukin, IL-4. Our results show that AFM1 inhibited the growth of HepG2 cells, inducing both a modulation of the lipidic, glycolytic, and amino acid metabolism and an increase of the inflammatory status of these cells.
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Affiliation(s)
- Silvia Marchese
- Unità di Farmacologia e Tossicologia-Dipartimento di Medicina Veterinaria e Produzioni Animali, Università degli Studi di Napoli "Federico II", 80138 Napoli, Italy.
| | - Angela Sorice
- Unità di Farmacologia Sperimentale, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy.
| | - Andrea Ariano
- Unità di Farmacologia e Tossicologia-Dipartimento di Medicina Veterinaria e Produzioni Animali, Università degli Studi di Napoli "Federico II", 80138 Napoli, Italy.
| | - Salvatore Florio
- Unità di Farmacologia e Tossicologia-Dipartimento di Medicina Veterinaria e Produzioni Animali, Università degli Studi di Napoli "Federico II", 80138 Napoli, Italy.
| | - Alfredo Budillon
- Unità di Farmacologia Sperimentale, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy.
| | - Susan Costantini
- Unità di Farmacologia Sperimentale, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy.
| | - Lorella Severino
- Unità di Farmacologia e Tossicologia-Dipartimento di Medicina Veterinaria e Produzioni Animali, Università degli Studi di Napoli "Federico II", 80138 Napoli, Italy.
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Lee S, Zhou P, Gupta A, Shin S. Reactive Ductules Are Associated With Angiogenesis and Tumor Cell Proliferation in Pediatric Liver Cancer. Hepatol Commun 2018; 2:1199-1212. [PMID: 30288475 PMCID: PMC6167070 DOI: 10.1002/hep4.1204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/07/2018] [Indexed: 02/06/2023] Open
Abstract
While reactive ductules (RDs) have been observed in viral hepatitis, biliary atresia, nonalcoholic fatty liver disease, and adult hepatocellular carcinoma (HCC), RDs in pediatric liver cancer remain uncharacterized. This study investigated the relationship of RDs with angiogenic paracrine factors, the extent of angiogenesis, and tumor cell proliferation in pediatric hepatoblastoma (HBL)/HCC livers. We quantified the extent of RDs and their expression of paracrine factors that include vascular endothelial growth factor (VEGF), vascular endothelial growth factor D (VEGFD), platelet‐derived growth factor C, and angiopoietin 1 (ANGPT1). In addition, we performed immunohistochemical detection of the endothelial marker clusters of differentiation (CD)34 and the proliferation marker Ki67 followed by correlation analyses. In HBL, we found the percentage of RDs with Ki67 expression (% Ki67+ RDs) significantly correlated with intratumoral Ki67+ areas (r = 0.5138, P = 0.0349) and % ANGPT1+ RDs positively correlated with % Ki67+ RDs (r = 0.5851, P = 0.0136). In HCC, the high ANGPT1+ RDs group (i.e., cases with % ANGPT1+ RDs ≥50) exhibited high intratumoral Ki67+ areas compared to the low ANGPT1+ RDs group. In the combined HBL and HCC liver tumor group, there was a positive association between % platelet‐derived growth factor C+ RDs and intratumoral Ki67+ areas (r = 0.4712, P = 0.0099) and the high VEGFD+ RDs group (≥50%) exhibited a high number of peritumoral CD34+ vessels compared to the low VEGFD+ RDs group. Conclusion: Paracrine factor‐expressing RDs are associated with angiogenesis and proliferation of pediatric liver tumors.
