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Biliary Rhabdomyosarcoma in Pediatric Patients: A Systematic Review and Meta-Analysis of Individual Patient Data
Juri Fuchs1, Anastasia Murtha-Lemekhova1, Markus Kessler2
1Department of General, Visceral and Transplantation Surgery, University Hospital Heidelberg, Heidelberg, Germany.
Insights
Complete surgical resection is crucial for treating pediatric biliary rhabdomyosarcoma (BRMS). This rare cancer has high morbidity, but surgery improves survival rates and reduces recurrence.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Rare Cancers
Background:
- Pediatric biliary rhabdomyosarcoma (BRMS) is rare, with limited evidence for treatment guidelines.
- The role of surgery in BRMS management remains controversial.
Approach:
- A systematic literature search identified 65 studies with data on 176 BRMS patients.
- Individual patient data were analyzed using Cox regression to identify prognostic factors.
- Therapeutic regimens and surgical impact were investigated.
Key Points:
- Overall 5-year survival for BRMS is 51%, improving to 65% for patients treated after 2000.
- Absence of surgical tumor resection independently predicted death (HR 8.9, p=0.007).
- Lack of surgery was linked to increased recurrence and disease-related death.
Conclusions:
- BRMS continues to have high morbidity and mortality.
- Surgical tumor resection is essential for effective oncological treatment of BRMS.
- International collaboration is needed to improve outcomes for this rare disease.
Background:
The biliary tree is a rare location of pediatric rhabdomyosarcoma. Due to the low incidence, there is a lack of evidence concerning therapeutic guidelines for this tumor location. In particular, the impact of surgery is discussed controversially.
Purpose:
Objective is to generate evidence-based treatment guidelines for pediatric biliary rhabdomyosarcoma (BRMS). All available published data on therapeutic regimens and important prognostic factors are investigated with a focus on the role of surgery.
Methods:
A systematic literature search of MEDLINE, Web of Science, and CENTRAL was performed. Patient data were entered individually. Data was pooled and qualitative and quantitative analyses of demographic data, therapy, postoperative/interventional outcomes, relapse, and survival were conducted. In an individual patient data analysis, cox regression was applied to identify key factors predicting the outcome of patients with BRMS.
Results:
65 studies met the inclusion criteria, providing data on 176 patients with BRMS. Individual patient data analysis showed a 5-year overall survival and progression-free survival of 51% and 50% for the total study population. For patients treated after 2000, 5-year OS and PFS was 65% and 59%, respectively. Absence of surgical tumor resection was an independent risk factor for death (Hazard ratio 8.9, 95%-CI 1.8-43.6, p = 0.007) and significantly associated with recurrent disease and disease-related death.
Conclusion:
This analysis provides comprehensive information on the largest number of patients hitherto reported in the literature. BRMS is still associated with high morbidity and mortality. Surgical tumor resection is essential for appropriate oncological treatment of BRMS. International cooperation studies are needed to enhance evidence and improve the outcome of this orphan disease.
Protocol Registration:
PROSPERO (CRD42021228911) https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021228911.
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