Navigating relapsed hepatoblastoma: Predictive factors and surgical treatment strategy
Abstract Objective Hepatoblastoma (HB) is the most common primary hepatic malignancy in childhood. Relapse occurs in more than 50% of high‐risk patients with a high mortality due to ineffective salvage therapies. The purpose of this study is to identify risk factors for relapsed HB and predictors of...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-12-01
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| Series: | Cancer Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cam4.6705 |
| _version_ | 1797387098052886528 |
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| author | Andres F. Espinoza Kalyani R. Patel Priya B. Shetty Richard S. Whitlock Pavel Sumazin Xinjian Yu Stephen F. Sarabia Martin Urbicain Andras Heczey Prakash Masand Sarah E. Woodfield Dolores H. López‐Terrada Sanjeev A. Vasudevan |
| author_facet | Andres F. Espinoza Kalyani R. Patel Priya B. Shetty Richard S. Whitlock Pavel Sumazin Xinjian Yu Stephen F. Sarabia Martin Urbicain Andras Heczey Prakash Masand Sarah E. Woodfield Dolores H. López‐Terrada Sanjeev A. Vasudevan |
| author_sort | Andres F. Espinoza |
| collection | DOAJ |
| description | Abstract Objective Hepatoblastoma (HB) is the most common primary hepatic malignancy in childhood. Relapse occurs in more than 50% of high‐risk patients with a high mortality due to ineffective salvage therapies. The purpose of this study is to identify risk factors for relapsed HB and predictors of survival in a single tertiary referral center. Methods A retrospective chart review showed 129 surgically treated HB patients from October 2004 to July 2020. Of the cohort, 22 patients presented with relapsed HB. Relapse was defined as re‐appearance of malignancy after 4 weeks of normalized AFP and disappearance of all tumors on imaging. Results Patients with relapsed HB had a 5‐year overall survival (OS) of 45.4% compared to 93.1% in those without relapse (p = 0.001). When comparing PRETEXT IV, microvascular invasion, metastatic disease, and age on multivariate logistic regression, only PRETEXT IV was an independent risk factor for relapsed HB with an OR of 2.39 (95% CI: 1.16–4.96; p = 0.019). Mixed epithelial and mesenchymal HB (12/19, 63.2%) was the most common histology of primary tumors while pure epithelial HB (13/15, 86.6%) was the most common relapsed histology. Combination of surgical and medical therapy for relapsed disease was predictive of survival with an HR of 16.3 (95% CI: 1.783–149.091; p = 0.013) compared to only chemotherapy. Conclusions This study demonstrates that PRETEXT IV staging is an independent predictor of relapsed disease. The most common relapsed histology was epithelial, suggesting a potential selection or resistance of this component. Surgical resection is a critical component of multimodal therapy for relapsed HB. |
| first_indexed | 2024-03-08T22:18:57Z |
| format | Article |
| id | doaj.art-0c97209ea30843db8d7cf1592b8908cd |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-03-08T22:18:57Z |
| publishDate | 2023-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-0c97209ea30843db8d7cf1592b8908cd2023-12-18T14:43:07ZengWileyCancer Medicine2045-76342023-12-011223212702127810.1002/cam4.6705Navigating relapsed hepatoblastoma: Predictive factors and surgical treatment strategyAndres F. Espinoza0Kalyani R. Patel1Priya B. Shetty2Richard S. Whitlock3Pavel Sumazin4Xinjian Yu5Stephen F. Sarabia6Martin Urbicain7Andras Heczey8Prakash Masand9Sarah E. Woodfield10Dolores H. López‐Terrada11Sanjeev A. Vasudevan12Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Surgical Oncology Program and Liver Tumor Program, Dan L. Duncan Cancer Center Baylor College of Medicine Houston Texas USADepartment of Pathology and Immunology Texas Children's Hospital, Baylor College of Medicine Houston Texas USADepartment of Pediatric Hematology and Oncology Texas Children's Hospital, Baylor College of Medicine Houston Texas USADivision of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Surgical Oncology Program and Liver Tumor Program, Dan L. Duncan Cancer Center Baylor