Finegold Milton J
Department of Pathology, Texas Children's Hospital, Houston, Texas 77030, USA.
Med Pediatr Oncol. 2002 Nov;39(5):484-6. doi: 10.1002/mpo.10172.
US and European practices differ with respect to treating hepatoblastoma (HB). Should chemotherapy be given prior to resection in all cases, and even without biopsy confirmation (SIOPEL)?
US data indicate that 40% of HBs are primarily resectable with no operative mortality and that those with pure fetal histology and low mitotic rate do not require toxic chemotherapy. They also suggest that those with a significant fraction of small undifferentiated cells do not respond to otherwise effective chemotherapy. Both US and European studies report a significant error rate in the clinical and imaging diagnosis of HB.
Although only 6.5% of confirmed HBs fall into categories that would be managed differently by US standards, there is no justification for denying those patients a more appropriate treatment nor should the 6-10% of cases that are misdiagnosed as HB be treated incorrectly.
美国和欧洲在治疗肝母细胞瘤（HB）方面的做法存在差异。所有病例是否都应在切除术前进行化疗，甚至在没有活检确诊的情况下（国际小儿肝肿瘤协作组方案）？
美国的数据表明，40%的肝母细胞瘤可直接切除，手术死亡率为零，且那些具有纯胎儿组织学特征和低有丝分裂率的病例无需进行毒性化疗。数据还表明，那些含有大量小的未分化细胞的病例对其他有效的化疗无反应。美国和欧洲的研究均报告了肝母细胞瘤临床和影像学诊断中的显著错误率。
尽管只有6.5%经确诊的肝母细胞瘤病例属于按照美国标准会有不同处理方式的类别，但没有理由拒绝给予这些患者更合适的治疗，同样，也不应错误治疗那些被误诊为肝母细胞瘤的6%至10%的病例。