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Affiliation(s)
- Sanghoon Lee
- Division of Pediatric General and Thoracic Surgery Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Ping Zhou
- Division of Pediatric General and Thoracic Surgery Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Anita Gupta
- Division of Pathology and Laboratory Medicine Cincinnati Children's Hospital Medical Center Cincinnati OH
| | - Soona Shin
- Division of Pediatric General and Thoracic Surgery Cincinnati Children's Hospital Medical Center Cincinnati OH
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Angelico R, Grimaldi C, Saffioti MC, Castellano A, Spada M. Hepatocellular carcinoma in children: hepatic resection and liver transplantation. Transl Gastroenterol Hepatol 2018; 3:59. [PMID: 30363724 DOI: 10.21037/tgh.2018.09.05] [Citation(s) in RCA: 155] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 09/03/2018] [Indexed: 12/12/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is a rare malignancy in children and at the time of diagnosis up to 80% of pediatric HCC are unresectable due to large and multiple lesions. The majority of pediatric HCC occurs on a background of normal liver, and consequently the absence of concomitant chronic liver disease generally allows tolerating pre- and post-operative chemotherapy. Based on the large experiences of adult HCC and pediatric hepatoblastoma, in the last years a multidisciplinary aggressive treatment composed of surgical resection and chemotherapy (based on cisplatin and doxorubicin) has been proposed, improving patient outcomes and recurrence rate in children with HCC. However, the overall survival rate in children with HCC is not satisfactory yet; while the 5-year survival rate may achieve up to 70-80% in non-metastatic resectable HCC, it remains <20% in children with unresectable HCC. The mainstay of the pediatric HCC therapeutic strategy is the radical tumor resection, weather by hepatic resection or liver transplantation, nevertheless the best surgical approaches as well as the optimal neoadjuvant and adjuvant treatment are still under debate. Different strategies have been explored to convert unresectable HCC into resectable tumors by extending criteria for surgical treatment and/or associating multi-modal treatments, such as systemic and local-regional therapy, but universal recommendation needs to be defined yet. The purpose of this review is to outline the role of different surgical approaches, including hepatic resection and liver transplantation, in pediatric HCC with or without underlying chronic liver disease.
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Affiliation(s)
- Roberta Angelico
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Chiara Grimaldi
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Maria Cristina Saffioti
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Aurora Castellano
- Division of Oncohematology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marco Spada
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Soini T, Eloranta K, Pihlajoki M, Kyrönlahti A, Akinrinade O, Andersson N, Lohi J, Pakarinen MP, Wilson DB, Heikinheimo M. Transcription factor GATA4 associates with mesenchymal-like gene expression in human hepatoblastoma cells. Tumour Biol 2018; 40:1010428318785498. [PMID: 30074440 DOI: 10.1177/1010428318785498] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
GATA4, a transcription factor crucial for early liver development, has been implicated in the pathophysiology of hepatoblastoma, an embryonal tumor of childhood. However, the molecular and phenotypic consequences of GATA4 expression in hepatoblastoma are not fully understood. We surveyed GATA4 expression in 24 hepatoblastomas using RNA in situ hybridization and immunohistochemistry. RNA interference was used to inhibit GATA4 in human HUH6 hepatoblastoma cells, and changes in cell migration were measured with wound healing and transwell assays. RNA microarray hybridization was performed on control and GATA4 knockdown HUH6 cells, and differentially expressed genes were validated by quantitative polymerase chain reaction or immunostaining. Plasmid transfection was used to overexpress GATA4 in primary human hepatocytes and ensuring changes in gene expression were measured by quantitative polymerase chain reaction. We found that GATA4 expression was high in most hepatoblastomas but weak or negligible in normal hepatocytes. GATA4 gene silencing impaired HUH6 cell migration. We identified 106 differentially expressed genes (72 downregulated, 34 upregulated) in knockdown versus control HUH6 cells. GATA4 silencing altered the expression of genes associated with cytoskeleton organization, cell-to-cell adhesion, and extracellular matrix dynamics (e.g. ADD3, AHNAK, DOCK8, RHOU, MSF, IGFBP1, COL4A2). These changes in gene expression reflected a more epithelial (less malignant) phenotype. Consistent with this notion, there was reduced F-actin stress fiber formation in knockdown HUH6 cells. Forced expression of GATA4 in primary human hepatocytes triggered opposite changes in the expression of genes identified by GATA4 silencing in HUH6 cells. In conclusion, GATA4 is highly expressed in most hepatoblastomas and correlates with a mesenchymal, migratory phenotype of hepatoblastoma cells.
