Cancer Research and Treatment

Original Articles

Pediatric cancer

Malignant Hepatocellular Neoplasm, Not Otherwise Specified, Displays Poorer Chemoresponsiveness and Postoperative Prognosis Than Hepatoblastoma: In Hye Song, Sujin Gang, Hee Mang Yoon, Pyeong Hwa Kim, Bokyung Ahn, Jihun Kim, Deok Hoon Kim, Jung-Man Namgoong, Kyung-Nam Koh; Cancer Res Treat. 2026;58(2):642-655. Published online May 12, 2025; DOI: https://doi.org/10.4143/crt.2025.117

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Purpose
Malignant hepatocellular neoplasm, not otherwise specified (HCN-NOS) is a provisional diagnostic entity, characterised by intermediate or a combination of hepatoblastoma and pediatric hepatocellular carcinoma (p-HCC) features. We compared the characteristics of HCN-NOS with hepatoblastoma and p-HCC.
Materials and Methods
The records of 148 pediatric patients diagnosed with hepatocellular malignancy after resection were retrieved from the institutional database. Clinical parameters and histopathology slides were reviewed to re-establish each patient’s diagnosis. Molecular analyses were conducted in 37 patients.
Results
Patients were profiled as 21 (14.2%) with HCN-NOS, 109 (73.6%) with hepatoblastoma, and 18 (12.2%) with p-HCC. The median age was 8.6 years in HCN-NOS, 1.2 years in hepatoblastoma, and 7.9 years in p-HCC. Background liver disease was frequently observed in p-HCC (11/18, 61%) but infrequent in HCN-NOS (4/21, 19%) and hepatoblastoma (4/109, 3.7%). HCN-NOS presented with a more advanced PRETEXT stage (p=0.012), metastasis (p < 0.001), and lymphovascular invasion (p < 0.001) than hepatoblastoma and p-HCC. Patients with HCN-NOS received longer cycles of preoperative chemotherapy; however, they reported a lower decrease in serum alpha-fetoprotein and tumor size than hepatoblastoma (p=0.043, p=0.004, and p=0.044, respectively). HCN-NOS was an independent poor prognostic factor for event-free survival (hazard ratio, 4.968; 95% confidence interval, 2.004 to 12.32; p < 0.001).
Conclusion
The possibility of HCN-NOS should be considered in pediatric patients with liver cancer, especially those ≥ 5 years old with no background liver disease. Because HCN-NOS exhibits poor chemoresponsiveness and unfavourable postoperative prognosis, liver transplantation should be strongly considered.

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Conversion Hepatectomy After New FP Therapy for Malignant Hepatocellular Neoplasm, Not Otherwise Specified: A Case Report
Etsuko Moriyama, Hironori Koga, Takashi Niizeki, Hideki Iwamoto, Shigeo Shimose, Tomotake Shirono, Takahiko Tokushige, Masahito Nakano, Ryoko Kuromatsu, Toru Goto, Masaki Honda, Taizo Hibi, Yoshiki Mikami, Reiichiro Kondo, Jun Akiba, Takumi Kawaguchi
Hepatology Research.2026; 56(6): 1047. CrossRef

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Prognostic Value of POST-Treatment Extent of Tumor (POSTTEXT) System in Patients with Hepatoblastoma: Hana Jeong, Hee Mang Yoon, Pyeong Hwa Kim, Ah Young Jung, Young Ah Cho, Jin Seong Lee, Kyung-Nam Koh, Jung-Man Namgoong; Cancer Res Treat. 2025;57(4):1198-1206. Published online January 20, 2025; DOI: https://doi.org/10.4143/crt.2024.600

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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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Surgical management of biliary fistula following associating liver partition and portal vein ligation for staged hepatectomy in pediatric hepatoblastoma: a case report and literature review
Gang Shen, Yunpeng Zhai, Huashan Zhao, Rui Guo, Hongxiu Xu, Sai Huang, Shisong Zhang
Frontiers in Oncology.2025;[Epub] CrossRef

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Children’s Hepatic Tumors International Collaboration-Hepatoblastoma Stratification (CHIC-HS) System for Pediatric Patients with Hepatoblastoma: A Retrospective, Hospital-Based Cohort Study in South Korea: Pyeong Hwa Kim, Hyun Joo Shin, Hee Mang Yoon, Young Hun Choi, Jung-Man Namgoong, Dae Yeon Kim, Kyung-Nam Koh, Mi-Jung Lee, Haesung Yoon, Chuhl Joo Lyu, Jung Woo Han, Seung Min Hahn, Young Ah Cho; Cancer Res Treat. 2022;54(1):253-258. Published online March 24, 2021; DOI: https://doi.org/10.4143/crt.2021.265

