The prognostic evaluation of marginal positive resection in hepatoblastoma: Japanese experience

Abstract

Aim: In the Japanese study group for Pediatric Liver Tumor (JPLT) studies, the survival of patients with hepatoblastoma (HB) was improved by cisplatin/pirarubicin-based chemotherapy with combined surgical resection. We aimed to clarify whether marginal positive resection is correlated with the prognosis of HB patients from the JPLT-2 study (1999-2012).

Methods: Of the 361 JPLT-2 patients, we excluded 4 who died before surgery, 14 inoperable following preoperative chemotherapy, and 6 macroscopically positive resections and analyzed local recurrence and survival rates in 337 patients who underwent primary resection including liver transplantation.

Results: The five-year event-free survival (EFS) and overall survival (OS) rates were 76.0% and 87.7% in patients (n = 312) with complete resection of their primary tumors and 59.1% and 83.0% in those (n = 25) with microscopically margin-positive resection (microMPR), respectively. Among patients without distant metastasis, the five-year EFS and OS rates were 81.4% and 90.8% in those (n = 263) with complete resection vs. 62.5% and 90.9% in those (n = 22) with microMPR, respectively. The EFS, but not OS, was significantly lower (P < 0.05) in patients with microMPR vs. complete resection. The local recurrence rate was significantly different (chi-square = 12.11, P < 0.01) between the two groups.

Conclusion: In patients administered cisplatin/pirarubicin-based chemotherapy, the presence of microMPR influenced local recurrence but not outcome. Advance of liver surgery including LT correlated with improving of resection rates. The presence of microMPR influenced the local recurrence but not the outcome in the JPLT-2 study. The outcome of patients with microMPR might depend on the postoperative treatment and/or tumor biology rather than occurrence of recurrence.

Keywords

Hepatoblastoma / surgical margin / outcome / surgery / chemotherapy / microscopic positive

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