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Affiliation(s)
- Tea Soini
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katja Eloranta
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjut Pihlajoki
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- 2 Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Antti Kyrönlahti
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- 2 Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Oyediran Akinrinade
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Noora Andersson
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jouko Lohi
- 3 Department of Pathology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko P Pakarinen
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- 4 Unit of Pediatric Surgery and Pediatric Liver and Gut Research Group, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - David B Wilson
- 2 Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- 5 Department of Developmental Biology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Markku Heikinheimo
- 1 Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- 2 Department of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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Culbreath KD, Garcia AV, Leeds IL, Ladd MR, Crawford T, Boss E, Rhee DS. Evaluation of Anemia and Nutritional Status on Children Undergoing Resection of Primary Liver Tumors. J Surg Res 2018; 232:547-552. [PMID: 30463771 DOI: 10.1016/j.jss.2018.06.053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/22/2018] [Accepted: 06/19/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Complete tumor resection of primary malignant liver tumors offers the best chance of survival. However, many of these children may experience anemia and failure to thrive. This study analyzes the association of preoperative anemia and nutritional support with outcomes in children undergoing major resection of primary malignant liver tumors. METHODS Using the National Surgical Quality Improvement Program Pediatric database from 2012 to 2015, children undergoing major liver resections for primary malignant hepatic tumors were selected. Patient demographics, comorbidities, and 30-d outcomes were compared with respect to the presence of preoperative anemia and the need for nutritional support. Outcomes included 30-d postoperative complications, perioperative blood transfusions, and hospital readmissions. Propensity score matching was performed to control for significant confounders. RESULTS One hundred ten children were included, 76 (69.1%) with preoperative anemia, and 36 (32.7%) receiving nutritional support. Anemia was associated with preoperative chemotherapy (P = 0.02) and steroids (P = 0.03). Nutritional support was associated with cardiac (P = 0.01), respiratory (P < 0.01), neurologic (P < 0.01), and hematologic comorbidities (P = 0.02). There were 20 (18.2%) postoperative complications and 6 (5.5%) hospital readmissions. After propensity score matching, there was no difference in complications between anemic and nonanemic patients (P = 0.13). Preoperative nutritional support was associated with an increased rate of complications (P < 0.01). Neither anemia (P = 1.00) nor nutritional support (P = 0.49) were associated with readmissions. CONCLUSIONS The need for nutritional support is common in children undergoing resection of primary malignant hepatic tumors. Anemia was not significantly associated with postoperative complications. In this study, nutritional support was associated with an increased risk of postoperative complications. The need for nutritional support may warrant special attention to the patient's overall conditioning during operative planning.
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Affiliation(s)
- Katherine D Culbreath
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Alejandro V Garcia
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ira L Leeds
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mitchell R Ladd
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Todd Crawford
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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38
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Kalish JM, Doros L, Helman LJ, Hennekam RC, Kuiper RP, Maas SM, Maher ER, Nichols KE, Plon SE, Porter CC, Rednam S, Schultz KAP, States LJ, Tomlinson GE, Zelley K, Druley TE. Surveillance Recommendations for Children with Overgrowth Syndromes and Predisposition to Wilms Tumors and Hepatoblastoma. Clin Cancer Res 2018; 23:e115-e122. [PMID: 28674120 DOI: 10.1158/1078-0432.ccr-17-0710] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 04/23/2017] [Accepted: 05/09/2017] [Indexed: 12/13/2022]
Abstract
A number of genetic syndromes have been linked to increased risk for Wilms tumor (WT), hepatoblastoma (HB), and other embryonal tumors. Here, we outline these rare syndromes with at least a 1% risk to develop these tumors and recommend uniform tumor screening recommendations for North America. Specifically, for syndromes with increased risk for WT, we recommend renal ultrasounds every 3 months from birth (or the time of diagnosis) through the seventh birthday. For HB, we recommend screening with full abdominal ultrasound and alpha-fetoprotein serum measurements every 3 months from birth (or the time of diagnosis) through the fourth birthday. We recommend that when possible, these patients be evaluated and monitored by cancer predisposition specialists. At this time, these recommendations are not based on the differential risk between different genetic or epigenetic causes for each syndrome, which some European centers have implemented. This differentiated approach largely represents distinct practice environments between the United States and Europe, and these guidelines are designed to be a broad framework within which physicians and families can work together to implement specific screening. Further study is expected to lead to modifications of these recommendations. Clin Cancer Res; 23(13); e115-e22. ©2017 AACRSee all articles in the online-only CCR Pediatric Oncology Series.
