BOB Ped Surg 2023 - Andrew Fleming, AAP - Presentation

Hepatoblastoma is the most common pediatric liver cancer

The number of contiguous hepatic sections uninvolved by tumor can be used radiographically to determine the pre-treatment extent of disease, making the PRETEXT group

PRETEXT group in combination with presence/absence of metastatic disease, alpha fetoprotein at diagnosis, PRETEXT modifiers, patient age and resectability at diagnosis can be used to risk stratify patients according to the AHEAD 1531 clinical trial

Complete surgical resection has been determined to be necessary for patient survival

Cisplatin based chemotherapies have improved rates of resectability and subsequently survival for hepatoblastoma patients

The reported survival benefits of pulmonary metastasectomy for hepatoblastoma have varied in the literature

No evidence of disease is defined as a normal AFP and the absence of detectable radiographic disease on interval surveillance imaging

Among 50 patients included for analysis, 24 were determined to be high risk

All patients received chemotherapy and 41 patients were successfully able to be rendered no evidence of disease status

14 patients underwent a total of 31 pulmonary procedures, having a median of four nodules resected per patient

Median of three nodules per patient contained pathologically confirmed viable hepatoblastoma, confirming a high degree of concordance between radiographic evidence of disease and pathological confirmation of disease

On logistic regression for three-year mortality, only achieving no evidence of disease was associated with a significant decrease in patient mortality

The overall survival of the entire cohort is quite high

The event-free survival is lower than overall survival due to relapse events after achieving no evidence of disease

The overall survival and event-free survival of the group in whom we were unable to render them no evidence of disease is significantly lower, with no patients in these cohorts surviving past two years

The overall survival is similar between high risk and not high risk patients who were able to be rendered no evidence of disease status

The event-free survival remains significantly lower for the high-risk no evidence of disease group due to five high-risk patients who relapsed

Three of five high-risk patients who relapsed were successfully salvaged using a combination of chemotherapy and further pulmonary resections

No evidence of disease status is necessary for survival in patients with hepatoblastoma

Repeated pulmonary metastasectomy and/or complex local control strategies to obtain no evidence of disease benefit high risk patients