Clinical Outcomes of Hepatoblastoma: An Experience of 37 Cases

Abstract

Background: Hepatoblastoma is the most common malignant liver tumor occurring in young children. Results
of the treatment have continuously improved with increasing 5-year survival rates.
Objective: The aim of this study was to review clinical outcomes of hepatoblastoma in 11-year period.
Materials and Methods: A retrospective study was conducted including 37 patients with hepatoblastoma
treated at Queen Sirikit National Institute of Child Health between 2003 and 2013. Patients’ data were reviewed
including demographics, clinical presentations, investigations, staging, histopathological reports and treatment
outcome. Clinical information was expressed as percentage, range, mean, median, standard deviation and analyzed
with Chi-square test.
Results: Thirty-seven patients with hepatoblastoma, 20 males and 17 females, were treated during the study
period. Mean age at the operation was 23.0 ± 28.2 months (ranged from 2 months to 12 years). Abdominal mass and
abdominal distension were the principal complaints. Investigations by ultrasonography and computed tomography
scan were performed in 14 (37.8%) and 31cases (83.8%), respectively. Alpha-fetoprotein level at the time of diagnosis
ranged from 627 to 484,000 ng/ml and it returned to normal after the treatment in 15 of the 33 patients (45.5%). Of
the 37 patients, 9 (24.3%) were noted to have distant metastasis at the time of diagnosis. The tumor sites were located
in the right, left and bilateral hepatic lobes in 21 (56.8%), 11 (29.7%) and 5 cases (13.5%), respectively. Primary tumor
resection was performed in 9 patients (24.3%). The 28 remainders underwent liver biopsies. After chemotherapy,
the residual tumors were completely resected in 12 cases. The histological types were epithelial (59.5%),
mesenchymal (37.8%) and undifferentiated cell type (2.7%). Four patients (10.8%) died due to serious immediate
post operative complications; massive intraabdominal bleeding due to tumor rupture (2 cases), hepatic failure
(1case) and pneumonia (1case). Of the 33 survived patients, 12 (36.4%) were alive over 2 years and 9 (27.3%) were
doing well over 5 years after the first operation with the longest follow-up of 9-year period.
Conclusion: Hepatoblastoma was mostly found in children younger than three years. Only one-fourth of the
patients could undergo primary tumor resections, while the residual tumors could be resected after chemotherapy
in one-third of the remainders. The survival rates at 2 and 5 years were 36.4% and 27.3,%, respectively.