Results of surgical resections with positive margins for children with hepatoblastoma: Case series from a single Asian center

Ren, Xiaobin; Li, Haibo; Diao, Mei; Chen, Long; Xu, Hang; Li, Long

doi:10.1002/pbc.27479

Cited by 15 publications

(11 citation statements)

References 18 publications

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“…This provides a pathological basis to determine the distance of the surgical margin. When patients with hepatoblastoma undergo surgery after chemotherapy, the margin may be positive if the surgical margin is not large enough, and postoperative chemotherapy and close follow-up are required; however, some studies show that a good prognosis can be obtained even if the surgical margin is positive (22). In our study, the farthest distance between the cancer nests and the capsule was 1 cm, but owing to the small number of cases, the specific tumor regression area requires further study.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Pathological Study of Tumor Border Invasion—Is Narrow Resection Margin Acceptable in Hepatoblastoma Surgery?

Shen

Zhao

et al. 2020

Front. Med.

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Aim: We aim to study clinically and pathologically whether narrow resection margin (<1 cm) is acceptable in hepatoblastoma surgery.Methods: A total of 42 patients who underwent surgery for hepatoblastoma were selected, and these patients were divided into two groups according to whether or not they underwent preoperative chemotherapy (CHT). The general characteristics of the patients were summarized, the resection margin distance was recorded, and the event-free survival rates were followed up. Pathologically, H&E staining and immunochemical staining were used to study the invasion distance outside the tumor capsule in the tumor border.Results: Clinically, the event-free survival rates were not significantly different between the patients with wide resection margin (>1 cm) and narrow resection margin (<1 cm) of the two groups. Pathologically, the tumor of all 42 patients had capsules surrounding the tumor. Of the patients in Group 1 (without preoperative CHT), 9% (2/22) had micrometastatic cancer nests outside the capsule, and the farthest distance from the cancer nests to the capsule was 4.6 mm. Of the patients in Group 2 (with preoperative CHT), 75% (15/20) showed residual cancer nests in the paratumor liver tissue, and the farthest distance was 9.6 mm; three and two cases, respectively, showed extracapsular intravascular microtumorous thrombi.Conclusion: Clinically and pathologically, narrow resection margin is acceptable in hepatoblastoma surgery.

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Section: Discussionmentioning

confidence: 99%

Clinical and Pathological Study of Tumor Border Invasion—Is Narrow Resection Margin Acceptable in Hepatoblastoma Surgery?

Shen

Zhao

et al. 2020

Front. Med.

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“…The 2-year EFS and OS for patients with positive surgical margins were lower than those of their counterparts, but the differences were not statistically significant. The evidence suggested that positive surgical margin might not affect the EFS and OS in the setting of neoadjuvant chemotherapy [20]. However, this might not be true in the setting of primary resection.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of children with hepatoblastoma who underwent liver resection at a tertiary hospital in China: a retrospective analysis

et al. 2020

BMC Pediatr

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Background: To report the outcomes of hepatoblastoma resected in our institution. Methods: We diagnosed 135 children with hepatoblastoma at our institution between January 2010 and December 2017. Patients who underwent liver resection were included for analysis. However, patients who abandoned treatment after diagnosis were excluded from analysis, but their clinical characteristics were provided in the supplementary material. Results: Forty-two patients abandoned treatment, whereas 93 patients underwent liver resection and were included for statistical analysis. Thirty-six, 23, 3, and 31 patients had PRETEXT stages II, III, IV, and unspecified tumours, respectively. Seven patients had ruptured tumour; 9 had lung metastasis (one patient had portal vein thrombosis concurrently). Sixteen patients underwent primary liver resection; 22, 25, and 30 patients received cisplatin-based neoadjuvant chemotherapy and delayed surgery, preoperative transarterial chemoembolization (TACE) and delayed surgery, and a combination of cisplatin-based neoadjuvant chemotherapy, TACE, and delayed surgery, respectively. Forty patients had both PRETEXT and POST-TEXT information available for analysis. Twelve patients were down-staged after preoperative treatment, including 2, 8, and 2 patients from stages IV to III, III to II, and II to I, respectively. Ten patients with unspecified PRETEXT stage were confirmed to have POST-TEXT stages II (n = 8) and I (n = 2) tumours. Seven tumours were associated with positive surgical margins, and 12 patients had microvascular involvement. During a median follow-up period of 30.5 months, 84 patients survived without relapse, 9 experienced tumour recurrence, and 4 died. The 2-year event-free survival (EFS) and overall survival (OS) rates were 89.4 ± 3.4%, and 95.2 ± 2.4%, respectively; they were significantly better among patients without metastasis (no metastasis vs metastasis: EFS, 93.5 ± 3.7% vs 46.7 ± 19.0%, adjusted p = 0.002. OS, 97.6 ± 2.4% vs 61.0 ± 18.1%, adjusted p = 0.005), and similar among patients treated with different preoperative strategies (chemotherapy only vs TACE only vs Both: EFS, 94.7 ± 5.1% vs 91.7 ± 5.6% vs 85.6 ± 6.7%, p = 0.542. OS, 94.1 ± 5.7% vs 95.7 ± 4.3% vs 96.7 ± 3.3%, p = 0.845).

