Infographic: Survival in children with hepatoblastoma and pulmonary metastatic disease at diagnosis based on extent of metastases and need for surgical clearance

Infographic · May 2026 · 2 min read

In brief

Multicenter study of 62 children with metastatic hepatoblastoma shows long-term survival is achievable regardless of pulmonary disease extent. Combination of chemotherapy and surgical metastasectomy successfully cleared lung metastases in 95% of patients, with similar outcomes whether disease was limited or extensive at diagnosis.

Children with hepatoblastoma and pulmonary metastases can achieve long-term survival regardless of metastatic burden extent (>10 vs ≤10 lesions).
95% of patients achieved pulmonary metastasis clearance through chemotherapy alone (54%) or combined with metastasectomy (46%), with similar survival outcomes.
Extensive pulmonary disease (>10 metastases) does not preclude curative treatment; aggressive multimodal therapy including metastasectomy is warranted.
All liver transplant recipients who underwent surgical clearance of metastatic disease were alive at follow-up, supporting aggressive surgical management.
Neoadjuvant chemotherapy combined with metastasectomy effectively clears pulmonary disease and enables long-term disease-free survival in metastatic hepatoblastoma.

Written by the GCMD Library team from the infographic.

The infographic uses a teal, purple, yellow, and gray color scheme with illustrated icons of a hospital building, liver, lungs, and liver transplant. Content is organized in distinct colored blocks with bullet points and key statistics highlighted in large yellow text. The layout flows from top to bottom with study design, patient cohort details, methods, key findings, and conclusion sections.

Stephanie F Polites, Robert A Vierkant, Jennifer H Aldrink, Timothy B Lautz, Mecklin V Ragan, Audra Reiter, Stephanie Y Chen, Eugene S Kim, Hannah N Rinehardt, Marcus Malek, Andrew M Fleming, Andrew J Murphy, Jonathan P Roach, Sridharan Radhakrishnan, Nelson Piche, Yasmin Osman, Harold N Lovvorn 3rd, Elisabeth T Tracy, Juan Favela, Hau D Le, John Marquart, Brian Craig, Dave R Lal, Natashia Seemann, Robin Petroze, Barrie S Rich, Richard D Glick, Leigh Selesner, Ashley Yoo, Elizabeth Fialkowski, Erin G Brown, Chloe Boehmer, Roshni Dasgupta, Max R Langham Jr, Gregory M Tiao, Zachary J Kastenberg

Purpose: This study analyzed the effect of pulmonary metastatic burden at diagnosis and response to chemotherapy on disease-free and overall survival in patients with hepatoblastoma (HB), hypothesizing that long-term survival can be achieved in the setting of extensive pulmonary metastatic disease requiring metastasectomy.

Methods: An analysis of a multicenter dataset including children with HB and pulmonary metastatic disease at diagnosis was performed. Patients who presented with >10 pulmonary metastases were defined as having extensive metastatic disease. Kaplan Meier and univariate Cox Proportional Hazards analyses assessed disease-free survival (DFS) and overall survival (OS), analyzing the effect of pulmonary metastatic disease extent and modality of clearance.

Results: Among 315 patients with HB, pulmonary metastatic disease at diagnosis (n = 62) was associated with poorer DFS and OS (both p > 0.05). Of patients with pulmonary metastases, 23 (37 %) had extensive disease. Clearance of metastases occurred in 59 (95 %) patients: 32 (54 %) with chemotherapy alone and 27 (46 %) with chemotherapy and metastasectomy. Survival was similar between patients with >10 vs. ≤10 lung metastases and between those who had clearance of lung metastases by chemotherapy alone vs. chemotherapy and metastasectomy (all p > 0.05). Among 16 patients who required liver transplantation, all patients who underwent surgical clearance of metastatic disease were alive at last follow-up.

Conclusion: Among patients with HB who had pulmonary metastatic disease at diagnosis, long-term survival is possible regardless of the extent of pulmonary disease. A combination of neoadjuvant chemotherapy and metastasectomy can be utilized to achieve lung clearance.

The text in the image

Survival in Children with Hepatoblastoma and Pulmonary Metastatic Disease at Diagnosis Based on Extent of Metastases and Need for Surgical Clearance | Multicenter retrospective cohort study | 315 patients with hepatoblastoma | 62 patients w/ lung metastases at dx | 37% had >10 lung metastases | Methods: | chemotherapy alone 54% | chemotherapy + surgical metastasectomy 46% | Lung metastases at diagnosis were linked to worse overall survival compared to localized disease | Extent of lung metastases (>10 vs ≤10) did NOT change survival | Survival was similar whether lung disease was cleared with chemotherapy alone or surgery | 16 patients required liver transplantation | Conclusion: Children with hepatoblastoma and lung metastases can still achieve long-term survival—even with extensive pulmonary disease. | https://pubmed.ncbi.nlm.nih.gov/41747957/ | Polites SF et. al. | Department of Surgery | Rochester, MN, USA | @LizzyPAC8 | @globalcastmd | @StayCurrentMD | Cincinnati Children's