Analysis of national and single-center incidence and survival after liver transplantation for hepatoblastoma

New trends and future opportunities

Ruy J. Cruz, Sarangarajan Ranganathan, George Mazariegos, Kyle Soltys, Navdeep Nayyar, Qing Sun, Geoffrey Bond, Peter Shaw, Kimberly Haberman, Lakshmanan Krishnamurti, J. Wallis Marsh, Abhinav Humar, Rakesh Sindhi

Research output: Contribution to journalArticle

Abstract

Background: Liver transplantation (LTx) for hepatoblatoma appears to be increasing. Favorable tumor histology is increasingly linked to survival after surgical resection and could also determine posttransplantation outcomes. Methods: To evaluate national trends in tumor and LTx incidence as the basis for observations at some LTx centers, and determinants of survival after LTx for hepatoblastoma, we queried the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) registry representing 9.451% of the U.S. population (1975-2007), the United Network for Organ Sharing (UNOS, 1988-2010, n = 332), and Children's Hospital of Pittsburgh database (CHP, 1987-2011, n = 35). Results: In the United States, hepatoblastoma cases increased 4-fold, LTx for hepatoblastoma increased 20-fold, and hepatoblastoma surpassed other unresectable liver malignancies requiring LTx by nearly 3-fold. Actuarial 5-year patient survival exceeded 75%. Recurrences in 16% were greater after segmental LTx in the total U.S. experience (P =.049). At CHP, 5 children died from recurrences (n = 4) and sepsis (n = 1). Tumors were epithelial (57%) or mixed epithelial-stromal (42%), Children's Oncology Group stage III (77%) or IV (23%). Recurrences were related to previous pulmonary metastases (P =.016), and tumor necrosis <50% (P =.013), but not to small cell undifferentiated tumor histology (P = NS). Hepatic artery thrombosis was more common after LTx for hepatoblastoma compared with nonmalignant indications (P =.0089). Thirty-three children received pre-LTx chemotherapy, 88.6% with cisplatin, and 85.7% received post-LTx chemotherapy. Conclusion: Outcomes after LTx for hepatoblastoma may benefit from improved detection and treatment of pretransplantation metastases, adequate tumor lysis after chemotherapy, and perioperative antithrombotic agents but are unaffected by undifferentiated tumor histology.

Original languageEnglish (US)
Pages (from-to)150-159
Number of pages10
JournalSurgery (United States)
Volume153
Issue number2
DOIs
StatePublished - Feb 2013
Externally publishedYes

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Hepatoblastoma
Liver Transplantation
Survival
Incidence
Neoplasms
Histology
Recurrence
Drug Therapy
Neoplasm Metastasis
Fibrinolytic Agents
National Cancer Institute (U.S.)
Hepatic Artery
Cisplatin
Registries
Sepsis
Epidemiology
Thrombosis
Necrosis
Databases
Lung

ASJC Scopus subject areas

  • Surgery

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Analysis of national and single-center incidence and survival after liver transplantation for hepatoblastoma : New trends and future opportunities. / Cruz, Ruy J.; Ranganathan, Sarangarajan; Mazariegos, George; Soltys, Kyle; Nayyar, Navdeep; Sun, Qing; Bond, Geoffrey; Shaw, Peter; Haberman, Kimberly; Krishnamurti, Lakshmanan; Marsh, J. Wallis; Humar, Abhinav; Sindhi, Rakesh.

In: Surgery (United States), Vol. 153, No. 2, 02.2013, p. 150-159.

Research output: Contribution to journalArticle

Cruz, RJ, Ranganathan, S, Mazariegos, G, Soltys, K, Nayyar, N, Sun, Q, Bond, G, Shaw, P, Haberman, K, Krishnamurti, L, Marsh, JW, Humar, A & Sindhi, R 2013, 'Analysis of national and single-center incidence and survival after liver transplantation for hepatoblastoma: New trends and future opportunities', Surgery (United States), vol. 153, no. 2, pp. 150-159. https://doi.org/10.1016/j.surg.2012.11.006
Cruz, Ruy J. ; Ranganathan, Sarangarajan ; Mazariegos, George ; Soltys, Kyle ; Nayyar, Navdeep ; Sun, Qing ; Bond, Geoffrey ; Shaw, Peter ; Haberman, Kimberly ; Krishnamurti, Lakshmanan ; Marsh, J. Wallis ; Humar, Abhinav ; Sindhi, Rakesh. / Analysis of national and single-center incidence and survival after liver transplantation for hepatoblastoma : New trends and future opportunities. In: Surgery (United States). 2013 ; Vol. 153, No. 2. pp. 150-159.
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title = "Analysis of national and single-center incidence and survival after liver transplantation for hepatoblastoma: New trends and future opportunities",
abstract = "Background: Liver transplantation (LTx) for hepatoblatoma appears to be increasing. Favorable tumor histology is increasingly linked to survival after surgical resection and could also determine posttransplantation outcomes. Methods: To evaluate national trends in tumor and LTx incidence as the basis for observations at some LTx centers, and determinants of survival after LTx for hepatoblastoma, we queried the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) registry representing 9.451{\%} of the U.S. population (1975-2007), the United Network for Organ Sharing (UNOS, 1988-2010, n = 332), and Children's Hospital of Pittsburgh database (CHP, 1987-2011, n = 35). Results: In the United States, hepatoblastoma cases increased 4-fold, LTx for hepatoblastoma increased 20-fold, and hepatoblastoma surpassed other unresectable liver malignancies requiring LTx by nearly 3-fold. Actuarial 5-year patient survival exceeded 75{\%}. Recurrences in 16{\%} were greater after segmental LTx in the total U.S. experience (P =.049). At CHP, 5 children died from recurrences (n = 4) and sepsis (n = 1). Tumors were epithelial (57{\%}) or mixed epithelial-stromal (42{\%}), Children's Oncology Group stage III (77{\%}) or IV (23{\%}). Recurrences were related to previous pulmonary metastases (P =.016), and tumor necrosis <50{\%} (P =.013), but not to small cell undifferentiated tumor histology (P = NS). Hepatic artery thrombosis was more common after LTx for hepatoblastoma compared with nonmalignant indications (P =.0089). Thirty-three children received pre-LTx chemotherapy, 88.6{\%} with cisplatin, and 85.7{\%} received post-LTx chemotherapy. Conclusion: Outcomes after LTx for hepatoblastoma may benefit from improved detection and treatment of pretransplantation metastases, adequate tumor lysis after chemotherapy, and perioperative antithrombotic agents but are unaffected by undifferentiated tumor histology.",
author = "Cruz, {Ruy J.} and Sarangarajan Ranganathan and George Mazariegos and Kyle Soltys and Navdeep Nayyar and Qing Sun and Geoffrey Bond and Peter Shaw and Kimberly Haberman and Lakshmanan Krishnamurti and Marsh, {J. Wallis} and Abhinav Humar and Rakesh Sindhi",
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T1 - Analysis of national and single-center incidence and survival after liver transplantation for hepatoblastoma

