| Objective To observe the prognostic factors of radical resection for pediatric hepatoblastoma(HB)and the preliminary pathological study of surgical margin for hepatoblastomaParticipants and methods:From January 2002 to June 2019,a total of 54 cases of hepatoblastoma radical resection in pediatric surgery department of affiliated hospital of Qingdao university were selected.The patients’gender,age,PRETEXT stage,preoperative chemotherapy,tumor resection margin distance,large vascular invasion,distant metastasis,tumor maximum diameter,preoperative AFP and other relevant clinical data were collected.Their postoperative specimens were retained,and pathological sections were prepared for microscopic analysis.R language 3.5.3 software and SPSS26.0 software were used for statistical analysis.Gender,age,clinical stage,etc.Non-normally distributed measurement data such as operation time,intraoperative blood loss,and postoperative hospital stay were expressed as the median(25th percentile to75th percentile),and Mann-Whitney U test was used to compare the differences between groups.The Kaplan-Meier method was used to estimate the survival rate and to plot the survival curve.All statistical tests with P<0.05 indicated that the difference was statistically significant.Results 1.54 patients in the age of 15 months(0～94 months),the male to female ratio is 1.7:1,the age was more than 54 months in 6 cases(11.11%),3 patients with AFP was less than 100μg/L(5.55%),20 patients(37.04%)had main hepatic vessels invasion,5patients with distant metastasis(9.26%),The PRETEXT stage of 15 patients was stage III(27.78%),4 patients with stage IV(7.41%),9 patients with surgery boundary was less than 1 cm(16.67%),There were 5 cases(9.26%)with isolated nests outside the capsule.2.The median follow-up time of patients in this group was 26 months(1～147 months),5-year DFS was 81.3%,5-year OS was 87.4%,2 patients had partial remission(PR) (3.70%),5 patients died(9.26%),and 10 patients lost to follow-up(18.52%).The 5-year OS of patients with surgical margins less than 1 cm was 86.5%,which showed no significant difference compared with 90%of 5-year OS of patients with surgical margins greater than or equal to 1 cm(c2=0.087,P>0.05).The 5-year OS of patients with isolated nests outside the capsule was 88.4%,which was not significantly different from that of84.4%of patients without suspicious nests(c~2=0.404,P>0.05).Statistical analysis showed that the surgical boundary distance and the existence of suspicious isolated nests outside the capsule were not factors affecting the 5-year disease-free survival rate and the overall survival rate.3.The overall survival rate of patients at the age of first diagnosis greater than or equal to54 months was significantly lower than that of patients younger than 54 months(c~2=4.006,P<0.05).Children with serum AFP levels less than 100μg/L had a lower overall survival rate than those with serum AFP levels greater than or equal to 100μg/L(c~2=10.005,P<0.05).The prognosis of children with tumors that invaded the primary branch blood vessels in the liver was worse than that of children who have not violated the primary blood vessels in the liver,and the prognosis of children with extrahepatic metastases was worse than that of children without extrahepatic metastases(c~2=8.588,12.581,P<0.05).4.The median operation time of children undergoing 3D reconstruction assisted surgery by Hisense CAS before surgery(3D reconstruction group)is 125.00(110.00～165.00)min,and the median operation time of the group without 3D reconstruction is 152.50(128.75～202.50)min The median intraoperative blood loss in the three-dimensional reconstruction group was 17.50(10.00～20.00)mL,and the non-three-dimensional reconstruction group was 45.00(20.00～50.00)mL.The difference between the two groups was statistically significant(P<0.05).The median postoperative hospital stay in the reconstruction group was 9.00(8.00-11.00)d,and the group without 3D reconstruction was 12.00(9.00-14.25)d.The difference was statistically significant(P<0.05)5.Conclusion The prognosis of HB radical resection is closely related to age,serum AFP level,presence or absence of vascular invasion and distant metastasis.Surgical margin less than 1cm and suspicious isolated cancer nest outside the tumor boundary do not affect the prognosis and long-term of children with HB Independent factors of survival,the Hisense CAS system can help physicians plan surgery to effectively shorten the treatment time of HB surgery,reduce the amount of intraoperative bleeding,and shorten the postoperative hospital stay. |
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