Yang Wei,Liu Shan,Ren Qinghua,et al.Hepatectomy for multifocal hepatoblastoma:a single-center report[J].Journal of Clinical Pediatric Surgery,2024,(06):543-549.[doi:10.3760/cma.j.cn101785-202310006-007]
多灶性肝母细胞瘤手术切除的单中心研究
- Title:
- Hepatectomy for multifocal hepatoblastoma:a single-center report
- Keywords:
- Hepatoblastoma; Surgical Procedures; Operative; Treatment Outcome; Clinical Study; Child
- 摘要:
- 目的 探讨多灶性肝母细胞瘤(hepatoblastoma,HB)手术切除治疗的可行性及有效性。 方法 本研究为回顾性研究,以2014年4月至2022年12月首都医科大学附属北京儿童医院肿瘤外科收治的21例多灶性HB患儿为研究对象,收集患儿临床特征、手术方式及远期预后等资料,并与同期收治的58例中高危单灶性HB患儿进行疗效对比。 结果 21例多灶性HB患儿中,11例为2个瘤灶,4例为3个瘤灶,1例为5个瘤灶,5例肝内瘤灶超过5个且无法明确计数。21例均接受肿瘤切除手术,其中9例行解剖性肝切除术,11例行不规则肝切除或瘤灶剜除术,1例行联合肝脏离断及门静脉结扎的分次肝切除术(associating liver partition and portal vein ligation for staged hepatectomy,ALPPS)。20例为R0切除,1例为R1切除,术后无一例发生严重并发症。本组多灶性HB患儿接受手术联合化疗的多学科综合治疗后,中位随访时间57个月,18例患儿无瘤生存,3例死亡。本组多灶性HB患儿3年无事件生存率(event-free survival,EFS)为57.58%,3年总生存率(overall survival,OS)为82.00%,局部进展累积发生率(cumulative incidence of local progression,CILP)为38.00%。同期收治的单灶性中高危HB患儿上述指标分别为91.84%、74.96%、20.04%。两组数据对比,差异无统计学意义(P＞0.05)。 结论 多灶性HB经规范外科手术切除辅助术前、术后化疗,可以获得较为满意的预后。
- Abstract:
- Objective To explore the feasibility and effectiveness of hepatectomy for multifocal hepatoblastoma (HB).Methods A retrospective analysis was conducted for 21 hospital cases of multifocal HB patients from April 2014 to December 2022.Clinical characteristics,surgical procedures and long-term outcomes were collected and compared with 58 cases of unifocal hepatoblastoma patients with intermediate/high-risk group during the same period.Results Among 21 children with multifocal HB,there were 2 tumor foci (n=11),3 tumor foci (n=4) and 5 tumor foci (n=1).Five cases had more than five intrahepatic tumor foci and a definite count was impossible.Tumor resection was anatomical (n=9),irregular (n=11) and combined liver dissection and portal vein ligation for staged hepatectomy (ALPPS,n=1).R0 resection (n=20) and R1 resection (n=1) were performed without serious postoperative complications.After receiving multidisciplinary comprehensive treatment of surgery plus chemotherapy,median follow-up time for multifocal HB was 57 months.The outcomes were disease-free survival (n=18) and death (n=3).The 3-year event free survival (EFS),3-year overall survival (OS) and cumulative incidence of local progression (CILP) in children with multifocal HB were 57.58%,82.00% and 38.00% respectively.The above parameters of single focus intermittent/high-risk HB admitted during the same period were 91.84%,74.96% and 20.04% respectively.No significant statistical difference existed between two datasets.Conclusions For multifocal HB,standardized surgical resection plus perioperative chemotherapy may achieve satisfactory outcomes.It provides an effective treatment for multifocal HB children.
参考文献/References:
[1] Lim IIP,Bondoc AJ,Geller JI,et al.Hepatoblastoma-the evolution of biology,surgery,and transplantation[J].Children (Basel),2018,6(1):1.DOI:10.3390/children6010001.
[2] Feng JC,Polychronidis G,Heger U,et al.Incidence trends and survival prediction of hepatoblastoma in children:a population-based study[J].Cancer Commun (Lond),2019,39(1):62.DOI:10.1186/s40880-019-0411-7.
[3] Czauderna P,Haeberle B,Hiyama E,et al.The children’s hepatic tumors international collaboration (CHIC):novel global rare tumor database yields new prognostic factors in hepatoblastoma and becomes a research model[J].Eur J Cancer,2016,52:92-101.DOI:10.1016/j.ejca.2015.09.023.
[4] Semeraro M,Branchereau S,Maibach R,et al.Relapses in hepatoblastoma patients:clinical characteristics and outcome-experience of the International Childhood Liver Tumour Strategy Group (SIOPEL)[J].Eur J Cancer,2013,49(4):915-922.DOI:10.1016/j.ejca.2012.10.003.
[5] Fonseca A,Gupta A,Shaikh F,et al.Extreme hepatic resections for the treatment of advanced hepatoblastoma:Are planned close margins an acceptable approach?[J].Pediatr Blood Cancer,2018,65(2):26820.DOI:10.1002/pbc.26820.
[6] Dall’Igna P,Cecchetto G,Toffolutti T,et al.Multifocal hepatoblastoma:is there a place for partial hepatectomy?[J].Med Pediatr Oncol,2003,40(2):113-117.DOI:10.1002/mpo.10107.
