title: Treatment outcomes for hepatoblastoma: experience of 35 cases at a single institution.
abstract: OBJECTIVE
  Hepatoblastoma is the most common malignant liver tumor in children. Comparative studies have elucidated the optimal pre- or postoperative chemotherapeutic regimens. The aim of this study was to investigate the prognostic significance of baseline tumor characteristics for overall survival and disease-free survival in children with hepatoblastoma.
  
  
  METHODS
  There were 19 male and 16 female children with a median age of 19 months at diagnosis (range: 1-169 months) in our institution between February 1990 and June 2009. We reviewed the clinical presentation, serum α-fetoprotein level at diagnosis, histological subtype, treatment, and outcomes.
  
  
  RESULTS
  Twenty-seven patients (78%) underwent neoadjuvant chemotherapy. The majority of patients subsequently underwent either hemihepatectomy (56%) or bisegmentectomy (16%). Only six patients underwent extended hepatic resection, and one of them required rescue liver transplantation. During follow-up, six patients died of progressive disease and two of perioperative mortality. Four of the six who died had pulmonary metastases at the time of diagnosis or follow-up. The median survival time was 28 months (range: 1-181 months). Five-year overall survival was 67.7% (95% confidence interval: 52.0-87.8%) and disease-free survival was 60.2% (95% confidence interval: 41.9-86.5%).
  
  
  CONCLUSIONS
  The potential down-staging effect of neoadjuvant chemotherapy on hepatoblastoma might facilitate remission and convert unresectable tumors into operable ones.
authors.affiliation: Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
authors.forename: Pei-Kwei
authors.initials: PK
authors.lastname: Tsay
authors.forename: Jin-Yao
authors.initials: JY
authors.lastname: Lai
authors.forename: Chao-Ping
authors.initials: CP
authors.lastname: Yang
authors.forename: Iou-Jih
authors.initials: IJ
authors.lastname: Hung
authors.forename: Chuen
authors.initials: C
authors.lastname: Hsueh
authors.forename: Ming-Horng
authors.initials: MH
authors.lastname: Tsai
authors.forename: Tang-Her
authors.initials: TH
authors.lastname: Jaing
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D018197:Hepatoblastoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D016896:Treatment Outcome