Neoadjuvant chemotherapy or upfront surgery in hepatoblastoma: A multicenter retrospective study

Background: We aimed to retrospectively investigate the role of neoadjuvant chemotherapy in low-risk patients with hepatoblastoma (HB) who underwent curative resection between February 2009 and December 2017. We also verified the feasibility of the risk stratification system to select the optimal patients for upfront resection. Procedure: We compared 5-year overall survival (OS) and event-free survival (EFS) between the upfront surgery (US) (n=26) and neoadjuvant chemotherapy (NC) (n=104) groups at three oncology centers in Beijing, China. To reduce the effect of covariate imbalances, propensity score matching (PSM) was used. We explored whether preoperative chemotherapy affected surgical outcomes and identified the risk factors for events and death, including resection margin status, PRETreatment EXTent of disease stages, age, sex, pathology classification, and α-fetoprotein levels. Results: The median follow-up period was 64 months (interquartile range 60–72). After PSM, 22 pairs of patients were identified and the patient characteristics were similar for all variables included in propensity score matching. In the US group, the 5-year EFS and OS rates were 81.8% and 86.3%, respectively. In the NC group, 5-year EFS and OS rates were 81.8% and 90.9%, respectively. No significant differences in EFS or OS were observed between the groups. Pathological classification was the only risk factor for death and disease progression, tumor recurrence, diagnosis of other malignant neoplasms, and death from any cause ( p =0.007 and p =0.032, respectively). Conclusion: Upfront resection can achieve long-term disease control in low-risk patients with resectable HB, thus reducing the cumulative toxicity of platinum-based chemotherapy drugs.