Faculty Collaboration Database

Predictive power of pretreatment prognostic factors in children with hepatoblastoma: a report from the Children's Oncology Group. Pediatr Blood Cancer 2009 Dec;53(6):1016-22

Date

07/10/2009

Pubmed ID

19588519

Pubmed Central ID

PMC4408767

DOI

10.1002/pbc.22088

Scopus ID

2-s2.0-71049119486 (requires institutional sign-in at Scopus site)   174 Citations

Abstract

BACKGROUND: PRETEXT is used to stratify risk in children with hepatoblastoma by the Liver Tumor Strategy Group (SIOPEL) of the International Society of Pediatric Oncology (SIOP). A recent analysis excluding patients that did not survive neoadjuvant chemotherapy, concluded that PRETEXT was superior to Children's Oncology Group (COG) stage for predicting survival. Puzzled by this result, we made a similar comparison of PRETEXT and COG stage. This time, however, we include all patients, and we compare predictive value at diagnosis, instead of after neoadjuvant chemotherapy.

METHODS: Hepatoblastoma patients in INT-0098 were retrospectively reviewed for PRETEXT and other potential prognostic factors including pathologic subtype, and alpha-fetoprotein (AFP).

RESULTS: Five-year overall survival by PRETEXT was 88.9%, 84.5%, 71.6%, and 30.9%, for PRETEXT I, II, III, and IV, respectively. The 5-year overall survival rates by COG stage were 100%, 97.5%, 100%, 70.2%, and 39.3% for Stage I pure fetal histology (PFH), Stage I unfavorable histology (UH = not PFH), Stage II, Stage III, and Stage IV, respectively. PRETEXT added significant additional prognostic information within the COG Stage III, but not COG Stage IV. Additional prognostic factors statistically significant for an increased risk of death were small-cell-undifferentiated (SCU) histologic subtype and AFP < 100 at diagnosis.

CONCLUSIONS: PRETEXT, COG stage, SCU histology, and AFP < 100, as assessed at diagnosis, are important determinants of survival that will allow us to better develop common international criteria for risk stratification. Common risk stratification is an essential prerequisite to establish effective cooperation across the ocean in this field of rare tumors.

Author List

Meyers RL, Rowland JR, Krailo M, Chen Z, Katzenstein HM, Malogolowkin MH

MESH terms used to index this publication - Major topics in bold

Child
Hepatoblastoma
Histology
Humans
Neoplasm Staging
Predictive Value of Tests
Prognosis
Retrospective Studies
Survival Analysis
Treatment Outcome
alpha-Fetoproteins