Complete Surgical Resection Is Curative for Children With Hepatoblastoma With Pure Fetal Histology: A Report From the Children's Oncology Group
Complete Surgical Resection Is Curative for Children With Hepatoblastoma With Pure Fetal Histology: A Report From the Children's Oncology Group
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DOI：
10.1200/jco.2010.29.3837
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发表时间：
2011-08-20
影响因子：
45.3
通讯作者：
Finegold, Milton J.
中科院分区：
文献类型：
--
作者：
Malogolowkin, Marcio H.;Katzenstein, Howard M.;Finegold, Milton J.
目的与其他肝母细胞瘤患者相比，经完全手术切除和最小辅助治疗的纯胎儿组织学（PFH）肝母细胞瘤患儿已显示出良好的结局。我们前瞻性地研究了减少治疗的安全性和有效性，在所有儿童阶段I PFH入组到两个连续的study.Patients和方法从1989年8月至1992年12月，9名儿童阶段I PFH治疗组间肝母细胞瘤研究INT-0098和非随机分配接受化疗后，手术切除与单剂丸阿霉素连续3天。从1999年3月至2006年11月，16名I期PFH儿童入选儿童肿瘤组研究P9645，切除后观察治疗。由研究组病理学家对组织学诊断进行中心确认。肝脏疾病的程度进行了分配回顾性根据治疗前的疾病程度（PRETEXT）系统，并指定为“后PRETEXT”，以澄清回顾性组assignment.Results五年无事件和总生存率为INT-0098治疗的9例患者为100%。入组P9645研究的所有16例患者在末次联系时均存活且无疾病，中位随访时间为4.9年。Retro-PRETEXT对21例有资料的患者进行分析，发现7例为I期，10例为II期，4例为III期。在可行的情况下，诊断时手术切除肝母细胞瘤，无需化疗，可以识别不需要额外治疗的儿童。J Clin Oncol 29：3301-3306. (C)2011年美国临床肿瘤学会
Purpose Children with pure fetal histology (PFH) hepatoblastoma treated with complete surgical resection and minimal adjuvant therapy have been shown to have excellent outcomes when compared with other patients with hepatoblastoma. We prospectively studied the safety and efficacy of reducing therapy in all children with stage I PFH enrolled onto two consecutive studies.Patients and Methods From August 1989 to December 1992, 9 children with stage I PFH were treated on the Intergroup Hepatoblastoma study INT-0098 and were nonrandomly assigned to receive chemotherapy after surgical resection with single-agent bolus doxorubicin for 3 consecutive days. From March 1999 to November 2006, 16 children with stage I PFH enrolled onto Children's Oncology Group Study P9645 were treated with observation after resection. Central confirmation of the histologic diagnosis by a study group pathologist was mandated. The extent of liver disease was assigned retrospectively according to the pretreatment extent of disease (PRETEXT) system and is designated "retro-PRETEXT" to clarify the retrospective group assignment.Results Five-year event-free and overall survival for the 9 patients treated on INT-0098 were 100%. All 16 patients enrolled onto the P9645 study were alive and free of disease at the time of last contact, with a median follow-up of 4.9 years. Retro-PRETEXT for the 21 patients with available data revealed seven patients with stage I disease, 10 patients with stage II disease, and four patients with stage III disease.Conclusion Children with completely resected PFH hepatoblastoma can achieve long-term survival without additional chemotherapy. When feasible, surgical resection of hepatoblastoma at diagnosis, without chemotherapy, can identify children for whom no additional therapy is necessary. J Clin Oncol 29:3301-3306. (C) 2011 by American Society of Clinical Oncology