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Prognostic implications of serum alpha-fetoprotein response during treatment of hepatoblastoma
Background We evaluated the outcomes and prognostic factors, especially serum levels of alpha‐fetoprotein (AFP) and their changes during the treatment of hepatoblastoma (HB). Procedure We retrospectively analyzed the medical records of 43 consecutive children with HB treated at a single institution...
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| Published in: | Pediatric blood & cancer 2011-10, Vol.57 (4), p.554-560 |
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| Main Authors: | , , , , , , |
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| container_end_page | 560 |
| container_issue | 4 |
| container_start_page | 554 |
| container_title | Pediatric blood & cancer |
| container_volume | 57 |
| creator | Koh, Kyung Nam Park, Meerim Kim, Bo Eun Bae, Keun Wook Kim, Kyung Mo Im, Ho Joon Seo, Jong Jin |
| description | Background
We evaluated the outcomes and prognostic factors, especially serum levels of alpha‐fetoprotein (AFP) and their changes during the treatment of hepatoblastoma (HB).
Procedure
We retrospectively analyzed the medical records of 43 consecutive children with HB treated at a single institution between 1991 and 2010.
Results
Of 43 patients, 5 (12%) underwent primary tumor resection at diagnosis and 38 (88%) received preoperative chemotherapy. Of those 38 patients, 7 (16%) died of progressive disease during preoperative chemotherapy, and 31 (72%) underwent curative operations, including 5 who underwent liver transplantation, after a median 4 cycles of chemotherapy (range, 3–14 cycles). The 5‐year overall survival and disease‐free survival rates were 62.1 ± 8.3% and 65.6 ± 7.6%, respectively. AFP >263,000 ng/mL at diagnosis, a decline of |
| doi_str_mv | 10.1002/pbc.23069 |
| format | article |
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We evaluated the outcomes and prognostic factors, especially serum levels of alpha‐fetoprotein (AFP) and their changes during the treatment of hepatoblastoma (HB).
Procedure
We retrospectively analyzed the medical records of 43 consecutive children with HB treated at a single institution between 1991 and 2010.
Results
Of 43 patients, 5 (12%) underwent primary tumor resection at diagnosis and 38 (88%) received preoperative chemotherapy. Of those 38 patients, 7 (16%) died of progressive disease during preoperative chemotherapy, and 31 (72%) underwent curative operations, including 5 who underwent liver transplantation, after a median 4 cycles of chemotherapy (range, 3–14 cycles). The 5‐year overall survival and disease‐free survival rates were 62.1 ± 8.3% and 65.6 ± 7.6%, respectively. AFP >263,000 ng/mL at diagnosis, a decline of <1 log in AFP levels after the first cycle of chemotherapy, preoperative AFP levels in the highest tertile, and postoperative AFP levels in the highest tertiles were significantly associated with treatment failure. Age younger than 1 year at diagnosis, thrombocytosis at diagnosis, and early PRETEXT (pretreatment extent of disease) stage were significantly associated with better survival outcomes, whereas gender and metastasis were not. Multivariate analysis showed that high level of preoperative AFP was an independent predictor of treatment failure.
Conclusions
Serial monitoring of changes in AFP levels during the treatment, especially perioperative changes, may help identify favorable and poor responders to chemotherapy. Alternative treatment, such as liver transplantation, should be considered for poor responders. Pediatr Blood Cancer 2011; 57: 554–560. © 2011 Wiley‐Liss, Inc.</description><identifier>ISSN: 1545-5009</identifier><identifier>EISSN: 1545-5017</identifier><identifier>DOI: 10.1002/pbc.23069</identifier><identifier>PMID: 21370433</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Adolescent ; Age Factors ; alpha-fetoprotein ; alpha-Fetoproteins - analysis ; Antineoplastic Agents - administration & dosage ; Area Under Curve ; Biomarkers, Tumor - blood ; Chemotherapy, Adjuvant ; Child ; Child, Preschool ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Hepatectomy ; hepatoblastoma ; Hepatoblastoma - blood ; Hepatoblastoma - therapy ; Humans ; Infant ; Kaplan-Meier Estimate ; Liver Neoplasms - blood ; Liver Neoplasms - therapy ; liver transplantation ; Male ; Neoadjuvant Therapy ; Prognosis ; prognostic factors ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity ; Treatment Outcome ; Young Adult</subject><ispartof>Pediatric blood & cancer, 2011-10, Vol.57 (4), p.554-560</ispartof><rights>Copyright © 2011 Wiley‐Liss, Inc.</rights><rights>Copyright © 2011 Wiley-Liss, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3629-da24dd135036de8795d2a269df592d94e0d061d21c3736abfa109ecefc63bb7c3</citedby><cites>FETCH-LOGICAL-c3629-da24dd135036de8795d2a269df592d94e0d061d21c3736abfa109ecefc63bb7c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21370433$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Koh, Kyung Nam</creatorcontrib><creatorcontrib>Park, Meerim</creatorcontrib><creatorcontrib>Kim, Bo Eun</creatorcontrib><creatorcontrib>Bae, Keun Wook</creatorcontrib><creatorcontrib>Kim, Kyung Mo</creatorcontrib><creatorcontrib>Im, Ho Joon</creatorcontrib><creatorcontrib>Seo, Jong Jin</creatorcontrib><title>Prognostic implications of serum alpha-fetoprotein response during treatment of hepatoblastoma</title><title>Pediatric blood & cancer</title><addtitle>Pediatr. Blood Cancer</addtitle><description>Background
We evaluated the outcomes and prognostic factors, especially serum levels of alpha‐fetoprotein (AFP) and their changes during the treatment of hepatoblastoma (HB).