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Purpose
In 2017, the Children’s Hepatic Tumors International Collaboration-Hepatoblastoma Stratification (CHIC-HS) system was introduced. We aimed to evaluate the accuracy of CHIC-HS System for the prediction of event-free survival (EFS) in Korean pediatric patients with hepatoblastoma.
Materials and Methods
This two-center retrospective study included consecutive Korean pediatric patients with histopathologically confirmed hepatoblastoma from March 1988 through September 2019. We compared EFS among four risk groups according to the CHIC-HS system. Discriminatory ability of CHIC-HS system was also evaluated using optimism-corrected C-statistics. Factors associated with EFS were explored using multivariable Cox regression analysis.
Results
We included 129 patients (mean age, 2.6±3.3 years; female:male, 63:66). The 5-year EFS rates in the very low, low, intermediate, and high-risk groups, according to the CHIC-HS system were 90.0%, 82.8%, 73.5%, and 51.3%, respectively. The CHIC-HS system aligned significantly well with EFS outcomes (p=0.004). The optimism-corrected C index of CHIC-HS was 0.644 (95% confidence interval [CI], 0.561 to 0.727). Age ≥ 8 (vs. age ≤ 2; hazard ratio [HR], 2.781; 95% CI, 1.187 to 6.512; p=0.018), PRE-Treatment EXTent of tumor (PRETEXT) stage IV (vs. PRETEXT I or II; HR, 2.774; 95% CI, 1.228 to 5.974; p=0.009), and presence of metastasis (HR, 2.886; 95% CI, 1.457 to 5.719; p=0.002), which are incorporated as the first three nodes in the CHIC-HS system, were independently associated with EFS.
Conclusion
The CHIC-HS system aligned significantly well with EFS outcomes in Korean pediatric patients with hepatoblastoma. Age group, PRETEXT stage, and presence of metastasis were independently associated with EFS.

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The importance of age as a prognostic predictor of childhood hepatoblastoma: an analysis of single-center childhood hepatoblastoma in China
Zhen Li, Hong Jiang, Yuan-Qi Wang, Wen-Qing Wang, Li-Bin Huang, Jun-Cheng Liu, Hong-Man Xue
BMC Pediatrics.2025;[Epub] CrossRef
Prognostic prediction of hepatoblastoma in children: development and validation of machine learning models—an SEER-based study
Jianfeng Luo, Kaikun Huang, Le Zheng, Long Li
Updates in Surgery.2025;[Epub] CrossRef
Prognostic Value of POST-Treatment Extent of Tumor (POSTTEXT) System in Patients with Hepatoblastoma
Hana Jeong, Hee Mang Yoon, Pyeong Hwa Kim, Ah Young Jung, Young Ah Cho, Jin Seong Lee, Kyung-Nam Koh, Jung-Man Namgoong
Cancer Research and Treatment.2025; 57(4): 1198. CrossRef
Elevated serum uric acid is associated with the risk of advanced staging and vascular involvement in patients with hepatoblastoma: a 14-year retrospective study
Yunlan Zhou, Jinning Li, Yanhui Ma, Mengjie Tang, Xiaojun Yuan, Lisong Shen
Frontiers in Oncology.2023;[Epub] CrossRef

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Pediatric Adenocarcinoma in Korea: A Multicenter Study: Hee-Beom Yang, Jung-Man Namgoong, Ki Hoon Kim, Dae Yeon Kim, Jinyoung Park, Hyun Beak Shin, Joong Kee Youn, Sanghoon Lee, Ji Won Lee, Sung Eun Jung, Jae Hee Chung, Yun-Mee Choe, Tae Gil Heo, In Geol Ho, Hyun-Young Kim; Cancer Res Treat. 2020;52(1):117-127. Published online June 3, 2019; DOI: https://doi.org/10.4143/crt.2019.092

