Postsurgical Staging for Childhood Liver Cancer
A staging system based on operative findings and surgical resectability has been used in the United States to group children with liver cancer. This staging system is used to determine treatment.[11,12,13]
Hepatoblastoma prognosis by postsurgical stage
Stages I and II
In stage I hepatoblastoma, the tumor is completely resected.
In stage II hepatoblastoma, microscopic residual tumor remains after resection.
Approximately 20% to 30% of children with hepatoblastoma are stage I or II. Prognosis varies depending on the subtype of hepatoblastoma:
- Pure fetal histology (4% of hepatoblastomas) have a 3- to 5-year OS rate of 100% with minimal or no chemotherapy.[1,13,14]
- Non-pure fetal histology, non-small cell undifferentiated stage I and II hepatoblastomas have a 3- to 4-year OS rate of 90% to 100% with adjuvant chemotherapy.[1,6,8,13,15]
- If any small cell undifferentiated elements are present in stage I or II hepatoblastoma, the 3-year survival rate is 40% to 70%.[1,16]
In stage III hepatoblastoma, there are no distant metastases and one of the following is true:
- The tumor is either unresectable or the tumor is resected with gross residual tumor.
- There are positive lymph nodes.
Approximately 50% to 70% of children with hepatoblastoma are stage III. The 3- to 5-year OS rate for children with stage III hepatoblastoma is less than 70%.[1,6,8,13,17]
Stage IV (distant metastases)
In stage IV hepatoblastoma, there is distant metastasis regardless of the extent of liver involvement.
Approximately 10% to 20% of children with hepatoblastoma are stage IV. The 3- to 5-year OS rate for children with stage IV hepatoblastoma vary widely based on published reports, from 20% to approximately 60%.[1,6,7,8,13,17]
Hepatocellular carcinoma prognosis by postsurgical stage of disease at diagnosis
- Children with stage I hepatocellular carcinoma have a good outcome.
- Stage II is too rarely seen to predict outcome.
- Stages III and IV are usually fatal.[10,19]
Treatment Options Under Clinical Evaluation: COG Hepatoblastoma Risk Groups