Hepatoblastoma Survival and the Prognostic Role of Cancer Stem Cell Markers

Abstract

Original ArticleAbstract Purpose: Hepatoblastoma (HB) is an embryonal tumor of the liver that occurs in infants and young children. Complete surgical resection and cisplatin-containing chemotherapy are crucial for cure in HB. Cancer stem cells (CSCs) constitute a newly identified subpopulation, which may differentiate into heterogeneous progenies of malignant cells. The aim of this study was to assess the survival outcome and the prognostic value of CSCs markers (CD133, CD90 and CD44) in a cohort of HB patients from Egypt. Methods: Disease status of 43 HB patients was evaluated at the main checkpoints of therapy and during follow-up. Treatment included surgical tumor resection and systemic chemotherapy (cisplatin, 5-fluorouracil, doxorubicin, and vincristine). Protein and RNA expressions of CD44, CD 90 and CD 133 were assessed by immunohistochemistry and quantitative PCR. Results:The OS for all patients was 58.2 at 4 years. Patients with localized disease stages (I&II) had a better OS than those with advanced stages (III&IV) (81.9% versus 30%, p<0.001). Total surgical resection was superior to incomplete/no resection (83.8% versus 25.2 %; p<0.001). The OS was significantly correlated with tumor response (p<0.001) and each of CD44, CD 90, CD 133 expression (p<0.001) whereas reduced DFS was associated with CD44 and CD133 expression (p<0.001). Conclusion: Localized disease is associated with higher OS than more advanced stages III and IV. Complete surgical resection facilitated with systemic preoperative chemotherapy in initially irresectable cases can improve survival in HB while CSC markers (CD133, 44, and 90) can predict survival and response to treatment in HB patients.