| Purpose: Analyzed the difference between the effect of different therapy for hepatoblastoma in children. Dicussed the treatment experience for hepatoblastoma in children.Methods:(1)Retrospect analyzed clinical data of 109 children with hepatoblastoma who had been treated at Children’s Hospital affiliated to Chongqing Medical University during the time period between 2005 and 2015, exclude the cases without confirming by pathological examination and giving up treatment directly. All of the cases were separated based on the staging standard of PRETEXT.(2)The cases of staging III and IV were divided into three groups, including the group of HIFU treatment after chemotherapy, the group of open operation after chemotherapy and the group of operation without chemotherapy.(3)Analyze the level of blood AFP in different therapy. The cases in the group of HIFU treatment after chemotherapy were compared with cases in the group of open operation after chemotherapy, and cases in the group of operation without chemotherapy were compared with cases in the group of open operation after chemotherapy.(4)The follow-up data was collected by telephone and outpatient, beginning after visited the doctor in the first time, until December 2015 or the time of the children dead.(5) The data were analyzed with chi-square test by the SPSS20.0 statistics software if the data meet the condition, otherwise we used Fisher’s chi-square test, and defined the significance test level as α=0.05. Calculated the survival rate of the cases with life table method.Result:(1)There were 75 cases of male and 34 cases of female in total. The sexual ratio was about 2.2:1.The age ranged from 24 days to 12 years and 11 months. The median age was 1 year and 3 months. A part of the cases accepted the operation without chemotherapy, including 3 cases of staging I and 4 cases of staging II. The staging III inclued 43 cases, in which 6 cases accepted HIFU treatment after chemotherapy, 19 cases accepted operation after chemotherapy and 8 cases accepted the operation without chemotherapy. The staging IV inclued 57 cases, in which 7 cases accepted HIFU treatment after chemotherapy, 18 cases accepted operation after chemotherapy and 4 cases accepted the operation without chemotherapy.(2)There were 13 cases accepted HIFU treatment after chemotherapy and 37 cases accepted operation after chemotherapy and 19 cases accepted the operation without chemotherapy in total. 40 cases didn’t finish the treatment, in which 18 cases were interrupted after diagnosis and 22 cases were interrupted during the period of chemotherapy. The group of HIFU treatment after chemotherapy contained 13 cases. The group of operation after chemotherapy contained 37 cases. And the group of operation without chemotherapy contained 12 cases.(3)Analyzed the blood AFP after the operation. There was no difference between the group of HIFU treatment after chemotherapy and the group of operation after chemotherapy in the first(p=0.719, p>0.05) and second(p=0.077,p>0.05)month after operation. In the same place, there was also no difference between the group of operation after chemotherapy and the group of operation without chemotherapy in the first(p=0.285, p>0.05) and second(p=0.674,p>0.05)month after operation.(4)Followed-up the cases for 1 month to 9 years and 4 months. There were 53 cases alive, 11 cases dead and 5 cases lost in total. And the 1-, 2- and 3-year survival rates were 93.0%, 79.2% and 72.0%. In these cases, the cases of staging I-II completed the treatment and survived in whole. The percentage of survival was 100%.(5)In the group of HIFU treatment after chemotherapy, there were 11 cases survived, 2 cases dead and 0 case lost. The 1-, 2- and 3-year survival rates were 92.1%, 83.3% and 83.3%. In the group of operation after chemotherapy, there were 28 cases survived, 6 cases dead and 3 cases lost. The 1-, 2- and 3-year survival rates were 92.0%, 75.5% and 64.1%. In the group of operation without chemotherapy, there were 7 cases survived, 3 cases dead and 2 cases lost. The 1-, 2- and 3-year survival rates were 91.4%, 72.7% and 56.7%.(6) Analyzed the survival rates after the operation. There was no difference between the group of HIFU treatment after chemotherapy and the group of operation after chemotherapy(p=0.722、0.261、0.091,p>0.05). There was also no difference between the group of operation after chemotherapy and the group of operation without chemotherapy(p=0.747、0.572、0.627,p>0.05).Conclusions:(1)Male patients were more common for children with hepatoblastoma, and the age was concentrated before 3 years old. Most children who accepted standard treatment could survive, and the 5-year survival rate could reach to 70%. 2 years after the first diagnosis is the most dangerous period for children with hepatoblastoma.(2)For children with hepatoblastoma in staging III-IV, there was no significant difference between different therapy in the serum of AFP after the operation, so we could not judge the effect only with the decrease of the serum AFP after the operation.(3)Both of the HIFU treatment after chemotherapy and operation after chemotherapy were reliable for hepatoblastoma in children. Neoadjuvant chemotherapy could improve the prognosis for children with hepatoblastoma. There was no significant difference between different therapy in survival rates. Medical workers should choose the individual therapy for children with hepatoblastoma according to the condition of the children. |
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