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Affiliation(s)
- Jennifer M Kalish
- Division of Human Genetics, Children's Hospital of Philadelphia and the Department of Pediatrics at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Leslie Doros
- Cancer Genetics Clinic, Children's National Medical Center, Washington, DC
| | - Lee J Helman
- Center for Cancer Research and Pediatric Oncology Branch, National Cancer Institute, Rockville, Maryland
| | - Raoul C Hennekam
- Department of Pediatrics, University of Amsterdam, Amsterdam, the Netherlands
| | - Roland P Kuiper
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Saskia M Maas
- Department of Clinical Genetics, Academic Medical Center, Amsterdam, the Netherlands
| | - Eamonn R Maher
- Department of Medical Genetics, University of Cambridge, and Cambridge NIHR Biomedical Research Centre, Cambridge, United Kingdom
| | - Kim E Nichols
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sharon E Plon
- Department of Pediatrics/Hematology-Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | | | - Surya Rednam
- Department of Pediatrics/Hematology-Oncology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Kris Ann P Schultz
- Division of Cancer and Blood Disorders, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Lisa J States
- Division of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gail E Tomlinson
- Division of Pediatric Hematology-Oncology and Greehey Children's Cancer Research Institute, The University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kristin Zelley
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Todd E Druley
- Division of Pediatric Hematology and Oncology, Washington University, St. Louis, Missouri
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Baumann U, Adam R, Duvoux C, Mikolajczyk R, Karam V, D'Antiga L, Chardot C, Coker A, Colledan M, Ericzon BG, Line PD, Hadzic N, Isoniemi H, Klempnauer JL, Reding R, McKiernan PJ, McLin V, Paul A, Salizzoni M, Furtado ESB, Schneeberger S, Karch A. Survival of children after liver transplantation for hepatocellular carcinoma. Liver Transpl 2018; 24:246-255. [PMID: 29222922 DOI: 10.1002/lt.24994] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 11/06/2017] [Accepted: 11/06/2017] [Indexed: 12/12/2022]
Abstract
Hepatocellular carcinoma (HCC) in childhood differs from adult HCC because it is often associated with inherited liver disease. It is, however, unclear whether liver transplantation (LT) for HCC in childhood with or without associated inherited disease has a comparable outcome to adult HCC. On the basis of data from the European Liver Transplant Registry (ELTR), we aimed to investigate if there are differences in patient and graft survival after LT for HCC between children and adults and between patients with underlying inherited versus noninherited liver disease, respectively. We included all 175 children who underwent LT for HCC and were enrolled in ELTR between 1985 and 2012. Of these, 38 had an associated inherited liver disease. Adult HCC patients with (n = 79) and without (n = 316, matched by age, sex, and LT date) inherited liver disease served as an adult comparison population. We used multivariable piecewise Cox regression models with shared frailty terms (for LT center) to compare patient and graft survival between the different HCC groups. Survival analyses demonstrated a superior longterm survival of children with inherited liver disease when compared with children with HCC without inherited liver disease (hazard ratio [HR], 0.29; 95% CI, 0.10-0.90; P = 0.03) and adults with HCC with inherited liver disease (HR, 0.27; 95% CI, 0.06-1.25; P = 0.09). There was no survival difference between adults with and without inherited disease (HR, 1.05; 95% CI, 0.66-1.66; P = 0.84). In conclusion, the potential survival advantage of children with an HCC based on inherited disease should be acknowledged when considering transplantation and prioritization for these patients. Further prospective studies accounting for tumor size and extension at LT are necessary to fully interpret our findings. Liver Transplantation 24 246-255 2018 AASLD.
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Affiliation(s)
- Ulrich Baumann
- Department for Pediatric Kidney, Liver, and Metabolic Diseases, Division of Pediatric Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany
| | - René Adam
- European Liver Transplant Registry, INSERM U 935, AP-HP Hôpital Paul Brousse, Université Paris-Sud, Villejuif, France
| | - Christophe Duvoux
- Department of Hepatology and Liver Transplant Unit, Henri Mondor Hospital AP-HP, Paris Est University, Créteil, France
| | - Rafael Mikolajczyk
- Research Group Epidemiological and Statistical Methods, Helmholtz Centre for Infection Research, Braunschweig, Germany.,German Center for Infection Research, Hannover-Braunschweig Site, Braunschweig, Germany
| | - Vincent Karam
- European Liver Transplant Registry, INSERM U 935, AP-HP Hôpital Paul Brousse, Université Paris-Sud, Villejuif, France
| | - Lorenzo D'Antiga
- Pediatric Hepatology, Gastroenterology and Transplantation, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Christophe Chardot
- Hopital Necker Enfants Malades, Service de Chirurgie Pediatrique, Paris, France
