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Journal of Peking University (Health Sciences) ›› 2021, Vol. 53 ›› Issue (1): 200-203. doi: 10.19723/j.issn.1671-167X.2021.01.030

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Therapeutic effect and clinical cost of multi-disciplinary team model of hepatoblastoma in children

GAO Yang-xu1,SUN Qing2,LI Hui1,XIE Yao2,YAO Hong-xin1,ZHAO Wei-hong2,Δ()   

  1. 1. Department of Pediatric Surgery, Peking University First Hospital, Beijing 100034, China
    2. Department of Pediatrics, Peking University First Hospital, Beijing 100034, China
  • Received:2020-07-31 Online:2021-02-18 Published:2021-02-07
  • Contact: Wei-hong ZHAO E-mail:zhaowh3212@126.com

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Abstract:

Objective: To summarize and analyze the treatment process, long-term efficacy and clinical economics of children’s hepatoblastoma (HB) in multi-disciplinary team (MDT) mode, so as to provide basis for the rational choice of diagnosis and treatment.Methods: From January 2014 to February 2019, 13 cases of hepatoblastoma in children who completed the whole treatment course in the Pediatric Hematology Tumor Ward of Peking University First Hospital were collected and analyzed, and were followed up until June 30, 2020. There were 9 males and 4 females who were diagnosed and treated according to the MDT process in the hospital. The median age was 16 months (2-54 months), 69.23% (9/13) were under 2 years old. The characteristics, diagnosis and treatment process and treatment effect of the cases were summarized, and the cost of clinical treatment was analyzed.Results: According to the pretreatment extent of disease(PRETEXT), there were 1, 9 and 3 children with stages Ⅱ, Ⅲ and Ⅳ. 76.92% (10/13) of the patients had the largest tumor diameter > 10 cm. All the patients received preoperative neoadjuvant chemotherapy (8 patients received 4 cycles of chemotherapy, and 6 patients changed the chemotherapy plan), surgical treatment and postoperative chemotherapy, the tumor volume decreased by more than 50% (64%-95%) in 12 cases, except 1 case with no significant increase of alpha fetal protein and multiple lesions .The median length of stay was 87 days (68-214 days), the median cost of stay was 200 000 yuan (115 000-500 000 yuan), the median length of stay was 7 days (5-17 days), the median cost of stay was 20 000 yuan (15 000-60 000 yuan), and the incidence of postoperative complications was 7.69% (1/13). All the patients were followed up for 16-69 months. All the patients survived.Conclusion: Under the MDT mode, the treatment is seamless connection, the long-term prognosis of children with HB is good, and the total hospitalization cost and time are within the acceptable range. Standard preoperative neoadjuvant chemotherapy can significantly reduce the tumor, improve the resection rate, reduce postoperative complications, reduce the total individual expenditure, shorten the total hospital stay, and further improve the long-term disease-free survival rate.

Key words: Hepatoblastoma, Multi-disciplinary team model, Clinical economic expenditure

CLC Number: 

  • R726.5

Table 1

Clinical data of 13 children with hepatoblastoma"

Items Cases,n
Gender
Male 9
Female 4
Age/years
≥2 4
<2 9
Diagnosis
Clinical 10
Pathological 3
Pathology
Epithelial 8
Mixed 5
Tumor diameter/cm
5-10 3
>10 10
Pulmonary metastasis 0
Vascular invasion 1
AFP≤100 μg/L 1
PRETEXT stage
Ⅱ 1
Ⅲ 9
Ⅳ 3
NACT cycle
2 2
3 3
4 8
NACT adjust 6
Reduce tumor volume
≥50% 12
<50% 1
Microscopically positive resection margin 2
Postoperative complications 1
[1] 王焕民. 小儿肝母细胞瘤的诊断与治疗[J]. 中华实用儿科临床杂志, 2013,28(3):166-167.
[2] 中国抗癌协会小儿肿瘤专业委员会. 儿童肝母细胞瘤多学科诊疗专家共识(CCCG-HB-2016)[J]. 中华小儿外科杂志, 2017,38(10):733-773.
[3] Venkatramani R, Stein JE, Sapra A, et al. Effect of neoadjuvant chemotherapy on resectability of stage Ⅲ and Ⅳ hepatoblastoma[J]. Br J Surg, 2015,102(1):108-113.
doi: 10.1002/bjs.9681 pmid: 25349947
[4] 王希思, 杨维, 黄程, 等. 儿童肝母细胞瘤的临床特征和治疗效果评价[J]. 首都医科大学学报, 2019,40(2):169-173.
[5] 孙静静, 高举. 儿童肝母细胞瘤的诊治进展[J]. 中华实用儿科临床杂志, 2017,32(15):1195-1197.
[6] Meyers R L, Maibach R, Hiyama E, et al. Risk-stratified staging in paediatric hepatoblastoma: a unified analysis from the children’s hepatictumors international collaboration[J]. Lancet Oncol, 2017,18(1):122.
doi: 10.1016/S1470-2045(16)30598-8 pmid: 27884679
[7] 国家统计局. 2015—2019年全国居民人均可支配收入[DB/OL]. (2020-01-17)[2020-07-07]. .
[8] Sunil BJ, Palaniappan R, Venkitaraman B, et al. Surgical resection for hepatoblastoma updated survival outcomes[J]. J Gastro-intest Canc, 2018,49(4):493-496.
[9] Aronson DC, Weeda VB, Maibach R, et al. Microscopically positive resection margin after hepatoblastoma resection: what is the impact on prognosis? A Childhood Liver Tumours Strategy Group (SIOPEL) report[J]. Eur J Cancer, 2019,106:126-132.
doi: 10.1016/j.ejca.2018.10.013 pmid: 30528797
[1] . [J]. Journal of Peking University(Health Sciences), 2017, 49(5): 924-926.
[2] . [J]. Journal of Peking University(Health Sciences), 0, (): 0-0.
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[1] . [J]. Journal of Peking University(Health Sciences), 2009, 41(4): 456 -458 .
[2] . [J]. Journal of Peking University(Health Sciences), 2009, 41(2): 125 -128 .
[3] . [J]. Journal of Peking University(Health Sciences), 2009, 41(1): 52 -55 .
[4] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 310 -314 .
[5] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 323 -328 .
[6] . [J]. Journal of Peking University(Health Sciences), 2007, 39(3): 329 -332 .
[7] . [J]. Journal of Peking University(Health Sciences), 2007, 39(4): 341 .
[8] . [J]. Journal of Peking University(Health Sciences), 2007, 39(4): 355 -360 .
[9] . [J]. Journal of Peking University(Health Sciences), 2007, 39(4): 365 -368 .
[10] . [J]. Journal of Peking University(Health Sciences), 2007, 39(4): 385 -387 .
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