title: Resectability and tumor response after preoperative chemotherapy in hepatoblastoma treated by the Japanese Study Group for Pediatric Liver Tumor (JPLT)-2 protocol.
abstract: OBJECTIVE
  We aimed to clarify whether surgical resectability and tumor response after preoperative chemotherapy (preCTx) represented prognostic factors for patients with hepatoblastoma (HBL) in the JPLT-2 study (1999-2012).
  
  
  METHODS
  Patients (N=342) with HBL who underwent preCTx were eligible. PRETEXT, CHIC risk stratification (standard [SR], intermediate [IR] and high risk [HR]) at diagnosis, POST-TEXT, and tumor resectability were evaluated by imaging. Tumor response was classified into responders (CR or PR) and nonresponders (NC or PD) according to RECIST criteria.
  
  
  RESULTS
  There were 7 PRETEXT I, 106 II, 143 III, and 86 IV, including 71 metastatic HBLs. In POST-TEXT, 12 PRETEXT II, 42 III, and 58 IV were down-staged. The 5-year EFS/OS rates of 198 SR, 73 IR, and 71 HR-HBLs were 82/94%, 49/64%, and 28/34%, respectively. In 198 SR, 154 of 160 responders and 24 of 38 nonresponders survived event-free (P<0.01). In 73 IR, 12 of 24 whose tumors remained unresectable experienced recurrence, 9 of whom were nonresponders (P<0.01). In 71 HR, chemoresponders and tumor resectability after preCTx correlated with favorable outcomes (P<0.05).
  
  
  CONCLUSIONS
  Evaluation of response and tumor resectability after preCTx is useful for predicting prognosis in HBLs. To improve outcomes, we should reconsider surgical procedures according to resectability and chemoresponsiveness.
  
  
  METHODS
  Level II.
authors.affiliation: Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, 734-8551, Japan; Japanese Study Group for Pediatric Liver Tumor. Electronic address: eiso@hiroshima-u.ac.jp.
authors.forename: Eiso
authors.initials: E
authors.lastname: Hiyama
authors.affiliation: Japanese Study Group for Pediatric Liver Tumor.
authors.forename: Tomoro
authors.initials: T
authors.lastname: Hishiki
authors.affiliation: Japanese Study Group for Pediatric Liver Tumor.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Watanabe
authors.affiliation: Japanese Study Group for Pediatric Liver Tumor.
authors.forename: Kohmei
authors.initials: K
authors.lastname: Ida
authors.affiliation: Japanese Study Group for Pediatric Liver Tumor.
authors.forename: Michihiro
authors.initials: M
authors.lastname: Yano
authors.affiliation: Japanese Study Group for Pediatric Liver Tumor.
authors.forename: Takaharu
authors.initials: T
authors.lastname: Oue
authors.affiliation: Japanese Study Group for Pediatric Liver Tumor.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Iehara
authors.affiliation: Japanese Study Group for Pediatric Liver Tumor.
authors.forename: Ken
authors.initials: K
authors.lastname: Hoshino
authors.affiliation: Japanese Study Group for Pediatric Liver Tumor.
authors.forename: Katsuyoshi
authors.initials: K
authors.lastname: Koh
authors.affiliation: Japanese Study Group for Pediatric Liver Tumor.
authors.forename: Yukichi
authors.initials: Y
authors.lastname: Tanaka
authors.affiliation: Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, 734-8551, Japan.
authors.forename: Sho
authors.initials: S
authors.lastname: Kurihara
authors.affiliation: Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, 734-8551, Japan.
authors.forename: Yuka
authors.initials: Y
authors.lastname: Ueda
authors.affiliation: Department of Pediatric Surgery, Hiroshima University Hospital, Hiroshima, 734-8551, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Onitake
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D002945:Cisplatin / Q000008:administration & dosage; D002985:Clinical Protocols; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000008:administration & dosage / Q000031:analogs & derivatives; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D018197:Hepatoblastoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage; D007223:Infant; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D008297:Male; D020360:Neoadjuvant Therapy; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D005047:Etoposide; D004317:Doxorubicin; D016190:Carboplatin; C027260:pirarubicin; D002945:Cisplatin; D007069:Ifosfamide
keywords: Chemoresponsiveness; Hepatoblastoma; Outcome; RECIST; Resectability