| | - Ahmet Coker
- Division of Hepatobiliary and Liver Transplantation, Department of Surgery Division, Ege University Medical School, Izmir, Turkey
| | - Michele Colledan
- Papa Giovanni 23 Hospital, Chirurgia III e Centro Trapianti di Fegato, Bergamo, Italy
| | - Bo-Goran Ericzon
- Department of Transplantation Surgery, Huddinge Hospital, Huddinge, Sweden
| | - Pål Dag Line
- Radiumhospitalet Medical Center Liver Transplant Unit, Rikshospitalet, Oslo, Norway
| | | | - Helena Isoniemi
- Transplantation and Liver Surgery Clinic, U.C.Helsingfors, Helsinki, Finland
| | - Jürgen L Klempnauer
- Klinik für Viszeral und Transplantationschirurgie, Hannover Medical School, Hannover, Germany
| | - Raymond Reding
- Cliniques Universitaires Saint Luc, Catholic University of Louvain, Brussels, Belgium
| | | | - Valérie McLin
- Swiss Center for Liver Disease in Children, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Andreas Paul
- Klinik für allgemeine und Transplantationschirurgie, C.U.K. GHS Essen, Essen, Germany
| | - Mauro Salizzoni
- Centro de Trapianti de Fegato, Azienda Ospedaliera S. Giovanni Battista, Torino, Italy
| | - Emanuel San Bento Furtado
- Gabinete de Coordenacao de Colheita de Orgaos e Transplantacao, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - Stefan Schneeberger
- Department of General and Transplant Surgery, University Hospital, Innsbruck, Austria
| | - André Karch
- Research Group Epidemiological and Statistical Methods, Helmholtz Centre for Infection Research, Braunschweig, Germany.,German Center for Infection Research, Hannover-Braunschweig Site, Braunschweig, Germany
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40
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Mussa A, Ferrero GB. Serum alpha-fetoprotein screening for hepatoblastoma in Beckwith-Wiedemann syndrome. Am J Med Genet A 2017; 173:585-587. [PMID: 28211991 DOI: 10.1002/ajmg.a.38077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/14/2016] [Indexed: 12/15/2022]
Affiliation(s)
- Alessandro Mussa
- Neonatal Intensive Care Unit, Department of Obstetrics and Gynecology, Città della Salute e della Scienza di Torino, Torino, Italy.,Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
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Mesenchymal Hamartoma of the Liver: Complete Excision Always Necessary. Case Rep Surg 2017; 2017:8314102. [PMID: 29348961 PMCID: PMC5733832 DOI: 10.1155/2017/8314102] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/12/2017] [Indexed: 11/17/2022] Open
Abstract
Mesenchymal hamartoma (MH) is not an uncommon tumor of the liver in the age group of 2-10 years. It is the second most common benign liver tumor in children. Previously considered a developmental anomaly, newer insights into other theories of origin including toxic-metabolic, ischemic, and a true neoplastic process are in progress. Previous understanding of a purely benign nature of the tumor is being overridden by a real malignant transformation. Complete excision of the tumor with clear margins is recommended to achieve a long term cure. A thorough understanding of the natural history of these tumors and skillful surgical treatment are indispensable elements of care.
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Zhang B, Liu G, Liu X, Zheng S, Dong K, Dong R. Circulating D-dimer level correlates with disease characteristics in hepatoblastoma patients. Medicine (Baltimore) 2017; 96:e8798. [PMID: 29381980 PMCID: PMC5708979 DOI: 10.1097/md.0000000000008798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Hepatoblastoma (HB) is the most common pediatric liver malignancy, typically affecting children within the first 4 years of life. However, only a few validated blood biomarkers are used in clinical evaluation. The current study explored the clinical application and significance of D-dimer levels in patients with HB. METHOD Forty-four patients with HB were included in this retrospective study. D-dimer and plasma fibrinogen levels were examined, and their correlation with other clinical features was analyzed. D-dimer and plasma fibrinogen levels were examined between HB and other benign hepatic tumors. RESULTS D-dimer levels were significantly associated with high-risk HB features, such as advanced stage and high α-fetoprotein (AFP) levels. Higher D-dimer levels were observed in stage 4 patients compared with stage 1/2/3 patients (P = .028). Higher D-dimer levels were also observed in patients with higher AFP levels before chemotherapy compared with patients with lower AFP levels after chemotherapy (P< 0.001). In addition, higher D-dimer levels were observed in HB compared with other benign hepatic tumors such as hepatic hemangioma and hepatocellular adenoma (P = .012). No significant difference in D-dimer levels was found between sex (P = .503) and age (≥12 vs <12 months, P = .424). There was no significant difference in plasma fibrinogen levels between sex or age and high-risk HB features, such as advanced stage and high AFP levels. CONCLUSIONS Elevated D-dimer levels could be a useful determinant biomarker for high-risk features in patients with HB. This finding also supports the clinical application of D-dimer in HB.
