小儿肝母细胞瘤患者放射学参数与生存结局之间关联的评估。
An evaluation of the association between radiological parameters and survival outcomes in pediatric patients with hepatoblastoma.
作者信息
Sirichamratsakul Kulpreeya, Kritsaneepaiboon Supika, Sripornsawan Pornpun, Kanjanapradit Kanet, Laochareonsuk Wison, Sangkhathat Surasak
机构信息
Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
出版信息
Pediatr Surg Int. 2022 Nov;38(11):1591-1600. doi: 10.1007/s00383-022-05208-w. Epub 2022 Sep 12.
BACKGROUND
We evaluated the survival outcomes following hepatic resection as a treatment modality in pediatric patients with hepatoblastoma at a single institution, and to identify radiological parameters associated with poorer survival outcomes.
METHODS
This was a retrospective cohort study. Medical records were reviewed, pertaining to pediatric patients diagnosed with hepatoblastoma who underwent surgical resection at a university hospital in Thailand between 2004 and 2021. Radiological parameters, clinical factors, and pathological data were also collected. Survival analysis was performed, and prognostic factors were identified using logistic regression analysis.
RESULTS
Forty-two suitable patients were identified. Three cases with incomplete data were excluded, resulting in 39 cases being analyzed. Except for two, all patients received preoperative chemotherapy following the Thai Pediatric Oncology Group regimen. The two- and five-year overall survival rates were 78.0% and 70.9%, respectively. Upon analysis, the radiological parameters associated with poorer survival were poor response to neoadjuvant chemotherapy, presence of metastasis, post-chemotherapy tumor diameter, Post treatment extent of disease (POSTTEXT) Stage IV disease, presence of portal vein involvement, and presence of residual disease; poor neoadjuvant-response, portal vein involvement, and metastasis were independently associated with worse outcomes. In patients with non-metastatic hepatoblastoma who had at least a 25% reduction in size following neoadjuvant chemotherapy, the 5-year survival rate was 90.9% (95% CI 50.8-98.6%).
CONCLUSIONS
Although preoperative evaluation of the tumor extent staging did not significantly affect survival, portal vein involvement as per POSTTEXT staging, stable or increasing tumor size, and metastasis following neoadjuvant chemotherapy were associated with poor overall survival.
LEVEL OF EVIDENCE
IIB.
背景
我们评估了在单一机构中，肝切除术作为小儿肝母细胞瘤治疗方式后的生存结果，并确定与较差生存结果相关的放射学参数。
方法
这是一项回顾性队列研究。回顾了泰国一家大学医院2004年至2021年间诊断为肝母细胞瘤并接受手术切除的小儿患者的病历。还收集了放射学参数、临床因素和病理数据。进行了生存分析，并使用逻辑回归分析确定预后因素。
结果
确定了42例合适的患者。排除3例数据不完整的病例，最终分析39例。除2例患者外，所有患者均按照泰国儿科肿瘤学组方案接受术前化疗。两年和五年总生存率分别为78.0%和70.9%。经分析，与较差生存相关的放射学参数包括新辅助化疗反应差、存在转移、化疗后肿瘤直径、治疗后疾病范围（POSTTEXT）IV期疾病、存在门静脉受累和存在残留疾病；新辅助化疗反应差、门静脉受累和转移与较差结局独立相关。在新辅助化疗后肿瘤大小至少缩小25%的非转移性肝母细胞瘤患者中，5年生存率为90.9%（95%CI 50.8-98.6%）。
结论
尽管术前对肿瘤范围分期的评估对生存没有显著影响，但根据POSTTEXT分期的门静脉受累、肿瘤大小稳定或增加以及新辅助化疗后转移与总体生存较差相关。
证据级别
IIB。
Zotero 插件