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01.12.2023 | Original Article

Clinical risk factors for patients with ruptured hepatoblastoma in children: a retrospective study from a single center in China

verfasst von: Saishuo Chang, Shen Yang, Wei Yang, Hong Qin, Haiyan Cheng, Xiaofeng Chang, Zhiyun Zhu, Jie Yin, Qinghua Ren, Shijie Yu, Huanmin Wang

Erschienen in: Pediatric Surgery International | Ausgabe 1/2023

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Abstract

Objective

Hepatoblastoma (HB) tumor rupture is a high-risk criterion in the International Childhood Liver Tumors Strategy Group (SIOPEL) 3/4 protocol. However, the causes and risk factors for HB rupture are still unknown, and whether tumor rupture is an independent risk factor for HB prognosis is still controversial. The purpose of this study was to retrospectively analyze the clinical characteristics of children with HB tumor rupture and to search for clinical risk factors to conduct early prediction and intervention.

Methods

We conducted a retrospective study of 27 patients with HB rupture between July 2009 and July 2019. To further identify the risk factors for HB rupture, we included 97 nonruptured HB patients from January 2013 to January 2019. We searched for potentially useful characteristics for HB rupture by univariate and multivariate logistic regression analyses.

Results

There were 27 patients with HB rupture, with the median age of 31 (12, 69) months. Nineteen cases (70.37%) were spontaneous tumor rupture, 1 case (3.70%) was posttraumatic rupture, 2 cases (7.41%) were tumor rupture after the biopsy, and 5 cases (18.52%) were tumor rupture after chemotherapy. After the tumor rupture, 4 patients died of hemorrhagic shock and multiple organ dysfunction syndrome (MODS), 4 patients refused further therapy and were discharged against medical advice, and the remaining 19 patients were stable after emergency treatment. After the treatment, 14 patients survived without disease, 2 patients died, and 3 patients were lost to follow-up. The median follow-up was 48 (33, 60) months, the 3-year overall survival (OS) was 54.7%. Compared with the non-tumor rupture group by multivariate logistic regression analysis, it was found that the maximum diameter of the primary tumor > 13.4 cm, and vascular invasion were independent risk factors for tumor rupture.

Conclusion

HB rupture is rare, but it seriously threatens the life and health of children. In the acute phase of tumor rupture, surgery, rescue chemotherapy, transcatheter arterial embolization (TAE) and other supportive care can be adopted. Large tumors and vascular invasion are risk factors for HB rupture.

Level of Evidence

Level IV

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Titel: Clinical risk factors for patients with ruptured hepatoblastoma in children: a retrospective study from a single center in China
verfasst von: Saishuo Chang
Shen Yang
Wei Yang
Hong Qin
Haiyan Cheng
Xiaofeng Chang
Zhiyun Zhu
Jie Yin
Qinghua Ren
Shijie Yu
Huanmin Wang
Publikationsdatum: 01.12.2023
Verlag: Springer Berlin Heidelberg
Erschienen in: Pediatric Surgery International / Ausgabe 1/2023
Print ISSN: 0179-0358
Elektronische ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-022-05362-1

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Clinical risk factors for patients with ruptured hepatoblastoma in children: a retrospective study from a single center in China