Procedure
We retrospectively analyzed the medical records of 43 consecutive children with HB treated at a single institution between 1991 and 2010.
Results
Of 43 patients, 5 (12%) underwent primary tumor resection at diagnosis and 38 (88%) received preoperative chemotherapy. Of those 38 patients, 7 (16%) died of progressive disease during preoperative chemotherapy, and 31 (72%) underwent curative operations, including 5 who underwent liver transplantation, after a median 4 cycles of chemotherapy (range, 3–14 cycles). The 5‐year overall survival and disease‐free survival rates were 62.1 ± 8.3% and 65.6 ± 7.6%, respectively. AFP >263,000 ng/mL at diagnosis, a decline of <1 log in AFP levels after the first cycle of chemotherapy, preoperative AFP levels in the highest tertile, and postoperative AFP levels in the highest tertiles were significantly associated with treatment failure. Age younger than 1 year at diagnosis, thrombocytosis at diagnosis, and early PRETEXT (pretreatment extent of disease) stage were significantly associated with better survival outcomes, whereas gender and metastasis were not. Multivariate analysis showed that high level of preoperative AFP was an independent predictor of treatment failure.
Conclusions
Serial monitoring of changes in AFP levels during the treatment, especially perioperative changes, may help identify favorable and poor responders to chemotherapy. Alternative treatment, such as liver transplantation, should be considered for poor responders. Pediatr Blood Cancer 2011; 57: 554–560. © 2011 Wiley‐Liss, Inc.</description><subject>Adolescent</subject><subject>Age Factors</subject><subject>alpha-fetoprotein</subject><subject>alpha-Fetoproteins - analysis</subject><subject>Antineoplastic Agents - administration & dosage</subject><subject>Area Under Curve</subject><subject>Biomarkers, Tumor - blood</subject><subject>Chemotherapy, Adjuvant</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Combined Modality Therapy</subject><subject>Disease-Free Survival</subject><subject>Female</subject><subject>Hepatectomy</subject><subject>hepatoblastoma</subject><subject>Hepatoblastoma - blood</subject><subject>Hepatoblastoma - therapy</subject><subject>Humans</subject><subject>Infant</subject><subject>Kaplan-Meier Estimate</subject><subject>Liver Neoplasms - blood</subject><subject>Liver Neoplasms - therapy</subject><subject>liver transplantation</subject><subject>Male</subject><subject>Neoadjuvant Therapy</subject><subject>Prognosis</subject><subject>prognostic factors</subject><subject>Retrospective Studies</subject><subject>ROC Curve</subject><subject>Sensitivity and Specificity</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>1545-5009</issn><issn>1545-5017</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNp1kEtP3DAURi1UxHvRP1BlV3UR8CN24mU7Ki-NKCqtkLqo5dg3M26TONiOgH9PhmFmx8p3cb4j6yD0keBTgjE9G2pzShkWcgcdEF7wnGNSftjeWO6jwxj_TajAvNpD-5SwEheMHaC_t8Eveh-TM5nrhtYZnZzvY-abLEIYu0y3w1LnDSQ_BJ_A9VmAOEwIZHYMrl9kKYBOHfRpNVrCoJOvWx2T7_Qx2m10G-Hk7T1Cv8-__5pd5vMfF1ezr_PcMEFlbjUtrCWMYyYsVKXklmoqpG24pFYWgC0WxFJiWMmErhtNsAQDjRGsrkvDjtDntXf648MIManORQNtq3vwY1RVRXFVYi4n8suaNMHHGKBRQ3CdDs-KYLWqqaaa6rXmxH56s451B3ZLbvJNwNkaeHQtPL9vUrffZhtlvl64mOBpu9DhvxIlK7m6v7lQc3YnflbXhfrDXgCvCo_J</recordid><startdate>201110</startdate><enddate>201110</enddate><creator>Koh, Kyung Nam</creator><creator>Park, Meerim</creator><creator>Kim, Bo Eun</creator><creator>Bae, Keun Wook</creator><creator>Kim, Kyung Mo</creator><creator>Im, Ho Joon</creator><creator>Seo, Jong Jin</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201110</creationdate><title>Prognostic implications of serum alpha-fetoprotein response during treatment of hepatoblastoma</title><author>Koh, Kyung Nam ; Park, Meerim ; Kim, Bo Eun ; Bae, Keun Wook ; Kim, Kyung Mo ; Im, Ho Joon ; Seo, Jong Jin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3629-da24dd135036de8795d2a269df592d94e0d061d21c3736abfa109ecefc63bb7c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Adolescent</topic><topic>Age Factors</topic><topic>alpha-fetoprotein</topic><topic>alpha-Fetoproteins - analysis</topic><topic>Antineoplastic Agents - administration & dosage</topic><topic>Area Under Curve</topic><topic>Biomarkers, Tumor - blood</topic><topic>Chemotherapy, Adjuvant</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Combined