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Affiliation(s)
- BinBin Zhang
- Children's Hospital of Fudan University
- Department of Pediatric Hepatobiliary Surgery, Children's Hospital of Fudan University
- Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - GongBao Liu
- Children's Hospital of Fudan University
- Department of Pediatric Hepatobiliary Surgery, Children's Hospital of Fudan University
- Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - XiangQi Liu
- Children's Hospital of Fudan University
- Department of Pediatric Hepatobiliary Surgery, Children's Hospital of Fudan University
- Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Shan Zheng
- Children's Hospital of Fudan University
- Department of Pediatric Hepatobiliary Surgery, Children's Hospital of Fudan University
- Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Kuiran Dong
- Children's Hospital of Fudan University
- Department of Pediatric Hepatobiliary Surgery, Children's Hospital of Fudan University
- Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
| | - Rui Dong
- Children's Hospital of Fudan University
- Department of Pediatric Hepatobiliary Surgery, Children's Hospital of Fudan University
- Key Laboratory of Neonatal Disease, Ministry of Health, Shanghai, China
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Pediatric Hepatocellular Carcinoma, a Single Center Study from the South of Iran: Case Series. HEPATITIS MONTHLY 2017. [DOI: 10.5812/hepatmon.11837] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Hiniker SM, Rangaswami A, Lungren MP, Thakor AS, Concepcion W, Balazy KE, Kovalchuk N, Donaldson SS. Stereotactic body radiotherapy for pediatric hepatocellular carcinoma with central biliary obstruction. Pediatr Blood Cancer 2017; 64. [PMID: 28436210 DOI: 10.1002/pbc.26330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/21/2016] [Accepted: 10/07/2016] [Indexed: 11/05/2022]
Abstract
Here, we present the case of a pediatric patient with newly diagnosed hepatocellular carcinoma causing central biliary obstruction and persistently elevated bilirubin of 3.0-4.3 mg/dl despite placement of bilateral internal-external biliary drains. The tumor was not resectable, and the patient was not a candidate for liver transplant due to nodal disease, for chemotherapy due to hyperbilirubinemia, or for local therapies aside from stereotactic body radiotherapy (SBRT). In this report, we discuss the successful use of SBRT in the management of this patient, and its role in allowing the patient to become a candidate for additional therapies.
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Affiliation(s)
- Susan M Hiniker
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
| | - Arun Rangaswami
- Department of Pediatric Hematology/Oncology, Lucile Packard Children's Hospital, Stanford, California
| | - Matthew P Lungren
- Department of Interventional Radiology, Lucile Packard Children's Hospital, Stanford, California
| | - Avnesh S Thakor
- Department of Interventional Radiology, Lucile Packard Children's Hospital, Stanford, California
| | - Waldo Concepcion
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Kathleen E Balazy
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Nataliya Kovalchuk
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Sarah S Donaldson
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California.,Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California
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Xie X, Zhu H, Zhang J, Wang M, Zhu L, Guo Z, Shen W, Wang D. Solamargine inhibits the migration and invasion of HepG2 cells by blocking epithelial-to-mesenchymal transition. Oncol Lett 2017; 14:447-452. [PMID: 28693190 DOI: 10.3892/ol.2017.6147] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 03/30/2017] [Indexed: 02/03/2023] Open
Abstract
Solamargine (SM), a steroidal alkaloid glycoside purified from the Chinese traditional herb Solanum incanum, is known to possess various biological activities. However, only a few previous studies have reported the anti-metastatic activity of SM. In the present study, the inhibitory effects of SM on metastatic action were investigated in human HepG2 cells. The proliferation effects of SM on the HepG2 cells was evaluated by MTT and colony formation assays. Wound-healing and Transwell assays were performed to examine the migration and invasion effects on SM-treated HepG2 cells. The epithelial-to-mesenchymal transition (EMT)-associated markers (E-cadherin, Vimentin and N-cadherin) were detected by western blotting analysis. In the present study, MTT and colony formation assays indicated that SM suppressed HepG2 cell viability in a dose-dependent manner. The wound-healing and Transwell assays revealed that the migration and invasion activities were significantly inhibited following exposure to SM. EMT has been demonstrated to be essential for promoting migration and invasion in tumor cells and has often been characterized with a loss of epithelial markers (E-cadherin) and an increase of mesenchymal markers (Vimentin and N-cadherin). In the western blotting analysis, the expression level of E-cadherin was significantly upregulated compared with that in the control group, whereas the expression levels of N-cadherin and Vimentin were downregulated. Thus, it was suggested that the underlying mechanism of SM inhibits migration and invasion in HepG2 cells and is associated with suppression of EMT.
