Aggressive Pursuit of No Evidence of Disease (NED) Status in Hepatoblastoma Improves Survival | Observational study | 50 patients | Patients with hepatoblastoma from 2005 to 2021 | Primary outcomes: Overall Survival (OS) & Event-free (EFS) stratified by risk | NED status | 82% were NED (n=41) | NED was inversely correlated with 5-year mortality (p < .01) | 10-year OS and EFS were improved by achieving NED (p < .01) | 24 high-risk vs. 26 not high-risk patients | 10-year OS was similar (when NED was attained (P = .83)) | NED status: Normal AFP and absence of detectable radiographic disease on interval surveillance imaging after treatment | Conclusion: NED status is necessary for survival in hepatoblastoma. To achieve long-term survival in high-risk patients, repeated pulmonary metastasectomy and/or complex local control strategies are important. | https://doi.org/10.1016/j.jpedsurg.2023.02.022 | Source: Fleming AM & Murphy AJ et.al. | Department of Surgery, University of Tennessee Health Science Center & St. Jude Children's Research Hospital, Memphis, TN, USA | @EmTombash | @StayCurrentMD | Cincinnati Children's | Journal of Pediatric Surgery
Aggressive Pursuit of No Evidence of Disease Status in Hepatoblastoma Improves Survival: An Observational Study
Infographic · Aug 2023 · 1 min read
In brief
In brief
Retrospective study of 50 hepatoblastoma patients demonstrates that achieving no evidence of disease status through aggressive surgical intervention—including repeated pulmonary metastasectomies—significantly improves 10-year survival. High-risk patients achieved similar outcomes to standard-risk when NED was attained, supporting aggressive surgical strategies for local and metastatic disease control.
- Achieving no evidence of disease (NED) status dramatically reduces 5-year mortality in hepatoblastoma (OR 0.006, P<0.01).
- High-risk patients achieve similar 10-year survival to standard-risk when NED is attained through aggressive surgical intervention.
- Repeated pulmonary metastasectomy (median 2.5 procedures) enables long-term survival even in bilateral metastatic disease.
- 82% of hepatoblastoma patients were rendered NED through persistent surgical resection of residual and metastatic disease.
- Three of five high-risk relapsed patients were successfully salvaged, supporting continued aggressive treatment at recurrence.
Written by the GCMD Library team from the infographic.
The infographic uses a teal and yellow color scheme with illustrated figures including a healthcare provider, a liver diagram, and a parent with child. Key statistics are presented in large text with arrows connecting concepts. The layout flows from top to bottom, with the conclusion highlighted in a yellow banner at the bottom.
Andrew M. Fleming, Andrew J. Murphy, Suraj Sarvode Mothi, Rodrigo B. Interiano, Amos Loh, Mary E. McCarville, Zachary Abramson, Sara A. Mansfield, Hafeez Abdelhafeez, Andrew M. Davidoff, Ankush Gosain, Jessica A. Gartrell, Wayne L. Furman, Max R. Langham Jr.
Background: The utility of repeated surgical interventions in hepatoblastoma to achieve no evidence of disease (NED) is not well-defined. We examined the effect of aggressive pursuit of NED status on event-free (EFS) and overall survival (OS) in hepatoblastoma with subgroup analysis of high-risk patients.
Methods: Hospital records were queried for patients with hepatoblastoma from 2005 to 2021. Primary outcomes were OS and EFS stratified by risk and NED status. Group comparisons were performed using univariate analysis and simple logistic regression. Survival differences were compared with log-rank tests.
Results: Fifty consecutive patients with hepatoblastoma were treated. Forty-one (82%) were rendered NED. NED was inversely correlated with 5-year mortality (OR 0.006; CI 0.001–0.056;P < .01). Ten-year OS (P < .01) and EFS (P < .01) were improved by achieving NED. Ten-year OS was similar between 24 high-risk and 26 not high-risk patients when NED was attained (P = .83). Fourteen high-risk patients underwent a median of 2.5 pulmonary metastasectomies, 7 for unilateral disease, and 7 for bilateral, with a median of 4.5 nodules resected. Five high-risk patients relapsed, and three were salvaged.
Conclusions: NED status is necessary for survival in hepatoblastoma. Repeated pulmonary metastasectomy and/or complex local control strategies to obtain NED can achieve long-term survival in high-risk patients.