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Analysis of risk factors for angiolymphatic invasion and establishment of a predictive nomogram for hepatoblastomas

  • Author Footnotes
    1 These authors contributed equally to this work.
    Meng Ke
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Beijing, Chaoyang District 100020, People's Republic of China

    Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Yan Zhou
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Beijing, Chaoyang District 100020, People's Republic of China

    Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China
    Search for articles by this author
  • Chang-zhen Yang
    Affiliations
    Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Beijing, Chaoyang District 100020, People's Republic of China

    Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China
    Search for articles by this author
  • Long Li
    Correspondence
    Corresponding authors at: Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Beijing, Chaoyang District 100020, People's Republic of China.
    Affiliations
    Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Beijing, Chaoyang District 100020, People's Republic of China

    Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China
    Search for articles by this author
  • Mei Diao
    Correspondence
    Corresponding authors at: Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Beijing, Chaoyang District 100020, People's Republic of China.
    Affiliations
    Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Beijing, Chaoyang District 100020, People's Republic of China

    Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China
    Search for articles by this author
  • Author Footnotes
    1 These authors contributed equally to this work.

      Abstract

      Background

      Hepatoblastomas (HBs)are malignant liver tumors that most commonly develop in pediatric patients. Although lymph node metastasis is rare in HBs, angiolymphatic invasion (ALI) is a risk factor affecting the prognosis of HBs. This study aimed to evaluate the risk factors for angiolymphatic invasion in HBs.

      Methods

      We retrospectively analyzed the clinical data of 165 patients with HBs who underwent surgical resection at our institution between March 2016 and May 2021 and established binary logistic regression models to predict risk factors for ALI. The R software was used to construct the nomogram.

      Results

      For the regression model based on the Children's Hepatic Tumors International Collaboration–Hepatoblastoma Stratification (CHIC–HS) system, tumor diameter, tumor response to neoadjuvant chemotherapy (NACT), and CHIC–HS were identified as independent risk factors for angiolymphatic invasion. For the regression model based on the pretreatment extent of the tumor (PRETEXT) stages with annotation factors, tumor diameter, multifocality, macrovascular involvement, tumor response to NACT, and PRETEXT stages were identified as independent risk factors for angiolymphatic invasion.

      Conclusions

      Using the CHIC–HS system/PRETEXT stages with annotation factors, tumor diameter and tumor response to NACT were identified as independent risk factors for angiolymphatic invasion. The distance between the tumor and portal vein was negatively correlated with the occurrence of multifocal tumors.

      Level of evidence

      Level III.

      Keywords

      Abbreviations:

      AFP (alpha-fetoprotein), ALI (angiolymphatic invasion), AUC (area under the roc curve), BMI (body mass index), CHIC–HS (children's hepatic tumors international collaboration–hepatoblastoma stratification), COG (children's oncology group), CT (computed tomography), HB (hepatoblastoma), MRI (magnetic resonance imaging), NACT (neoadjuvant chemotherapy), PD (progressive disease), PHITT (Pediatric Hepatic International Tumor Trial), PRETEXT (pretreatment extent of the tumor), POSTTEXT (posttreatment extent of disease), ROC (receiver operating characteristic curve), SCUD (small cell undifferentiated), SD (stable disease), SIOPEL (International Childhood Liver Tumors Strategy Group)
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