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Affiliation(s)
- Xiaodong Xie
- Department of Radiology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, Jiangsu 210000, P.R. China
| | - Haitao Zhu
- Department of Radiology, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
| | - Jia Zhang
- Department of Radiology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, Jiangsu 210000, P.R. China
| | - Meiqin Wang
- Department of Radiology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, Jiangsu 210000, P.R. China
| | - Li Zhu
- Department of Radiology, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
| | - Zhen Guo
- Department of Radiology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, Jiangsu 210000, P.R. China
| | - Wenrong Shen
- Department of Radiology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, Jiangsu 210000, P.R. China
| | - Dongqing Wang
- Department of Radiology, The Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212013, P.R. China
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Soini T, Pihlajoki M, Kyrönlahti A, Andersson LC, Wilson DB, Heikinheimo M. Downregulation of transcription factor GATA4 sensitizes human hepatoblastoma cells to doxorubicin-induced apoptosis. Tumour Biol 2017; 39:1010428317695016. [PMID: 28349834 DOI: 10.1177/1010428317695016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Hepatoblastoma, the most common type of pediatric liver cancer, is treated with a combination of surgery and chemotherapy. An essential drug in the treatment of hepatoblastoma is doxorubicin, which in high doses is cardiotoxic. This adverse effect is due to downregulation of cardiac expression of transcription factor GATA4, leading in turn to diminished levels of anti-apoptotic BCL2 (B-cell lymphoma 2) protein family members. GATA4 is also expressed in early fetal liver, but absent from normal postnatal hepatocytes. However, GATA4 is highly expressed in hepatoblastoma tissue. In this study, we assessed the role of GATA4 in doxorubicin-induced apoptosis of hepatoblastoma cells. Herein, we demonstrate that doxorubicin decreases GATA4 expression and alters the expression pattern of BCL2 family members, most profoundly that of BCL2 and BAK, in the HUH6 hepatoblastoma cell line. Silencing of GATA4 by siRNA prior to doxorubicin treatment sensitizes HUH6 cells to the apoptotic effect of this drug by further shifting the balance of BCL2 family members to the pro-apoptotic direction. Specifically, expression levels of anti-apoptotic BCL2 were decreased and pro-apoptotic BID were increased after GATA4 silencing. On the whole, our results indicate that since high endogenous levels of transcription factor GATA4 likely protect hepatoblastoma cells from doxorubicin-induced apoptosis, these cells can be rendered more sensitive to the drug by downregulation of GATA4.
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Affiliation(s)
- Tea Soini
- 1 Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marjut Pihlajoki
- 1 Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,2 Department of Pediatrics, School of Medicine, Washington University in St. Louis and St. Louis Children's Hospital, St. Louis, MO, USA
| | - Antti Kyrönlahti
- 1 Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,2 Department of Pediatrics, School of Medicine, Washington University in St. Louis and St. Louis Children's Hospital, St. Louis, MO, USA
| | - Leif C Andersson
- 3 Department of Pathology, University of Helsinki and HUSLAB, Helsinki, Finland
| | - David B Wilson
- 2 Department of Pediatrics, School of Medicine, Washington University in St. Louis and St. Louis Children's Hospital, St. Louis, MO, USA.,4 Department of Developmental Biology, School of Medicine, Washington University in St. Louis and St. Louis Children's Hospital, St. Louis, MO, USA
| | - Markku Heikinheimo
- 1 Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,2 Department of Pediatrics, School of Medicine, Washington University in St. Louis and St. Louis Children's Hospital, St. Louis, MO, USA
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Schmid I, von Schweinitz D. Pediatric hepatocellular carcinoma: challenges and solutions. J Hepatocell Carcinoma 2017; 4:15-21. [PMID: 28144610 PMCID: PMC5248979 DOI: 10.2147/jhc.s94008] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a very rare entity in children, making it nearly impossible to orchestrate Phase II/III studies even as multinational cooperative trials. In contrast to adults, nearly 50% of the children have a response (α-fetoprotein decline and/or tumor shrinkage) to chemotherapeutic agents such as cisplatin and doxorubicin (PLADO), demonstrating that HCC in childhood can be chemotherapy sensitive. As a result, the main treatment options in pediatric HCC focus on systemic drug therapies and resection as the central therapy. In nonmetastatic patients with complete resection upfront, the 5-year event-free survival and overall survival has reached 80%–90%. In almost all reported