Upfront or delayed surgery in resectable hepatoblastoma: analysis from the children's hepatic tumors international collaboration database.
Publication Title
EClinicalMedicine
Document Type
Article
Publication Date
10-1-2024
Keywords
washington; spokane
Abstract
BACKGROUND: 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: 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: 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: The outcomes, surgical resectability, and complications were not significantly different between the UF and DL groups. Eligible patients with a low AFP level (/mL) or older age (≥3 years old) showed better outcomes in the UF group and might be considered for initial resection.
FUNDING: 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.
Clinical Institute
Women & Children
Clinical Institute
Cancer
Specialty/Research Institute
Oncology
Specialty/Research Institute
Pediatrics
Specialty/Research Institute
Hematology
DOI
10.1016/j.eclinm.2024.102811
