The importance of age as prognostic factor for the outcome of patients with hepatoblastoma: Analysis from the Children's Hepatic tumors International Collaboration (CHIC) database

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  • Beate Haeberle
    Division of Pediatric Surgery University of Munich Munich Germany
  • Arun Rangaswami
    Division of Pediatric Hematology and Oncology University of California San Francisco San Francisco California
  • Mark Krailo
    Department of Preventive Medicine University of Southern California California Los Angeles
  • Piotr Czauderna
    Department of Surgery for Children and Adolescents Medical University of Gdansk Gdansk Poland
  • Eiso Hiyama
    Department of Pediatric Surgery Hiroshima University Hiroshima Japan
  • Rudolf Maibach
    IBCSG Coordinating Center Bern Switzerland
  • Dolores Lopez‐Terrada
    Department of Pathology and Immunology Baylor College of Medicine Houston Texas
  • Daniel C. Aronson
    Department of Pediatric Surgery University Children's Hospital Zurich Zurich Switzerland
  • Rita Alaggio
    Department of Pathology Bambino Gesu Pediatric Hospital Roma Italy
  • Marc Ansari
    Pediatric Department Onco‐Hematology Unit Geneva University Hospital Geneva Switzerland
  • Marcio H. Malogolowkin
    Division of Pediatric Hematology Oncology University of California Davis Comprehensive Cancer Center California Sacramento
  • Giorgio Perilongo
    Department of Pediatrics University of Padua Padua Italy
  • Allison F. O'Neill
    Department of Pediatric Oncology Dana‐Farber Cancer Institute Boston Children's Hospital and Harvard Medical School Boston Massachusetts
  • Angela D. Trobaugh‐Lotrario
    Department of Pediatric Hematology/Oncology Providence Sacred Heart Children's Hospital Spokane Washington
  • Kenichiro Watanabe
    Department of Hematology and Oncology Shizuoka Children's Hospital Shizuoka Japan
  • Irene Schmid
    Department of Pediatric Hematology and Oncology University of Munich Munich Germany
  • Dietrich von Schweinitz
    Division of Pediatric Surgery University of Munich Munich Germany
  • Sarangarajan Ranganathan
    Division of Pathology and Laboratory Medicine Cincinnati Children's Hospital Mediacla Center Cincinnati Ohio
  • Kenichi Yoshimura
    Innovative Clinical Research Center (iCREK) Kanazawa University Hospital Japan
  • Tomoro Hishiki
    Department of Pediatric Surgery Chiba University Graduate School of Medicine Chiba Japan
  • Yukichi Tanaka
    Department of Pathology Kanagawa Children's Medical Center Yokohama Japan
  • Jin Piao
    Department of Preventive Medicine University of Southern California California Los Angeles
  • Yurong Feng
    Children's Oncology Group Los Angeles California
  • Eugenia Rinaldi
    CINECA Bologna Italy
  • Davide Saraceno
    CINECA Bologna Italy
  • Marisa Derosa
    CINECA Bologna Italy
  • Rebecka L. Meyers
    Division of Pediatric Surgery University of Utah School of Medicine Utah Salt Lake City

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<jats:title>Abstract</jats:title><jats:sec><jats:title>Purpose</jats:title><jats:p>Treatment outcomes for hepatoblastoma have improved markedly in the contemporary treatment era, principally due to therapy intensification, with overall survival increasing from 35% in the 1970s to 90% at present. Unfortunately, these advancements are accompanied by an increased incidence of toxicities. A detailed analysis of age as a prognostic factor may support individualized risk‐based therapy stratification.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We evaluated 1605 patients with hepatoblastoma included in the CHIC database to assess the relationship between event‐free survival (EFS) and age at diagnosis. Further analysis included the age distribution of additional risk factors and the interaction of age with other known prognostic factors.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Risk for an event increases progressively with increasing age at diagnosis. This pattern could not be attributed to the differential distribution of other known risk factors across age. Newborns and infants are not at increased risk of treatment failure. The interaction between age and other adverse risk factors demonstrates an attenuation of prognostic relevance with increasing age in the following categories: metastatic disease, AFP < 100 ng/mL, and tumor rupture.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Risk for an event increased with advancing age at diagnosis. Increased age attenuates the prognostic influence of metastatic disease, low AFP, and tumor rupture. Age could be used to modify recommended chemotherapy intensity.</jats:p></jats:sec>

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