Clinical Prognostic Factors In Childhood Hepatoblastoma

OBJECTIVE: In this paper,we use the statistical analysis of the clinical data collected from the cases of hepatoblastoma to discuss the following three parts: 1)Prognosis factors of hepatoblastoma before treatment.2)Prognosis factors of hepatoblastoma after chemotherapy.3)The timing of different surgical procedures,and the effect of neoadjuvant chemotherapy and preoperative interventional therapyMETHODS: A total of 70 patients were enrolled in clinical data.The overall survival time of children and the event free survival time were investigated by Kaplan-Meier method.Survival curves between the groups were examined by log-rank method.Cox regression analysis was used to analyze multivariate analysis.RESULTS: It was found that age less than 3 years old and lung metastasis were independent risk factors for overall survival.In addition,PRETEXT III,IV also has a correlation for event free survival.The distance between the tumor and the confluence of hepatic veins was the independent factor affecting the survival rate(p=0.037).After the 4th chemotherapy,the distance from the border of the tumor to the portal vein bifurcation and the confluence of hepatic veins were larger than that of the 2nd chemotherapy,and the difference was significant(p=0.001).For the patients who were not sensitive to the previous two chemotherapies,the distance from the border of the tumor to the portal vein bifurcation after the 4th chemotherapy was larger than that after the 2nd chemotherapy,but the difference was not statistically significant(p=0.109).The distance from the border of the tumor to the confluence of hepatic veins was larger than that of the 2nd chemotherapy after the 4th chemotherapy,and the difference was statistically significant(p=0.04).In 6 cases,the tumor was difficult to be resected,the number of chemotherapy was increased and the hepatic arterial chemoembolization was used.There was no significant difference in the maximum diameter of the tumor,the distance from the edge of the tumor to the portal vein and the confluence of the hepatic veins,before and after hepatic arterial chemoembolization.CONCLUSIONS: This study identifies age,PRETEXT stage,lung metastasis,multifocal,and pathological types as important prognostic factors.The independent risk factors after neoadjuvant chemotherapy are the distance between the tumor and the confluence of the hepatic veins.For the patients in the low risk group,the tumor can be resected directly,and the preoperative chemotherapy is not needed.The increase in the number of chemotherapy can reduce tumor volume,increase the distance between the tumor and the major blood vessels,and for those still close to the confluence of hepatic vein and portal vein after 2nd chemotherapy,increasing the number of chemotherapy only makes the tumor away from hepatic vein,while do little effect to the distance between tumor to the portal vein has.In refractory tumor,whether to use the hepatic arterial chemoembolization has no significant on reducing the difficulty of surgery.