Vascular invasion is a prognostic indicator in hepatoblastoma

• Published in: Journal of pediatric surgery 2017-06, Vol.52 (6), p.956-961
• Main Authors: Shi, Yan, Commander, Sarah J, Masand, Prakash M, Heczey, Andras, Goss, John A, Vasudevan, Sanjeev A
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Child, Preschool; Female; Follow-Up Studies; Hepatoblastoma; Hepatoblastoma - diagnosis; Hepatoblastoma - mortality; Hepatoblastoma - pathology; Hepatoblastoma - surgery; Humans; Infant; Infant, Newborn; Liver - blood supply; Liver - pathology; Liver - surgery; Liver Neoplasms - diagnosis; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver resection; Liver Transplantation; Male; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Orthotopic liver transplant; Pediatrics; Prognosis; Retrospective Studies; Surgery; Survival Analysis; Vascular invasion
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2017.03.017

Abstract Introduction The data regarding vascular invasion as a prognostic factor in hepatoblastoma (HB) is conflicted. The purpose of this study is to examine the relationship between vascular invasion and outcomes. Methods This is a retrospective review of patients < 18-years-old who underwent resection for hepatoblastoma from 1998 to 2015. Pathology reports were used to identify patients who had pathologic vascular invasion (VI), and those who did not (NVI). Results Sixty-six children were identified with a median age at diagnosis of 21 months (Interquartile range: 10–33 months). Pathologic vascular invasion was present in 42/66 (64%) patients. A significant difference (p = 0.02) in 3-year overall survival (3YOS) was detected between NVI (95%) and VI (61%). Recurrent disease was present in 8/66 (12%) patients. A marginally significant difference (p = 0.08) was found in 3-year recurrence free survival (3YRFS) between NVI (94%) and the VI (76%) groups. Patients with NVI had no metastatic disease, a lower recurrence rate, universally responded to neoadjuvant chemotherapy, and were less likely to have small cell undifferentiated histology. Twenty-one children underwent orthotopic liver transplant (OLT), with no difference in 3YROS or 3YRFS. Conclusion Pathologic vascular invasion is associated with significantly worse 3YOS in HB, and lack of vascular invasion was associated with more favorable disease characteristics. The presence of pathologic vascular invasion did not confer a worse outcome in patients treated with liver transplantation in this cohort of patients. Level of evidence Type of Study: Retrospective Review, Level III.