Prognostic Value of POST-Treatment Extent of Tumor (POSTTEXT) System in Patients with Hepatoblastoma.

IF 3.8 2区医学 Q2 ONCOLOGY Cancer Research and Treatment Pub Date : 2025-10-01 Epub Date: 2025-01-20 DOI:10.4143/crt.2024.600

Hana Jeong, Hee Mang Yoon, Pyeong Hwa Kim, Ah Young Jung, Young Ah Cho, Jin Seong Lee, Kyung-Nam Koh, Jung-Man Namgoong

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Abstract

Purpose: This study aimed to assess prognostic values of the POST-Treatment Extent of tumor (POSTTEXT) system and clinical factors after neoadjuvant chemotherapy in hepatoblastoma patients and evaluate benefits of post-treatment imaging and clinical factors concomitant with Children's Hepatic Tumors International Collaboration-Hepatoblastoma Stratification (CHIC-HS) system.

Materials and methods: This single-center retrospective study of hepatoblastoma cases (2006-2022) included pediatric patients receiving ≥ 4 cycles of neoadjuvant chemotherapy, with pre- and post-treatment imaging and complete medical records. Clinical data included age, sex, and serum α-fetoprotein (AFP) levels. Cox regression analyses identified predictors of event-free survival (EFS). Time-dependent receiver operating characteristic curves assessed the predictive power of combining the CHIC-HS risk stratification with post-treatment factors. Inter-reader agreement was analyzed using weighted kappa.

Results: Among the 109 hepatoblastoma patients, 73 (mean age, 2.2±2.7 years) met the inclusion criteria. Prognostic factors for EFS included AFP levels after the fourth cycle of neoadjuvant chemotherapy (hazard ratio [HR], 1.233; 95% confidence interval [CI], 1.086 to 1.400; p=0.001), tumor size change ratio (HR, 0.654; 95% CI, 0.448 to 0.955; p=0.030), and POSTTEXT annotation factor M (HR, 5.209; 95% CI, 1.639 to 16.553; p=0.005). Incorporating AFP levels after the fourth cycle of neoadjuvant chemotherapy into the CHIC-HS improved predictive power (p=0.043). POSTTEXT system showed better inter-reader agreement than PRE-Treatment Extent of tumor (PRETEXT).

Conclusion: Predictors of EFS in hepatoblastoma include AFP levels after the fourth cycle of neoadjuvant chemotherapy, tumor size change ratio, and metastasis (POSTTEXT M). Combining AFP levels after the fourth cycle of neoadjuvant chemotherapy to the CHIC-HS improved the predictive ability.

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肝母细胞瘤患者治疗后肿瘤范围（POSTTEXT）系统的预后价值。

目的：评价肝母细胞瘤患者新辅助化疗后肿瘤治疗后范围（POSTTEXT）系统及临床因素的预后价值，评价儿童肝肿瘤国际合作-肝母细胞瘤分层（CHIC-HS）系统治疗后影像学及临床因素的获益。材料和方法：本研究为肝母细胞瘤病例（2006-2022）的单中心回顾性研究，纳入了接受≥4个周期新辅助化疗的儿科患者，这些患者有治疗前和治疗后的影像和完整的医疗记录。临床资料包括年龄、性别和血清甲胎蛋白（AFP）水平。Cox回归分析确定了无事件生存期（EFS）的预测因子。时间相关的受试者工作特征曲线评估了chc - hs风险分层与治疗后因素相结合的预测能力。使用加权kappa分析读者间协议。结果：109例肝母细胞瘤患者中，73例（平均年龄：2.2±2.7岁）符合纳入标准。EFS的预后因素包括新辅助化疗第四个周期后的AFP水平(HR, 1.233；95% ci, 1.806-1.400；p=0.001)，肿瘤大小变化率(HR, 0.654；95% ci, 0.448-0.955；p=0.03)、POSTTEXT标注因子M (HR, 5.209；95% ci, 1.639-16.553；p = 0.005)。将新辅助化疗第4周期后的AFP水平纳入CHIC-HS可提高预测能力（p=0.043）。POSTTEXT系统比托辞系统表现出更好的读者间一致性。结论：肝母细胞瘤EFS的预测因子包括新辅助化疗第4周期后AFP水平、肿瘤大小变化率和转移（POSTTEXT M），将新辅助化疗第4周期后AFP水平与CHIC-HS结合可提高预测能力。

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来源期刊

Cancer Research and Treatment ONCOLOGY-

CiteScore

8.00

自引率

2.20%

发文量

126

审稿时长

>12 weeks

期刊介绍： Cancer Research and Treatment is a peer-reviewed open access publication of the Korean Cancer Association. It is published quarterly, one volume per year. Abbreviated title is Cancer Res Treat. It accepts manuscripts relevant to experimental and clinical cancer research. Subjects include carcinogenesis, tumor biology, molecular oncology, cancer genetics, tumor immunology, epidemiology, predictive markers and cancer prevention, pathology, cancer diagnosis, screening and therapies including chemotherapy, surgery, radiation therapy, immunotherapy, gene therapy, multimodality treatment and palliative care.