EN
TÜRKÇE
Oral Presentation - 125
Correlation between PRETEXT staging and post operative outcome of hepatic resection in children with hepatoblastoma according to SIOPEL protocol
Mahfuz Alam Khan
Bangabandhu Sheikh Mujib Medical University, Dhaka
Background: Hepatoblastoma relies on cisplatin-based chemotherapy followed by complete surgical removal. Pretreatment evaluation by imaging is crucial to define disease extension, risk stratification and treatment planning which has direct effect on surgical outcome and patient survival.
Aims: To evaluate the relation between post operative outcome of hepatic resection with PRETEXT staging according to SIOPEL protocol.
Methods: This prospective type of observational study was done in Department of Paediatric surgery, BSMMU, Dhaka, Bangladesh during August’ 2021 to August’ 2023. 12 children were enrolled in this study. After PRETEXT staging they all received neoadjuvant chemotherapy according to SIOPEL protocol followed by surgical resection and adjuvant chemotherapy.
Results: Median age was 22.50 months. 66.7% subjects were male. PRETEXT II & PRETEXT III was found 66.7% & 33.3% respectively. 66.7% subjects had annotation factor positive. Median S.AFP was 900.0, 100.9 and 4.2 (ng/ml) in preoperative, 14d postoperative and 3m postoperative respectively. Both the differences were statistically significant . Median S.AFP found 1.65(ng/ml) in 6m postoperative. The difference was statistically not significant with preoperative. Among cases with local recurrence median S.AFP at diagnosis,preoperative, 14d postoperative, 3m postoperative and 6m postoperative period were 400000, 8249, 2000, 1000 and 300000 ng/ml respectively. Among cases without local recurrence median S.AFP at diagnosis, preoperative, 14d postoperative, 3m postoperative and 6m postoperative period were 2000, 93.5, 8.5, 2.3 and 1.3 ng/ml respectively. 25.0% subjects had focal lesion on 6m postoperative sonographic estimation. 25.0% subjects had multifocality. 50.0% subjects had involvement of caudate lobe. In PRETEXT II, PRETEXT III and Multifocality recurrence rate was observed 12.5%, 50.0%, 50.0% respectively. There was only one case of multiple positive annotation factor (CF) observed and it experienced local recurrence.
Conclusion: In children with hepatoblastoma, PRETEXT staging along with annotation factors (CF and F) strongly predicted post operative outcomes, particularly local recurrence.