Upfront or delayed surgery in resectable hepatoblastoma: analysis from the children's hepatic tumors international collaboration database.

Age at diagnosis Alpha-fetoprotein Hepatoblastoma Outcome Resectable Up-front surgery

Journal

EClinicalMedicine
ISSN: 2589-5370
Titre abrégé: EClinicalMedicine
Pays: England
ID NLM: 101733727

Informations de publication

Date de publication:
Oct 2024
Historique:
received: 29 05 2024
revised: 14 08 2024
accepted: 19 08 2024
medline: 23 9 2024
pubmed: 23 9 2024
entrez: 23 9 2024
Statut: epublish

Résumé

In the treatment of resectable hepatoblastoma (HB), it has not been established whether upfront surgery (UF) at diagnosis or neoadjuvant chemotherapy and delayed surgery (DL) is preferred. We compared patients with localized HB who underwent either UF, or DL after neoadjuvant chemotherapy in the Children's Hepatic tumors International Collaboration (CHIC) database of 1605 cases enrolled in eight multicenter hepatoblastoma trials between 1988 and 2010. Among the 512 resectable HB patients who had PRETEXT (PRETreament EXTent of disease) I or II unruptured tumors at diagnosis without extrahepatic invasion, distant metastases, or massive vascular invasion, 172 underwent UF and 340 underwent DL. The primary outcomes were event-free and overall survivals after start of treatment in these two groups. Survival analysis was performed using the Kaplan-Maier analysis with long-rank tests and multivariable Cox regression models. Complete resection rates were comparable (93.6% in UF and 89.7% in DL). The total cycles of chemotherapy of DL (median:6) were significantly more than those of UF (median:4) ( The outcomes, surgical resectability, and complications were not significantly different between the UF and DL groups. Eligible patients with a low AFP level (<1000 ng/mL) or older age (≥3 years old) showed better outcomes in the UF group and might be considered for initial resection. European Network for Cancer Research in Children and Adolescents, funded through the Framework Program 7 of the European Commission; Children's Oncology Group Cure Search grant contributed by the Hepatoblastoma Foundation; Practical Research for Innovative Cancer Control and Project Promoting Clinical Trials for Development of New Drugs and Medical Devices, Japan Agency for Medical Research and Development; Japan Society for the Promotion of Science; and Swiss Cancer Research grant.

Sections du résumé

Background UNASSIGNED
In the treatment of resectable hepatoblastoma (HB), it has not been established whether upfront surgery (UF) at diagnosis or neoadjuvant chemotherapy and delayed surgery (DL) is preferred. We compared patients with localized HB who underwent either UF, or DL after neoadjuvant chemotherapy in the Children's Hepatic tumors International Collaboration (CHIC) database of 1605 cases enrolled in eight multicenter hepatoblastoma trials between 1988 and 2010.
Methods UNASSIGNED
Among the 512 resectable HB patients who had PRETEXT (PRETreament EXTent of disease) I or II unruptured tumors at diagnosis without extrahepatic invasion, distant metastases, or massive vascular invasion, 172 underwent UF and 340 underwent DL. The primary outcomes were event-free and overall survivals after start of treatment in these two groups. Survival analysis was performed using the Kaplan-Maier analysis with long-rank tests and multivariable Cox regression models.
Findings UNASSIGNED
Complete resection rates were comparable (93.6% in UF and 89.7% in DL). The total cycles of chemotherapy of DL (median:6) were significantly more than those of UF (median:4) (
Interpretation UNASSIGNED
The outcomes, surgical resectability, and complications were not significantly different between the UF and DL groups. Eligible patients with a low AFP level (<1000 ng/mL) or older age (≥3 years old) showed better outcomes in the UF group and might be considered for initial resection.
Funding UNASSIGNED
European Network for Cancer Research in Children and Adolescents, funded through the Framework Program 7 of the European Commission; Children's Oncology Group Cure Search grant contributed by the Hepatoblastoma Foundation; Practical Research for Innovative Cancer Control and Project Promoting Clinical Trials for Development of New Drugs and Medical Devices, Japan Agency for Medical Research and Development; Japan Society for the Promotion of Science; and Swiss Cancer Research grant.

Identifiants

DOI: 10.1016/j.eclinm.2024.102811 PMID: 39309724 PMC: PMC11414700
pubmed: 39309724
doi: 10.1016/j.eclinm.2024.102811
pii: S2589-5370(24)00390-0
pmc: PMC11414700
doi:

Types de publication

Journal Article

Langues

eng

Pagination

102811

Informations de copyright

© 2024 The Authors.

Déclaration de conflit d'intérêts

We declare no competing interests.

Auteurs

Eiso Hiyama (E)

Natural Science for Basic Research and Development, Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima University, Hiroshima, Japan.

Tomoro Hishiki (T)

Department of Pediatric Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.

Kenichi Yoshimura (K)

Department of Biostatistics and Health Data Science, Nagoya City University, Japan.

Mark Krailo (M)

Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.

Rudolf Maibach (R)

ETOP IBCSG Partners Foundation, Bern, Switzerland.

Beate Haeberle (B)

Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Germany.

Arun Rangaswami (A)

Division of Pediatric Hematology and Oncology, University of California San Francisco, San Francisco, CA, USA.

Dolores Lopez-Terrada (D)

Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA.

Marcio H Malogolowkin (MH)

Division of Pediatric Hematology Oncology, University of California Davis Comprehensive Cancer Center, Sacramento, CA, USA.

Marc Ansari (M)

Cansearch Research Platform for Pediatric Oncology and Hematology, Faculty of Medicine, Department of Pediatrics, Gynecology and Obstetrics, University of Geneva, Geneva, Switzerland.
Division of Pediatric Oncology and Hematology, Department of Women, Child and Adolescent, University Geneva Hospitals, Geneva, Switzerland.

Rita Alaggio (R)

Pathology Unit, IRCCS Ospedale Pediatrico Bambino Gesu Pediatric Hospital, Roma, Italy.
Department of Medical and Surgical Biotechnology Sciences, Sapienza University, Roma, Italy.

Allison F O'Neill (AF)

Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.

Angela D Trobaugh-Lotrario (AD)

Department of Pediatric Hematology/Oncology, Providence Sacred Heart Children's Hospital, Spokane, WA, USA.

Kenichiro Watanabe (K)

Department of Hematology and Oncology, Shizuoka Children's Hospital, Shizuoka, Japan.

Irene Schmid (I)

Department of Pediatric Hematology and Oncology, Dr. von Hauner Children`s Hospital, University Hospital, LMU Munich, Munich, Germany.

Sarangarajan Ranganathan (S)

Division of Pathology and Laboratory Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.

Yukichi Tanaka (Y)

Department of Pathology, Kanagawa Children's Medical Center, Yokohama, Japan.

Takeshi Inoue (T)

Department of Pathology, Osaka City General Hospital, Osaka, Japan.

Jin Piao (J)

Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA.

Jason Lin (J)

Division of Cancer Genetics, Chiba Cancer Center Research Institute, Chiba, Japan.

Piotr Czauderna (P)

Department of Surgery and Urology, for Children and Adolescents, Medical University of Gdansk, Poland.

Rebecka L Meyers (RL)

Division of Pediatric Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA.

Daniel C Aronson (DC)

Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.

Classifications MeSH