Is multifocality a prognostic factor in childhood hepatoblastoma?

Abstract

BACKGROUND:

The aim of this study was to assess the prognostic value of multifocality and the effectiveness of two different therapeutic strategies in patients with newly diagnosed hepatoblastoma.

PROCEDURES:

Between 1998 and 2011, 31 patients diagnosed with hepatoblastoma were referred to Ospedale Papa Giovanni XXIII, Bergamo, Italy. Patients were stratified according to SIOPEL protocols into high-risk (HR if AFP <100 ng/mL and/or PRETEXT IV and/or vascular invasion and/or extra-hepatic intra-abdominal disease and/or metastases) and standard-risk (SR, all others). The patient data we evaluated were: multifocality; patient age; gender; platelet count; AFP level at diagnosis, during treatment and follow-up; histotype; gestational age; birth weight; surgery (either resection or transplantation) and chemotherapy regimen adopted before and after surgery. The outcome measures were event free survival (EFS) and overall survival (OS); survival curves were estimated according to Kaplan-Meier.

RESULTS:

EFS and OS were associated significantly with multifocality (3-year EFS 40% vs. 95%, P = 0.006; 3-year OS 42% vs. 95%, P = 0.004). Multivariate analysis demonstrated that multifocality predicts lower EFS (hazard ratio 10.01, P = 0.007). Other factors at diagnosis did not reach statistical significance. A marked treatment dependent improvement was associated with intensive chemotherapy given both before and after liver transplantation (P = 0.06).

CONCLUSIONS:

Patients diagnosed with multifocal tumors had lower EFS levels. Multifocality should be taken into account for future stratification and further studied to assess genetic profile, immunochemistry and prognostic role.

• Authors: Francesco Saettini, Valentino Conter, Massimo Provenzi, Matteo Rota, Eugenia Giraldi, Carlo Foglia, Laura Cavalleri, Lorenzo D'Antiga
• Journal: Pediatric blood & cancer (Pediatr Blood Cancer) Vol. 61 Issue 9 Pg. 1593-7 (Sep 2014) ISSN: 1545-5017 [Electronic] United States
• PMID: 24757164 (Publication Type: Journal Article)
• Copyright: © 2014 Wiley Periodicals, Inc.

Topics

• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Child
• Child, Preschool
• Combined Modality Therapy
• Female
• Follow-Up Studies
• Hepatoblastoma (mortality, secondary, therapy)
• Humans
• Infant
• Infant, Newborn
• Liver Neoplasms (mortality, pathology, therapy)
• Male
• Multivariate Analysis
• Neoplasm Metastasis
• Neoplasm Staging
• Prognosis
• Retrospective Studies
• Survival Rate