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“…The 2-year EFS and OS for patients with positive surgical margins or microvascular involvement were lower than those of their counterparts, but the differences were not statistically significant. The evidence suggested that positive surgical margin might not affect the EFS and OS in the setting of neoadjuvant chemotherapy (19). However, this might not be true in the setting of primary resection.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of children with hepatoblastoma who underwent liver resection at a tertiary hospital in China: A retrospective analysis

et al. 2020

Preprint

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Objective: To report the outcomes of hepatoblastoma resected in our institution. Methods: We diagnosed 135 children with hepatoblastoma at our institution between January 2010 and December 2017. Patients who underwent liver resection were included for analysis. However, patients who abandoned treatment after diagnosis were excluded from analysis, but their clinical characteristics were provided in the supplementary material. Results: Forty-two patients abandoned treatment, whereas 93 patients underwent liver resection and were included for statistical analysis. Thirty-six, 23, 3, and 31 patients had PRETEXT stages II, III, IV, and unspecified tumours, respectively. Seven patients had ruptured tumour; 9 had lung metastasis (one patient had portal vein thrombosis concurrently). Sixteen patients underwent primary liver resection; 22, 25, and 30 patients received cisplatin-based neoadjuvant chemotherapy and delayed surgery, preoperative transarterial chemoembolization (TACE) and delayed surgery, and a combination of cisplatin-based neoadjuvant chemotherapy, TACE, and delayed surgery, respectively. Forty patients had both PRETEXT and POST-TEXT information available for analysis. Twelve patients were down-staged after preoperative treatment, including 2, 8, and 2 patients from stages IV to III, III to II, and II to I, respectively. Ten patients with unspecified PRETEXT stage were confirmed to have POST-TEXT stages II (n=8) and I (n=2) tumours. Seven tumours were associated with positive surgical margins, and 12 patients had microvascular involvement. During a median follow-up period of 30.5 months, 84 patients survived without relapse, 9 experienced tumour recurrence, and 4 died. The 2-year event-free survival (EFS) and overall survival (OS) rates were 89.4±3.4%, and 95.2±2.4%, respectively; they were significantly better among patients without metastasis (no metastasis vs metastasis: EFS, 93.5±3.7% vs 46.7±19.0%, adjusted p =0.004. OS, 97.6±2.4% vs 61.0±18.1%, adjusted p =0.003), and similar among patients treated with different preoperative strategies (chemotherapy only vs TACE only vs Both: EFS, 94.7±5.1% vs 91.7±5.6% vs 85.6±6.7%, p =0.542. OS, 94.1±5.7% vs 95.7±4.3% vs 96.7±3.3%, p =0.845). Conclusion: The OS for patients with hepatoblastoma who underwent liver resection was satisfactory. Neoadjuvant chemotherapy and TACE seemed to have a similar effect on OS. However, the abandonment of treatment by patients with hepatoblastoma was common, and may have biased our results.

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Results of surgical resections with positive margins for children with hepatoblastoma: Case series from a single Asian center

Cited by 15 publications

References 18 publications

Clinical and Pathological Study of Tumor Border Invasion—Is Narrow Resection Margin Acceptable in Hepatoblastoma Surgery?

Clinical and Pathological Study of Tumor Border Invasion—Is Narrow Resection Margin Acceptable in Hepatoblastoma Surgery?

Outcomes of children with hepatoblastoma who underwent liver resection at a tertiary hospital in China: a retrospective analysis

Outcomes of children with hepatoblastoma who underwent liver resection at a tertiary hospital in China: A retrospective analysis

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