Modality Therapy</topic><topic>Disease-Free Survival</topic><topic>Female</topic><topic>Hepatectomy</topic><topic>hepatoblastoma</topic><topic>Hepatoblastoma - blood</topic><topic>Hepatoblastoma - therapy</topic><topic>Humans</topic><topic>Infant</topic><topic>Kaplan-Meier Estimate</topic><topic>Liver Neoplasms - blood</topic><topic>Liver Neoplasms - therapy</topic><topic>liver transplantation</topic><topic>Male</topic><topic>Neoadjuvant Therapy</topic><topic>Prognosis</topic><topic>prognostic factors</topic><topic>Retrospective Studies</topic><topic>ROC Curve</topic><topic>Sensitivity and Specificity</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Koh, Kyung Nam</creatorcontrib><creatorcontrib>Park, Meerim</creatorcontrib><creatorcontrib>Kim, Bo Eun</creatorcontrib><creatorcontrib>Bae, Keun Wook</creatorcontrib><creatorcontrib>Kim, Kyung Mo</creatorcontrib><creatorcontrib>Im, Ho Joon</creatorcontrib><creatorcontrib>Seo, Jong Jin</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric blood & cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Koh, Kyung Nam</au><au>Park, Meerim</au><au>Kim, Bo Eun</au><au>Bae, Keun Wook</au><au>Kim, Kyung Mo</au><au>Im, Ho Joon</au><au>Seo, Jong Jin</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prognostic implications of serum alpha-fetoprotein response during treatment of hepatoblastoma</atitle><jtitle>Pediatric blood & cancer</jtitle><addtitle>Pediatr. Blood Cancer</addtitle><date>2011-10</date><risdate>2011</risdate><volume>57</volume><issue>4</issue><spage>554</spage><epage>560</epage><pages>554-560</pages><issn>1545-5009</issn><eissn>1545-5017</eissn><abstract>Background
We evaluated the outcomes and prognostic factors, especially serum levels of alpha‐fetoprotein (AFP) and their changes during the treatment of hepatoblastoma (HB).
Procedure
We retrospectively analyzed the medical records of 43 consecutive children with HB treated at a single institution between 1991 and 2010.
Results
Of 43 patients, 5 (12%) underwent primary tumor resection at diagnosis and 38 (88%) received preoperative chemotherapy. Of those 38 patients, 7 (16%) died of progressive disease during preoperative chemotherapy, and 31 (72%) underwent curative operations, including 5 who underwent liver transplantation, after a median 4 cycles of chemotherapy (range, 3–14 cycles). The 5‐year overall survival and disease‐free survival rates were 62.1 ± 8.3% and 65.6 ± 7.6%, respectively. AFP >263,000 ng/mL at diagnosis, a decline of <1 log in AFP levels after the first cycle of chemotherapy, preoperative AFP levels in the highest tertile, and postoperative AFP levels in the highest tertiles were significantly associated with treatment failure. Age younger than 1 year at diagnosis, thrombocytosis at diagnosis, and early PRETEXT (pretreatment extent of disease) stage were significantly associated with better survival outcomes, whereas gender and metastasis were not. Multivariate analysis showed that high level of preoperative AFP was an independent predictor of treatment failure.
Conclusions
Serial monitoring of changes in AFP levels during the treatment, especially perioperative changes, may help identify favorable and poor responders to chemotherapy. Alternative treatment, such as liver transplantation, should be considered for poor responders. Pediatr Blood Cancer 2011; 57: 554–560. © 2011 Wiley‐Liss, Inc.</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>21370433</pmid><doi>10.1002/pbc.23069</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Age Factors alpha-fetoprotein alpha-Fetoproteins - analysis Antineoplastic Agents - administration & dosage Area Under Curve Biomarkers, Tumor - blood Chemotherapy, Adjuvant Child Child, Preschool Combined Modality Therapy Disease-Free Survival Female Hepatectomy hepatoblastoma Hepatoblastoma - blood Hepatoblastoma - therapy Humans Infant Kaplan-Meier Estimate Liver Neoplasms - blood Liver Neoplasms - therapy liver transplantation Male Neoadjuvant Therapy Prognosis prognostic factors Retrospective Studies ROC Curve Sensitivity and Specificity Treatment Outcome Young Adult |
| title | Prognostic implications of serum alpha-fetoprotein response during treatment of hepatoblastoma |
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