Analysis of Factors Associated with the Recurrence Rate of Paediatric Hepatoblastoma: A Single Center Study

Author(s): Abdullah All Mahmud*, A.K.M. Zahid Hossain, Asish Kumar Sarkar, Mahfuz Alam Khan, A M Shahinoor, Umme Habiba Dilshad Munmun, Tanjirul Islam, Syeda Sushmita Zafar, Umma Sadia

Background: Hepatoblastoma (HB) is the most common malignant liver tumor in children, occurring mainly under age five, with a peak incidence between 6 months and three years. The disease, arising from immature hepatic stem cells, has seen improved survival rates over recent decades, exceeding 80% due to advancements in chemotherapy and surgery. However, recurrence remains a significant issue, affecting about 20% of patient’s post-remission. Prognostic factors include age, tumor stage (PRETEXT), metastatic disease, and surgical margin status.

Aim of the study: This study aimed to analyze the various factors associated with the recurrence of pediatric hepatoblastoma to identify critical predictors and inform more effective management strategies.

Methods: This study is a prospective observational analysis of children with hepatic resection for hepatoblastoma after neo-adjuvant chemotherapy following the SIOPEL protocol, conducted at BSMMU, Dhaka, Bangladesh, from August 2021 to August 2023. Twelve children with upper abdominal masses were assessed using serum AFP levels, abdominal CT or MRI, and the PRETEXT staging system. Patients were classified into standard-risk and high-risk groups, excluding those with lung metastases. Patients were monitored for survival, recurrence, and AFP changes post-treatment over six months. Data were analyzed using SPSS, focusing on demographics, pathological findings, and clinical outcomes.

Result: The study analyzed 12 pediatric hepatoblastoma patients with a male predominance, primarily under three years old. The most common PRETEXT stage was IIC. Sixty-six percent had advanced disease with positive annotation factors. Recurrence occurred in 25% of the cohort, all under ten years old, with stage III and CF annotation factors linked to higher recurrence. Elevated serum alpha-fetoprotein (AFP) levels at six months post-operation were significantly higher in recurrences. Sonographic follow-up revealed focal lesions in 25% of the recurrence group. Critical factors for higher recurrence included younger age, advanced PRETEXT stages, positive annotation factors, elevated AFP levels, and focal lesions.

Conclusion: The study underscores the need for early and precise staging, identifying annotation factors, and monitoring AFP levels to predict pediatric hepatoblastoma recurrence. Advanced PRETEXT stages and positive factors linked to higher recurrence risk. Elevated postoperative AFP levels are a crucial biomarker for recurrence, guiding follow-up and treatment strategies.