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A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
Published on: September 30, 2021
[Treatment outcome of 100 patients with hepatoblastoma based on a new risk stratification]
1Department of Pediatric Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Guangzhou 510060, China.
Insights
A new risk stratification for hepatoblastoma (HB) shows excellent outcomes for low-risk patients. High-risk hepatoblastoma patients still require improved survival rates and novel treatment strategies.
Area of Science:
- Pediatric Oncology
- Hepatobiliary Malignancies
- Cancer Risk Stratification
Background:
- Hepatoblastoma (HB) is a rare pediatric liver cancer.
- Effective risk stratification is crucial for tailoring treatment and improving outcomes in HB patients.
- Current risk stratification methods may not be optimally suited for all populations, necessitating localized approaches.
Purpose of the Study:
- To develop and validate a risk stratification method for hepatoblastoma (HB) applicable in China.
- To explore novel treatment strategies for high-risk HB patients.
- To evaluate the efficacy of a comprehensive treatment approach based on the new risk stratification.
Main Methods:
- A cohort of 100 newly diagnosed pediatric HB patients (under 18) were stratified into four risk groups (extremely low, low, intermediate, high) based on clinical stage, AFP level, and pathology.
- Treatment protocols varied by risk group, including surgery alone, C5V, C5VD, and alternating C5VD/IIV regimens.
- Chemotherapy response, tumor relapse, progression, and survival rates were assessed over a median follow-up of 20 months.
Main Results:
- Patients were stratified into extremely low-risk (2%), low-risk (10%), medium-risk (51%), and high-risk (37%) groups.
- The overall response rate to chemotherapy was 78.3% (65/83 patients).
- Two-year progression-free survival (PFS) and overall survival (OS) rates were 69.2% and 72.0%, respectively. High-risk patients had significantly lower survival rates (PFS 43.2%, OS 44.8%) compared to other groups.
Conclusions:
- The developed HB risk classification system is simple, feasible, and effective for implementation in China.
- Patients classified as extremely low-, low-, and medium-risk demonstrate excellent outcomes with the current comprehensive treatment strategies.
- Significant improvements in survival rates for high-risk HB patients are needed, highlighting the necessity for developing and investigating new therapeutic interventions.
Abstract:
Objective: To provide the risk stratification method of hepatoblastoma (HB) suitable for implementation in China and explore the new treatment method for high-risk HB patients. Methods: A total of 100 cases of children and adolescents under 18 years old with newly diagnosed HB in Sun Yat-sen University Cancer Center and Sun Yat-sen University First Affiliated Hospital from September 2014 to September 2018 were included. According to the clinical stage, AFP level, pathological subtype and other factors, patients were stratified into four groups: extremely low-, low-, intermediate- and high-risk. The patients at very low risk were treated with surgery only and followed-up. The patients at very low risk were treated with C5V(Cisplatin+ 5-Fluroracil+ Vincristine) regimen for 4 courses. The patients at intermediate risk were treated with C5VD(Cisplatin+ 5-Fluroracil+ Vincristine+ Doxorubicin)regimen before and after surgery for 6-8 courses. The patients at high risk were treated with C5VD and IIV (ifoshamide+ irinotecan+ vincristine) alternately before and after surgery for 8 courses. Results: One hundred patients were stratified into extremely low-risk, low-risk, medium-risk and high-risk groups for 2, 10, 51 and 37 cases, respectively. Eighty three cases had evaluable lesions before chemotherapy. Among them, 65 patients achieved partial remission, stable disease and progressive disease were observed in 10, and 8 cases, respectively, with a response rate of 78.3%. During a median follow-up of 20 months, 30 patients experienced tumor relapse or progression, and 27 of them died. The 2-years progression-free survival (PFS) and overall survival (OS) rates were 69.2% and 72.0%, respectively. The 2-years PFS rates of patients with extremely low risk, low risk, medium risk and high risk were 100%, 88.9%, 75.3% and 43.2%, respectively. The 2-years OS rates were 100%, 100%, 81.0% and 44.8%, respectively. Conclusions: The novel HB risk classification is simple and feasible. With active comprehensive treatment, patients at extremely low-, low- and medium-risk have excellent outcomes. The survival rate of high-risk HB patients remains to be improved, and new treatment strategies need to be explored.