[7] Eisenhauer EA,Therasse P,Bogaerts J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline (version 1.1)[J].Eur J Cancer,2009,45(2):228-247.DOI:10.1016/j.ejca.2008.10.026.
[8] 中国抗癌协会小儿肿瘤专业委员会,中华医学会小儿外科分会肿瘤专业组.儿童肝母细胞瘤多学科诊疗专家共识(CCCG-HB-2016)[J].中华小儿外科杂志,2017,38(10):733-739.DOI:10.3760/cma.j.issn.0253-3006.2017.10.003. Pediatric Oncology Specialty Committee of Chinese Anti-Cancer Association;Pediatric Oncology Specialty Group,Branch of Pediatric Surgery,Chinese Medical Association:Expert Consensus on Multidisciplinary Management of Hepatoblastoma (CCCG-HB-2016)[J].Chin J Pediatr Surg,2017,38(10):733-739.DOI:10.3760/cma.j.issn.0253-3006.2017.10.003.
[9] Dindo D,Demartines N,Clavien PA.Classification of surgical complications:a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J].Ann Surg,2004,240(2):205-213.DOI:10.1097/01.sla.0000133083.54934.ae.
[10] Wiederkehr JC,Avilla SG,Mattos E,et al.Associating liver partition with portal vein ligation and staged hepatectomy (ALPPS) for the treatment of liver tumors in children[J].J Pediatr Surg,2015,50(7):1227-1231.DOI:10.1016/j.jpedsurg.2014.10.019.
[11] Czauderna P,Lopez-Terrada D,Hiyama E,et al.Hepatoblastoma state of the art:pathology,genetics,risk stratification,and chemotherapy[J].Curr Opin Pediatr,2014,26(1):19-28.DOI:10.1097/MOP.0000000000000046.
[12] 杨维,任清华,秦红,等.儿童肝母细胞瘤精准肝切除手术效果评价[J].临床小儿外科杂志,2020,19(5):392-397.DOI:10.3969/j.issn.1671-6353.2020.05.004. Yang W,Ren QH,Qin H,et al.Evaluations of precise hepatectomy for pediatric hepatoblastoma[J].DOI:10.3969/j.issn.1671-6353.2020.05.004.
[13] Otte JB,Pritchard J,Aronson DC,et al.Liver transplantation for hepatoblastoma:results from the International Society of Pediatric Oncology (SIOP) study SIOPEL-1 and review of the world experience[J].Pediatr Blood Cancer,2004,42(1):74-83.DOI:10.1002/pbc.10376.
[14] Hou JY,Yeh TC,Huang TH,et al.A retrospective study of clinical features and outcome in patients with refractory or recurrent hepatoblastoma:a single institution experience[J].Pediatr Neonatol,2021,62(4):400-405.DOI:10.1016/j.pedneo.2021.03.018.
[15] Hamilton EC,Balogh J,Nguyen DT,et al.Liver transplantation for primary hepatic malignancies of childhood:the UNOS experience[J].J Pediatr Surg,2018,53(1):163-168.DOI:10.1016/j.jpedsurg.2017.10.035.
[16] Workman JK,Myrick CW,Meyers RL,et al.Pediatric organ donation and transplantation[J].Pediatrics,2013,131(6):e1723-e1730.DOI:10.1542/peds.2012-3992.
[17] Younes A,Elgendy A,Fadel S,et al.Surgical resection of hepatoblastoma:factors affecting local recurrence[J].Eur J Pediatr Surg,2021,31(5):432-438.DOI:10.1055/s-0040-1717087.
[18] Neto JS,Fonseca EA,Candido HL,et al.Alternatives for vascular reconstruction in pediatric living donor liver transplantation[J].Pediatr Transplant,2016,20(5):717-722.DOI:10.1111/petr.12720.
[19] Héry G,Franchi-Abella S,Habes D,et al.Initial liver transplantation for unresectable hepatoblastoma after chemotherapy[J].Pediatr Blood Cancer,2011,57(7):1270-1275.DOI:10.1002/pbc.23301.
[20] Otte JB,de Ville de Goyet J,Reding R.Liver transplantation for hepatoblastoma:indications and contraindications in the modern era[J].Pediatr Transplant,2005,9(5):557-565.DOI:10.1111/j.1399-3046.2005.00354.x.
[21] 施佳,程千千,武志祥,等.吲哚菁绿近红外荧光显像在儿童肝母细胞瘤手术中的应用初探[J].临床小儿外科杂志,2021,20(10):916-920.DOI:10.12260/lcxewkzz.2021.10.004. Shi J,Cheng QQ,Wu ZX,et al.Application of near-infrared indocyanine green fluorescent imaging during surgery of childhood hepatoblastoma[J].J Clin Ped Sur,2021,20(10):916-920.DOI:10.12260/lcxewkzz.2021.10.004.
[22] Angelico R,Grimaldi C,Gazia C,et al.How do synchronous lung metastases influence the surgical management of children with hepatoblastoma? An update and systematic review of the literature[J].Cancers (Basel),2019,11(11):1693.DOI:10.3390/cancers11111693.
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备注/Memo
收稿日期:2023-10-07。
基金项目:国家自然科学基金(82293660/82293665)
通信作者:王焕民,Email:wanghuanmin@bch.com.cn