Prognosis of Pulmonary Metastasis in Pediatric Hepatoblastoma

Background Hepatoblastoma is the most common primary malignant liver tumor in children and 20% patients have pulmonary metastasis at diagnosis, which highly accepted abnormal AFP as the marker of diagnosis and recurrence, but no one pays attention to other serum markers. Methods Clinical data and serological markers were collected from pediatric HB patients who received systematic treatment at our hospital. Multivariate logistic regression was performed to identify independent risk factors for pulmonary metastasis in HB. Cox proportional hazards regression was further applied to analyze prognostic factors in the pulmonary metastasis group. Results A total of 146 HB patients were included in this study, comprising 117 non-metastasis cases and 29 pulmonary metastasis cases. Subgroup analysis of the 28 pulmonary metastasis cases showed that presence of extrapulmonary metastasis and pulmonary metastasis resection were significant prognostic factors. Cox regression analysis further indicated that Initial D-D/FIB >1.6, GPR >1.35, postoperative 1-month AFP >324.4 ng/ml, postoperative 2-month AFP >185.9 ng/ml, presence of extrapulmonary metastasis were prognostic risk factors. Conclusions The pulmonary metastasis group showed significantly lower OS and EFS compared to the non-metastasis group. Multifocal liver tumors, initial tumor diameter >10cm, and vascular tumor thrombus were identified as independent risk factors for pulmonary metastasis in HB. Additionally, presence of extrapulmonary metastasis, postoperative 1-month AFP and postoperative 2-month AFP were independent prognostic predictors for HB patients with pulmonary metastasis. Serological markers may serve as valuable indicators for monitoring disease progression and guiding prognosis in HB with pulmonary metastasis.