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Purpose
Adenocarcinoma is an extremely rare malignancy in the pediatric population. Research regarding pediatric adenocarcinoma is very rare in Korea. This study aimed to investigate the clinical features of pediatric adenocarcinomas of various primary organ sites in Korea.
Materials and Methods
Pediatric patients under 18 years, diagnosed with adenocarcinoma of various sites between January 1995 and December 2016, were included. We retrospectively reviewed patient and tumor characteristics and calculated survival estimates, reported as 5-year survival rate and 95% confidence interval.
Results
Of 80 patients (median age, 15 years; range, 10 to 17 years), 37 (46.3%) were men, and 24 (30%) had a family history of cancer or underlying disease relevant to malignancy. The cancer locations were the colon and rectum (n=32), ovaries (n=18), stomach (n=15), lung (n=4), small bowel (n=1), and other sites (n=10). Totally, 54.8% patients (42/77) had stage 3 or 4 disease. The median follow-up period was 2.0 years (range, 0 to 20.4). The 5-year overall survival estimate for all patients, and for those with stomach, colorectal, ovarian, and other cancer sites were 57.9%±11.5%, 58.2%±25.7%, 41.5%±18.2%, 87.5%±16.2%, and 64.0%±34.4%, respectively. The 5-year survival rate differed significantly between categories of adenocarcinomas into gastrointestinal (GI) (44.7%) and non-GI adenocarcinomas (78.8%) (p=0.007). The 5-year survival rate also differed significantly according to carcinoembryonic antigen level (69.3% in < 3 ng/mL, 23.8% in > 3 ng/mL; p < 0.001).
Conclusion
In pediatric patients, adenocarcinomas arise from various organs and are often diagnosed at advanced stages. Large, prospective studies for their accurate clinical characteristics and prognostic factors are needed.

Citations

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Risk Stratification in Primary Gastric Malignancies in Children, Adolescents, and Young Adults: A SEER-Based Analysis
Stavros P. Papadakos, Ioannis Katsaros, Stamatina Vogli, Alexandra Argyrou, Ioannis Karniadakis, Ioannis A. Ziogas, Paraskevas Gkolfakis, Stamatios Theocharis, Dimitrios Schizas
Journal of Personalized Medicine.2026; 16(4): 198. CrossRef
Pretreatment level of circulating tumor cells is associated with lymph node metastasis in papillary thyroid carcinoma patients with ≤ 55 years old
Ming Yu, Jiaqin Deng, Yihua Gu, Yeqian Lai, Yuedong Wang
World Journal of Surgical Oncology.2025;[Epub] CrossRef
Early prediction of thyroid capsule invasion in papillary microcarcinoma using ultrasound-based deep learning models: a retrospective multicenter study
Lin Sui, Bojian Feng, Xiayi Chen, Zhiyan Jin, Xinying Zhu, Tian Jiang, Yuqi Yan, Yahan Zhou, Chen Chen, Jincao Yao, Min Lai, Lujiao Lv, Yifan Wang, Liping Wang, Cong Li, Lina Feng, Wenwen Yue, Daizhang Yu, Kaiyuan Shi, Vicky Yang Wang, Yang Zhang, Dong Xu
Insights into Imaging.2025;[Epub] CrossRef
Nomogram to predict central lymph node metastasis in papillary thyroid carcinoma
Dehui Qiao, Xian Deng, Ruichen Liang, Xu Li, Rongjia Zhang, Zhi Lei, Hui Yang, Xiangyu Zhou
Clinical & Experimental Metastasis.2024; 41(5): 613. CrossRef
Artificial intelligence–based prediction of cervical lymph node metastasis in papillary thyroid cancer with CT
Cai Wang, Pengyi Yu, Haicheng Zhang, Xiao Han, Zheying Song, Guibin Zheng, Guangkuo Wang, Haitao Zheng, Ning Mao, Xicheng Song
European Radiology.2023; 33(10): 6828. CrossRef
Primary lung adenocarcinoma in three adolescent patients affected by bone sarcomas
Luisella Righi, Alberto Righi, Simona Vatrano, Ida Rapa, Angela Listì, Jasna Metovic, Michele Rocca, Mariacristina Salone, Paolo Giovenali, Angelo Sidoni, Fabrizio Tabbò, Angelo Paolo Dei Tos, Marco Volante, Mauro Papotti
Virchows Archiv.2021; 478(6): 1125. CrossRef
Case Report: Primary Bilateral Minimally Invasive Adenocarcinoma of the Lungs in an 11-Year-Old Child: A Rare Case
Xing Lei, Yongfei Zheng, Guohua Zhang, Hailan Zheng
Frontiers in Surgery.2021;[Epub] CrossRef

10,649 View
247 Download
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