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Tuesday March 28, 2023 - 09:10 to 10:10

Room: Hill Country AB

406.3 Survival after surgical management of hepatoblastoma: resection versus transplant

Karla Estefania, Spain

Pediatric surgery


Survival after surgical management of hepatoblastoma: resection versus transplant

Karla Estefania1, Antonio Muñoz-Serrano1, María Velayos-Lopez1, Carla Ramirez-Amorós1, Javier Serradilla1, Ane Andrés1, Francisco Hernández1.


Introduction: In children, hepatoblastoma (HB) is preferentially managed by hepatic resection (HR).  However, in irresectable cases, liver transplantation (LT) is the only option. We compared outcomes following HR and LT for HB.
Methods: We retrospectively reviewed HB cases that underwent surgical management over a 25-year period (1996-2021). We assessed overall survival and disease-free survival at 1-, 5- and 10-years using the Kaplan-Meier method, log-rank tests, and multivariable Cox regression.
Results: We included 76 children, 46 (60.5%) male and 30 (39.5%) female, with a median age at diagnosis of 24.7 months (IQR: 9.41-50.38). HR was performed in 49 (64.5%) and LT in 27 (35.5%). Both groups were comparable by age, sex, alpha-fetoprotein levels, histology, and metastatic disease at diagnosis. The LT group had longer median time from diagnosis to surgery (4.4 vs 3.55 months; p<0.004), more multifocal tumors (51.9% vs 4.1%; p<0.001), and vascular invasion (63% vs 22.4%; p<0.001). Both groups had similar 1-, 5- and 10-year overall survival rates (p=0.97), respectively 93%, 89% and 87% for HR; and 100%, 93% and 85% for LT. Likewise, disease-free survival at 1, 5 and 10 years was 93.5%, 82.6% and 82.6% for HR; and 100%, 93% and 85% for LT (p=0.89). In multivariate analysis, metastatic disease at diagnosis (HR 6.14, CI 1.37-27.51), multifocality (HR 5.29, CI 1.49-18.74), and extrahepatic abdominal involvement (HR 11.11, CI 2.14-57.58) were associated with decreased overall survival.
Conclusion: Children with hepatoblastoma who underwent both HR and LT had excellent long-term overall survival. Multifocality, metastatic disease, and extrahepatic abdominal involvement impact outcomes.


[1] Lim IIP, Bondoc AJ, Geller JI, Tiao GM. and Transplantation. Published online 2019. doi:10.3390/children6010001
[2] Dasgupta P, Henshaw C, Youlden DR, et al. Global trends in incidence rates of childhood liver cancers: A systematic review and meta-analysis. Paediatr Perinat Epidemiol. 2020;34(5):609-617. doi:10.1111/ppe.12671
[3] Hubbard AK, Spector LG, Fortuna G, Marcotte EL, Poynter JN. Trends in international incidence of pediatric cancers in children under 5 years of age: 1988–2012. JNCI Cancer Spectr. 2019;3(1):1-8. doi:10.1093/jncics/pkz007
[4] Feng J, He Y, Wei L, et al. Assessment of Survival of Pediatric Patients With Hepatoblastoma Who Received Chemotherapy Following Liver Transplant or Liver Resection. JAMA Netw open. 2019;2(10):e1912676.
[5] Kulkarni S, Brauer DG, Turmelle Y, et al. Surgical Therapy for Pediatric Hepatoblastoma in the USA over the Last Decade: Analysis of the National Cancer Database. J Gastrointest Cancer. 2021;52(2):547-556. doi:10.1007/s12029-020-00421-z
[6] Uchida H, Sakamoto S, Sasaki K, et al. Surgical treatment strategy for advanced hepatoblastoma: Resection versus transplantation. Pediatr Blood Cancer. 2018;65(12):1-10. doi:10.1002/pbc.27383

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