Midterm results with hepatectomy after preoperative chemotherapy in hepatoblastoma
Midterm results with hepatectomy after preoperative chemotherapy in hepatoblastoma
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DOI：
10.1007/s00383-005-1381-1
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发表时间：
2005-05-01
影响因子：
1.8
通讯作者：
Gupta, AK
中科院分区：
文献类型：
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作者：
Bajpai, M;Pal, K;Gupta, AK
我们评估了婴儿和儿童肝母细胞瘤在术前强化化疗后的手术治疗结果，特别参考了组织学和肝脏受累程度。回顾10例肝母细胞瘤患儿的临床特点，包括对新辅助化疗的反应、组织学亚型、肝切除范围、手术并发症和预后。通过计算机断层扫描对肿瘤大小进行体积评估来衡量对化疗的反应。顺铂和阿霉素（PLADO方案）长达3个周期显著减小了计算机断层扫描的肿瘤体积（平均消退率65.9%）;甲胎蛋白（AFP）水平也从初始平均值16，116.4 ng/ml降至2，050.9 ng/ml。5例患者接受了右肝切除术，2例接受了右三叶切除术，2例接受了左肝切除术，1例接受了左三叶切除术。切除标本的组织学显示，胎儿组织学在4例，分化差（间变性）亚型在3例，混合组织学与间充质成分和类骨质形成在3例。有100%的可切除性，包括6个不可切除的肿瘤（化疗前）。此外，对于术前化疗后肿瘤缩小的患者，肝切除术的侵入性往往较小。术前给予顺铂和阿霉素可显著减小肿瘤大小，从而可以进行安全的根治性肝切除术。它还允许术后化疗的早期管理。虽然目前的方案获得了总体良好的结果，但我们也记录了我们在双叶肿瘤患者（尽管进行了三叶切除术）、肿瘤对新辅助化疗反应较差的患者和间变性组织学患者中的不良结局经验。总的来说，在60个月的随访中，我们报告了80%的联合方法生存率。
We evaluated the results of surgical treatment for hepatoblastoma in infants and children after intensive preoperative chemotherapy, with special reference to histology and extent of liver involvement. The clinical features of 10 children with hepatoblastoma were reviewed regarding response to neoadjuvant chemotherapy, histological subtypes, extent of hepatectomy, operative complications, and prognosis. Response to chemotherapy was measured by volumetric assessment of tumour size by computed tomography scan. Cisplatin and Adriamycin (PLADO regime) up to three cycles markedly reduced the tumour volume on computed tomography (mean regression rate 65.9%); alpha-foetoprotein (AFP) levels also decreased from an initial mean of 16,116.4 ng/ml to 2,050.9 ng/ml. Five patients underwent right hepatectomy, two had right trisegmentectomy, two had left hepatectomy, and one had left trisegmentectomy. Histopathology of resected specimens revealed foetal histology in four patients, poorly differentiated (anaplastic) subtype in three, and mixed histology with mesenchymal components and osteoid formation in three. There was 100% resectability including six unresectable tumours (prechemotherapy). Moreover, hepatic resection tended to be less invasive in patients whose tumours had been much reduced after preoperative chemotherapy. Preoperative administration of cisplatin and Adriamycin reduces the tumour size significantly so that a safe radical hepatectomy can be performed. It also allows early administration of postoperative chemotherapy. Although overall good results were obtained with the current protocol, we also document our experience of unfavourable outcomes in patients with bilobar tumours (despite trisegmentectomy), patients with tumours showing poor response to neoadjuvant chemotherapy, and patients with anaplastic histology. Overall, at a 60-month follow-up we report an 80% survival rate by a combined approach.