Huang Sihan, Lin Yaobin, Liu Shan, Shang Jin, Wang Zhihong
Department of Hematology-Oncology, Fujian Children's Hospital, College of Clinical Medicine for Obstetrics and Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.
Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.
Heliyon. 2024 Jul 11;10(14):e34510. doi: 10.1016/j.heliyon.2024.e34510. eCollection 2024 Jul 30.
The prognosis of patients with hepatoblastoma has been unsatisfactory. This study analyzed the effects of different treatment methods on cancer-specific survival (CSS) in children with hepatoblastoma.
From 2000 to 2018, patients with hepatoblastoma were included in the Surveillance, Epidemiology, and End Results (SEER) database. CSS was estimated using the Kaplan-Meier method. Cox regression analysis assessed prognostic factors. The predictive models were validated using the concordance index (C-index), calibration curve and receiver operating characteristic (ROC) curve.
Of the 785 included patients, 730 (93.0 %) underwent chemotherapy, 516 (65.7 %) underwent liver tumour resection and 129 (16.4 %) underwent liver transplantation. Both chemotherapy and surgery could significantly improve the CSS rate (all < 0.001). However, there was no difference in CSS rate between the two surgical methods (liver tumour resection and liver transplantation) ( = 0.613). Further subgroup analysis revealed that children who underwent liver tumour resection or liver transplantation based on chemotherapy (all > 0.05) had a similar prognosis. Multivariate analysis revealed that age ( = 0.003), race ( = 0.001), operative method ( < 0.001), chemotherapy ( < 0.001), distant metastasis ( < 0.001) and tumour size ( < 0.001) were independent factors related to CSS. The C-index of the new nomogram was 0.759, and its consistency was good. The ROC curves verified that the nomogram had a better prediction ability for 1-, 3- and 5-year CSS rates.
In children with hepatoblastoma, there was no statistically significant difference in CSS between chemotherapy combined with liver transplantation and liver tumour resection. The nomogram we constructed demonstrated satisfactory CSS prediction ability.
肝母细胞瘤患者的预后一直不尽人意。本研究分析了不同治疗方法对肝母细胞瘤患儿癌症特异性生存（CSS）的影响。
2000年至2018年，将肝母细胞瘤患者纳入监测、流行病学和最终结果（SEER）数据库。采用Kaplan-Meier法估计CSS。Cox回归分析评估预后因素。使用一致性指数（C-index）、校准曲线和受试者工作特征（ROC）曲线对预测模型进行验证。
纳入的785例患者中，730例（93.0%）接受了化疗，516例（65.7%）接受了肝肿瘤切除术，129例（16.4%）接受了肝移植。化疗和手术均能显著提高CSS率（均P<0.001）。然而，两种手术方法（肝肿瘤切除术和肝移植）的CSS率无差异（P=0.613）。进一步的亚组分析显示，基于化疗接受肝肿瘤切除术或肝移植的儿童（均P>0.05）预后相似。多因素分析显示，年龄（P=0.003）、种族（P=0.001）、手术方式（P<0.001）、化疗（P<0.001）、远处转移（P<0.001）和肿瘤大小（P<0.001）是与CSS相关的独立因素。新列线图的C-index为0.759，一致性良好。ROC曲线验证了列线图对1年、3年和5年CSS率具有较好的预测能力。
在肝母细胞瘤患儿中，化疗联合肝移植与肝肿瘤切除术的CSS无统计学显著差异。我们构建的列线图显示出令人满意的CSS预测能力。