College of Medicine Houston Texas USADepartment of Pediatric Hematology and Oncology Texas Children's Hospital, Baylor College of Medicine Houston Texas USADepartment of Pediatric Hematology and Oncology Texas Children's Hospital, Baylor College of Medicine Houston Texas USADepartment of Pathology and Immunology Texas Children's Hospital, Baylor College of Medicine Houston Texas USADepartment of Pathology and Immunology Texas Children's Hospital, Baylor College of Medicine Houston Texas USADepartment of Pediatric Hematology and Oncology Texas Children's Hospital, Baylor College of Medicine Houston Texas USASingleton Department of Pediatric Radiology Texas Children's Hospital, Baylor College of Medicine Houston Texas USADivision of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Surgical Oncology Program and Liver Tumor Program, Dan L. Duncan Cancer Center Baylor College of Medicine Houston Texas USADepartment of Pathology and Immunology Texas Children's Hospital, Baylor College of Medicine Houston Texas USADivision of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Surgical Oncology Program and Liver Tumor Program, Dan L. Duncan Cancer Center Baylor College of Medicine Houston Texas USAAbstract Objective Hepatoblastoma (HB) is the most common primary hepatic malignancy in childhood. Relapse occurs in more than 50% of high‐risk patients with a high mortality due to ineffective salvage therapies. The purpose of this study is to identify risk factors for relapsed HB and predictors of survival in a single tertiary referral center. Methods A retrospective chart review showed 129 surgically treated HB patients from October 2004 to July 2020. Of the cohort, 22 patients presented with relapsed HB. Relapse was defined as re‐appearance of malignancy after 4 weeks of normalized AFP and disappearance of all tumors on imaging. Results Patients with relapsed HB had a 5‐year overall survival (OS) of 45.4% compared to 93.1% in those without relapse (p = 0.001). When comparing PRETEXT IV, microvascular invasion, metastatic disease, and age on multivariate logistic regression, only PRETEXT IV was an independent risk factor for relapsed HB with an OR of 2.39 (95% CI: 1.16–4.96; p = 0.019). Mixed epithelial and mesenchymal HB (12/19, 63.2%) was the most common histology of primary tumors while pure epithelial HB (13/15, 86.6%) was the most common relapsed histology. Combination of surgical and medical therapy for relapsed disease was predictive of survival with an HR of 16.3 (95% CI: 1.783–149.091; p = 0.013) compared to only chemotherapy. Conclusions This study demonstrates that PRETEXT IV staging is an independent predictor of relapsed disease. The most common relapsed histology was epithelial, suggesting a potential selection or resistance of this component. Surgical resection is a critical component of multimodal therapy for relapsed HB.https://doi.org/10.1002/cam4.6705hepatoblastomapatient‐derived xenograftrelapse |
| spellingShingle | Andres F. Espinoza Kalyani R. Patel Priya B. Shetty Richard S. Whitlock Pavel Sumazin Xinjian Yu Stephen F. Sarabia Martin Urbicain Andras Heczey Prakash Masand Sarah E. Woodfield Dolores H. López‐Terrada Sanjeev A. Vasudevan Navigating relapsed hepatoblastoma: Predictive factors and surgical treatment strategy Cancer Medicine hepatoblastoma patient‐derived xenograft relapse |
| title | Navigating relapsed hepatoblastoma: Predictive factors and surgical treatment strategy |
| title_full | Navigating relapsed hepatoblastoma: Predictive factors and surgical treatment strategy |
| title_fullStr | Navigating relapsed hepatoblastoma: Predictive factors and surgical treatment strategy |
| title_full_unstemmed | Navigating relapsed hepatoblastoma: Predictive factors and surgical treatment strategy |
| title_short | Navigating relapsed hepatoblastoma: Predictive factors and surgical treatment strategy |
| title_sort | navigating relapsed hepatoblastoma predictive factors and surgical treatment strategy |
| topic | hepatoblastoma patient‐derived xenograft relapse |
| url | https://doi.org/10.1002/cam4.6705 |
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