T2 - New trends and future opportunities

AU - Cruz, Ruy J.

AU - Ranganathan, Sarangarajan

AU - Mazariegos, George

AU - Soltys, Kyle

AU - Nayyar, Navdeep

AU - Sun, Qing

AU - Bond, Geoffrey

AU - Shaw, Peter

AU - Haberman, Kimberly

AU - Krishnamurti, Lakshmanan

AU - Marsh, J. Wallis

AU - Humar, Abhinav

AU - Sindhi, Rakesh

PY - 2013/2

Y1 - 2013/2

N2 - Background: Liver transplantation (LTx) for hepatoblatoma appears to be increasing. Favorable tumor histology is increasingly linked to survival after surgical resection and could also determine posttransplantation outcomes. Methods: To evaluate national trends in tumor and LTx incidence as the basis for observations at some LTx centers, and determinants of survival after LTx for hepatoblastoma, we queried the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) registry representing 9.451% of the U.S. population (1975-2007), the United Network for Organ Sharing (UNOS, 1988-2010, n = 332), and Children's Hospital of Pittsburgh database (CHP, 1987-2011, n = 35). Results: In the United States, hepatoblastoma cases increased 4-fold, LTx for hepatoblastoma increased 20-fold, and hepatoblastoma surpassed other unresectable liver malignancies requiring LTx by nearly 3-fold. Actuarial 5-year patient survival exceeded 75%. Recurrences in 16% were greater after segmental LTx in the total U.S. experience (P =.049). At CHP, 5 children died from recurrences (n = 4) and sepsis (n = 1). Tumors were epithelial (57%) or mixed epithelial-stromal (42%), Children's Oncology Group stage III (77%) or IV (23%). Recurrences were related to previous pulmonary metastases (P =.016), and tumor necrosis <50% (P =.013), but not to small cell undifferentiated tumor histology (P = NS). Hepatic artery thrombosis was more common after LTx for hepatoblastoma compared with nonmalignant indications (P =.0089). Thirty-three children received pre-LTx chemotherapy, 88.6% with cisplatin, and 85.7% received post-LTx chemotherapy. Conclusion: Outcomes after LTx for hepatoblastoma may benefit from improved detection and treatment of pretransplantation metastases, adequate tumor lysis after chemotherapy, and perioperative antithrombotic agents but are unaffected by undifferentiated tumor histology.

AB - Background: Liver transplantation (LTx) for hepatoblatoma appears to be increasing. Favorable tumor histology is increasingly linked to survival after surgical resection and could also determine posttransplantation outcomes. Methods: To evaluate national trends in tumor and LTx incidence as the basis for observations at some LTx centers, and determinants of survival after LTx for hepatoblastoma, we queried the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) registry representing 9.451% of the U.S. population (1975-2007), the United Network for Organ Sharing (UNOS, 1988-2010, n = 332), and Children's Hospital of Pittsburgh database (CHP, 1987-2011, n = 35). Results: In the United States, hepatoblastoma cases increased 4-fold, LTx for hepatoblastoma increased 20-fold, and hepatoblastoma surpassed other unresectable liver malignancies requiring LTx by nearly 3-fold. Actuarial 5-year patient survival exceeded 75%. Recurrences in 16% were greater after segmental LTx in the total U.S. experience (P =.049). At CHP, 5 children died from recurrences (n = 4) and sepsis (n = 1). Tumors were epithelial (57%) or mixed epithelial-stromal (42%), Children's Oncology Group stage III (77%) or IV (23%). Recurrences were related to previous pulmonary metastases (P =.016), and tumor necrosis <50% (P =.013), but not to small cell undifferentiated tumor histology (P = NS). Hepatic artery thrombosis was more common after LTx for hepatoblastoma compared with nonmalignant indications (P =.0089). Thirty-three children received pre-LTx chemotherapy, 88.6% with cisplatin, and 85.7% received post-LTx chemotherapy. Conclusion: Outcomes after LTx for hepatoblastoma may benefit from improved detection and treatment of pretransplantation metastases, adequate tumor lysis after chemotherapy, and perioperative antithrombotic agents but are unaffected by undifferentiated tumor histology.

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