Li Zhuo,Cheng Lin,Han Lulu,et al.Treatment decision-making and short-term outcomes for hepatoblastoma based upon tumor volume proportion[J].Journal of Clinical Pediatric Surgery,,():355-359.[doi:10.3760/cma.j.cn101785-202507010]
Treatment decision-making and short-term outcomes for hepatoblastoma based upon tumor volume proportion
- Keywords:
- Hepatoblastoma; Tumor Burden; Chemotherapy; Adjuvant; Imaging; Three-Dimensional; Treatment Outcome; Child
- Abstract:
- Objective To explore the timing of surgery and treatment strategies for hepatoblastoma (HB) children with varying tumor volume proportions through examining the correlation between tumor size and treatment selection,thereby providing evidence for optimizing clinical decision-making.Methods For this retrospective case series study,the relevant clinical data were collected from 59 HB children between January 2014 and December 2024.All of them underwent Hisense CAS three-dimensional reconstruction at various stages of pre-initial treatment,post-initial treatment and post-revision surgery.Tumor and normal liver volumes were measured at multiple stages (pre-initial treatment,post-chemotherapy & post-surgery) using Hisense CAS three-dimensional reconstruction CT imaging data.Tumor volume proportion was calculated as[tumor volume/(normal liver volume + tumor volume)×100%].They were categorized into two groups based upon tumor volume proportion: <50% as small volume proportion group (n=27) while ≥50% as large volume proportion group (n=32).Perioperative indicators were compared between direct surgery and preoperative neoadjuvant chemotherapy within each group,including: intraoperative volume of blood loss,postoperative recovery time and residual liver ratio.Results All procedures were uneventful without intraoperative complications.Within small volume group: Intraoperative volume of blood loss was significantly lower in direct surgery group than that in preoperative chemotherapy group[8.50(6.00,17.50) vs.20.00(10.00,60.00)mL](P=0.014).However,postoperative recovery time (P=0.388) and remaining liver volume ratio (P=0.396) showed no statistically significant differences.Within large-volume proportion group,direct surgery (n=10) and preoperative chemotherapy (n=22) were performed; Residual liver volume in children on preoperative chemotherapy was significantly higher than that in those undergoing direct surgery[89.25(84.42,93.33)% vs.80.91(77.24,84.93)%](P=0.004); Postoperative recovery time for children on preoperative chemotherapy was also significantly shorter than that for those undergoing direct surgery[7.00(6.00,9.08) vs.9.00(7.08,11.83) day](P=0.037).However,no statistically significant difference existed in intraoperative volume of blood loss (P=0.194).Conclusions Both approaches have demonstrated favorable outcomes for hepatoblastoma.For children with smaller tumor-to-liver ratios,direct surgery resulted in lower intraoperative blood loss.For those with larger tumor-to-liver ratios,preoperative chemotherapy boosted the proportion of residual liver and shortened postoperative recovery time.However,further clinical studies are required for confirming these findings.
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Memo
收稿日期:2025-7-5。
基金项目:泰山学者攀登专家项目(tspd20240820);国家杰出医师项目(qyfy5080)
通讯作者:陈鑫,Email:m15506399877@163.com;董蒨,Email:qdupediatrsurg@163.com