CORRELATION BETWEEN PRETEXT STAGING AND POST OPERATIVE OUTCOME OF HEPATIC RESECTION IN CHILDREN WITH HEPATOBLASTOMA ACCORDING TO SIOPEL PROTOCOL

Abstract

Background:

Hepatoblastoma, the most frequent paediatric malignant hepatic tumor, relies on cisplatin-based chemotherapy followed by complete surgical removal. Pretreatment evaluation by imaging is crucial to defining the extent of the disease, risk stratification, and treatment planning process, which directly affect surgical outcomes and patient survival (short and long term). This study evaluates the relationship between the postoperative outcome of hepatic resection and PRETEXT staging according to the SIOPEL protocol.

Aim of the study:

The study aims to evaluate the correlation between PRETEXT Staging and postoperative outcomes in children with hepatoblastoma according to the SIOPEL protocol.

Methods:

This prospective observational study was conducted in the Department of Paediatric Surgery, BSMMU, Dhaka, Bangladesh, from August 2021 to August 2023. A total of 12 children were enrolled in this study. Study variables were PRETEXT staging and annotation factors, pre and postoperative S. Alfa fetoprotein level, and sonographic estimation of local recurrence. Proper clinical history, physical examination and initial investigations were recorded, and all cases were staged according to pretreatment extent of disease (PRETEXT) system. They all received neoadjuvant chemotherapy according to SIOPEL protocol, followed by surgical resection and adjuvant chemotherapy. Statistical results were analysed using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22).

Results:

The median age was 22.50 months, with ranged from 10 to 75 months. Two-thirds (66.7%) of subjects were male. PRETEXT II comprises 66.7% of study subjects, whereas PRETEXT III was found 33.3%. No cases of PRETEXT I & IV were recorded. 66.7% of subjects had a positive annotation factor. The median S. alfa fetoprotein was 900.0 (ng/ml), 100.9 (ng/ml) and 4.2 (ng/ml) in preoperative, post operative 14 days and post operative three months respectively. Both the differences were statistically significant (p<0.05) with preoperative value. The median S. alfa fetoprotein found 1.65(ng/ml) in 6 months postoperative period which was statistically non-significant with preoperative value. Among cases with local recurrence median S. alfa fetoprotein at diagnosis, preoperative, 14 days postoperative, three months postoperative and six months postoperative period were 400000 ng/ml, 8249 ng/ml, 2000 ng/ml, 1000 ng/ml and 300000 ng/ml respectively. Among cases without local recurrence median S. alfa fetoprotein at diagnosis, preoperative, 14 days postoperative, three months postoperative, and six months postoperative period were 2000 ng/ml, 93.5 ng/ml, 8.5 ng/ml, 2.3 ng/ml and 1.3 ng/ml respectively. One-fourth (25.0%) of subjects had focal lesions at six months postoperative sonographic estimation. One-fourth (25.0%) of subjects had multifocality. Half of the subjects were involved in the caudate lobe. 12.5% of subjects had a recurrence in PRETEXT II with a 95% CI was 0 to 31.6. 50% of PRETEXT III cases were found with recurrence with a 95% CI of 1-99. 50% of multifocal cases were found with recurrence with 95% CI of 1-99. Only one case of multiple positive annotation factor (CF) was observed, and it experienced local recurrence with a 95% CI of 100. The mean postoperative hospital stay was 8.50±1.31 days.

Conclusion:

In children with hepatoblastoma, PRETEXT staging, along with annotation factors (CF and F), strongly predicted postoperative outcomes, particularly local recurrence.