Survival in children with hepatoblastoma and pulmonary metastatic disease at diagnosis based on extent of metastases and need for surgical clearance.
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Ошибки и ограничения
История · было → стало
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Polites Stephanie F, Vierkant Robert A, Aldrink Jennifer H, Lautz Timothy B, Ragan Mecklin V, Reiter Audra, Chen Stephanie Y, Kim Eugene S, Rinehardt Hannah N, Malek Marcus, Fleming Andrew M, Murphy Andrew J, Roach Jonathan P, Radhakrishnan Sridharan, Piche Nelson, Osman Yasmin, Lovvorn Harold N, Tracy Elisabeth T, Favela Juan, Le Hau D, Marquart John, Craig Brian, Lal Dave R, Seemann Natashia, Petroze Robin, Rich Barrie S, Glick Richard D, Selesner Leigh, Yoo Ashley, Fialkowski Elizabeth, Brown Erin G, Boehmer Chloe, Dasgupta Roshni, Langham Max R, Tiao Gregory M, Kastenberg Zachary J
Аннотация
METHODS: An analysis of a multicenter dataset including children with HB and pulmonary metastatic disease at diagnosis was performed. Patients who presented with >10 pulmonary metastases were defined as having extensive metastatic disease. Kaplan Meier and univariate Cox Proportional Hazards analyses assessed disease-free survival (DFS) and overall survival (OS), analyzing the effect of pulmonary metastatic disease extent and modality of clearance.
RESULTS: Among 315 patients with HB, pulmonary metastatic disease at diagnosis (n = 62) was associated with poorer DFS and OS (both p > 0.05). Of patients with pulmonary metastases, 23 (37 %) had extensive disease. Clearance of metastases occurred in 59 (95 %) patients: 32 (54 %) with chemotherapy alone and 27 (46 %) with chemotherapy and metastasectomy. Survival was similar between patients with >10 vs. ≤10 lung metastases and between those who had clearance of lung metastases by chemotherapy alone vs. chemotherapy and metastasectomy (all p > 0.05). Among 16 patients who required liver transplantation, all patients who underwent surgical clearance of metastatic disease were alive at last follow-up.
CONCLUSION: Among patients with HB who had pulmonary metastatic disease at diagnosis, long-term survival is possible regardless of the extent of pulmonary disease. A combination of neoadjuvant chemotherapy and metastasectomy can be utilized to achieve lung clearance.