studies, children received adjuvant chemotherapy (mostly PLADO), but it has never been proven that postoperative chemotherapy is superior to observation. No data are available for the effects of sorafenib. The 3-year survival is <20% in children with unresectable HCC independent of the chemotherapy given preoperatively. Currently, PLADO in combination with sorafenib is recommended with the goal of achieving operability status. Alternatively, data are promising for the combination of sorafenib with gemcitabine and oxaliplatin. For children with nonresectable and nonmetastastic liver tumors, it has been shown that the Milan criteria regarding liver transplantation are not applicable – individual decisions have to be made. Transarterial chemoembolization could be offered to patients with chemotherapy-resistant liver tumors for palliative care or potentially to achieve surgical resectability, and therefore cure. Information about the feasibility or effects of new agents or approaches as discussed in adult HCC patients is not available for childhood HCC. Research has to be done for characterizing the molecular and genomic mechanisms of pediatric HCC to support the development of novel therapeutic approaches and the implementation of personalized medicine.
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Affiliation(s)
| | - Dietrich von Schweinitz
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
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Abstract
RATIONALE Hepatoblastoma is a rare malignancy. Approximately 100 cases are diagnosed yearly in the United States. The highest incidence occurs in infants and in children younger than 5 years. Cases involving patients older than 5 years are very rare. We describe the case of a patient who was diagnosed with hepatoblastoma at an atypical age of presentation for this type of malignancy. We also performed Ovid MEDLINE search for hepatoblastoma and epidemiology reports occurring in children between the ages of 5 and 18 years. In this article we review the epidemiology and summarize case reports published between 1997 and 2012 of patients with hepatoblastoma, who were older than 5 years. PATIENT CONCERNS AND DIAGNOSIS Our patient is an 11 year old boy with stage IV hepatoblastoma with lung and omental metastases at diagnosis. INTERVENTIONS The patient received 7 cycles of chemotherapy following the treatment plan of COG protocol AHEP 0731, off study. He also had tumor resection and omentectomy and achieved complete remission. OUTCOMES He later had disease recurrence and after undergoing treatment with different modalities, ultimately died of his disease. Review of SEER program data shows that the incidence of hepatoblastoma in children above the age of 5 years is too infrequent to be calculated. Literature review revealed 13 cases of patients diagnosed at age older than 5 years. Most cases were published due to unusual associations and/or complications. There are no obvious unifying characteristics for these cases, although there may be a slight male preponderance and many patients in this selected series presented with elevated Alpha-fetoprotein. LESSONS The reported case is rare, given the very low incidence of hepatoblastoma outside of infancy. A systematic review of characteristics and outcomes for patients older than 5 years who are enrolled in cooperative group hepatoblastoma trials may reveal important information about the epidemiology and tumor biology in this rare patient population.
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Abstract
This review highlights the complications and their risk factors encountered in pediatric hepatobiliary surgery, specifically in the context of pediatric hepatic resection, excision of choledochal cyst, and the Kasai hepatoportoenterostomy procedure for biliary atresia as well as other procedures potentially affecting the biliary tree. With the understanding that these are relatively rare procedures, case reports and small case series are included in addition to larger series when available. The review focuses on publications in English over the past 15 years. Complications included both surgery-specific pathology, such as biliary stricture after excision of choledochal cyst, and disease-specific entities, such as malnutrition in biliary atresia. This review may be useful when considering a particular procedure or in the discussion thereof with a patient and family. Additionally, it illuminates the need for additional work with larger patient databases to refine and expand our knowledge of these complications and precipitating risk factors.
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Affiliation(s)
- Gabriella Grisotti
- Department of Surgery, Yale School of Medicine, 333 Cedar St, FMB 131, P.O. Box 208062, New Haven, Connecticut 06520
| | - Robert A Cowles
- Department of Surgery, Yale School of Medicine, 333 Cedar St, FMB 131, P.O. Box 208062, New Haven, Connecticut 06520.
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