# BOB Ped Surg 2023 - Andrew Fleming, AAP - Presentation — GCMD Library

Watch Andrew Fleming, MD, present his presentation on "Aggressive Pursuit of No Evidence of Disease Status in Hepatoblastoma Improves Survival."

Type: video · posted 2023-02-06 Canonical: https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366 ## Chapters - [0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=0) Introduction and Background on Hepatoblastoma - [2:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=120) Study Rationale and Methods - [4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=240) Results: Patient Cohort and Pulmonary Metastasectomy - [6:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=360) Survival Analysis and Conclusions ## Statements - "Hepatoblastoma is the most common pediatric liver cancer" — Andrew Fleming (epidemiological) [0:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=0) - "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" — Andrew Fleming (clinical) [0:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=30) - "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" — Andrew Fleming (guideline) [1:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=60) - "Complete surgical resection has been determined to be necessary for patient survival" — Andrew Fleming (clinical) [1:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=90) - "Cisplatin based chemotherapies have improved rates of resectability and subsequently survival for hepatoblastoma patients" — Andrew Fleming (clinical) [1:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=105) - "The reported survival benefits of pulmonary metastasectomy for hepatoblastoma have varied in the literature" — Andrew Fleming (epidemiological) [2:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=120) - "No evidence of disease is defined as a normal AFP and the absence of detectable radiographic disease on interval surveillance imaging" — Andrew Fleming (clinical) [3:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=180) - "Among 50 patients included for analysis, 24 were determined to be high risk" — Andrew Fleming (epidemiological) [4:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=240) - "All patients received chemotherapy and 41 patients were successfully able to be rendered no evidence of disease status" — Andrew Fleming (clinical) [4:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=255) - "14 patients underwent a total of 31 pulmonary procedures, having a median of four nodules resected per patient" — Andrew Fleming (clinical) [4:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=270) - "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" — Andrew Fleming (clinical) [5:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=300) - "On logistic regression for three-year mortality, only achieving no evidence of disease was associated with a significant decrease in patient mortality" — Andrew Fleming (clinical) [5:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=330) - "The overall survival of the entire cohort is quite high" — Andrew Fleming (clinical) [6:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=360) - "The event-free survival is lower than overall survival due to relapse events after achieving no evidence of disease" — Andrew Fleming (clinical) [6:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=375) - "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" — Andrew Fleming (clinical) [6:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=390) - "The overall survival is similar between high risk and not high risk patients who were able to be rendered no evidence of disease status" — Andrew Fleming (clinical) [7:00](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=420) - "The event-free survival remains significantly lower for the high-risk no evidence of disease group due to five high-risk patients who relapsed" — Andrew Fleming (clinical) [7:15](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=435) - "Three of five high-risk patients who relapsed were successfully salvaged using a combination of chemotherapy and further pulmonary resections" — Andrew Fleming (clinical) [7:30](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=450) - "No evidence of disease status is necessary for survival in patients with hepatoblastoma" — Andrew Fleming (clinical) [7:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=465) - "Repeated pulmonary metastasectomy and/or complex local control strategies to obtain no evidence of disease benefit high risk patients" — Andrew Fleming (clinical) [7:45](https://library.globalcastmd.com/watch/bob-ped-surg-2023-andrew-fleming-aap-presentation-6366?t=465) --- Not medical advice · citation policy: https://library.globalcastmd.com/ai