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Impact of microscopically margin-positive resection on survival in children with hepatoblastoma after hepatectomy: a retrospective cohort study

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Abstract

Background

Impact of R1 (microscopically margin-positive) resection on survival of patients with hepatoblastoma (HB) remains debatable. This study aimed to compare the long-term outcomes of R0 (microscopically margin-negative) and R1 resection for HB in children after hepatectomy.

Methods

We retrospectively reviewed files of children with HB who underwent resection at our institution between September 1, 2005, and November 30, 2017. Survival analyses and prognostic factors were evaluated using Kaplan–Meier curves and Cox regression models.

Results

Of 259 patients, 218 (84.2%) underwent R0 and 41 (15.8%) R1 resection. After adjusting for confounding factors, R1 resection demonstrated non-significantly lower overall survival (OS: hazard ratio [HR] = 0.75; 95% CI 0.34–1.64) and shorter event-free survival (EFS: HR = 0.97; 95% CI 0.53–1.78) rates than R0 resection. However, stratified analysis showed significantly increased risk of poor OS and EFS in patients with metastasis and mixed epithelial/mesenchymal pathologic subtype in R1 compared with R0 resection (P values for interactions < 0.05). There was no significant difference between R0 resection with metastasis and R1 resection with metastasis in the incidence of local recurrence (P = 0.494); however, a significant difference in the incidence of local recurrence was seen between R0 and R1 resection for subgroups with mixed pathologic subtypes (P = 0.035).

Conclusions

With effective chemotherapy, microscopic margin status may not be associated with survival outcome in children with HB undergoing hepatectomy. However, stratified analysis showed that R1 resection might be associated with decreased survival in children with mixed epithelial/mesenchymal HB, compared with R0 resection, and not affect survival outcomes in those with an epithelial subtype and without metastasis.

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Author notes

  1. Xianghai Ren and Haibo Li contributed equally to this article.

Authors and Affiliations

  1. Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, People’s Republic of China

    Xianghai Ren, Haibo Li, Hang Xu & Long Li

  2. Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing, People’s Republic of China

    Xianghai Ren, Haibo Li, Mei Diao, Hang Xu & Long Li

Authors
  1. Xianghai Ren
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  2. Haibo Li
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  3. Mei Diao
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  4. Hang Xu
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  5. Long Li
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Correspondence to Long Li.

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Ren, X., Li, H., Diao, M. et al. Impact of microscopically margin-positive resection on survival in children with hepatoblastoma after hepatectomy: a retrospective cohort study. Int J Clin Oncol 25, 765–773 (2020). https://doi.org/10.1007/s10147-019-01573-0

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  • DOI: https://doi.org/10.1007/s10147-019-01573-0

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