An update on diagnosis and treatment of hepatoblastoma

Progress in the study of therapeutic strategies for hepatoblastoma in children

Hepatoblastoma (HB) is the most common primary malignant liver tumor in children, representing approximately 50% to 60% of pediatric liver cancers. It predominantly affects children under the age of 3 years, with a slightly higher incidence in boys compared to girls. The main pathological subtypes of HB are epithelial and mixed types. The etiology and pathogenesis are unclear and may be related to factors such as genetics and gene mutations. The diagnosis primarily relies on imaging examinations (including abdominal ultrasound, computed tomography, and magnetic resonance imaging) and serum alpha-fetoprotein testing. Treatment approaches include surgical resection, chemotherapy, and liver transplantation. Surgical resection is currently the only curative option, especially effective for early-stage localized tumors; chemotherapy can be used to shrink tumors before surgery or to manage their progression; liver transplantation is recommended for cases that cannot be surgically removed or for instances where the disease recurs after surgery. Recent advancements have encouraged a multidisciplinary approach to treatment, with ongoing research into new chemotherapeutic and targeted agents. Despite these developments, challenges remain, such as the need for more precise and individualized therapies, chemotherapy resistance that can lead to poor outcomes in some patients, and a shortage of organ donors, along with the risk of immune rejection after transplantation. A thorough synthesis of current therapeutic strategies will establish an evidence-based foundation to enhance the management of HB in children, ultimately improving prognosis and quality of life.

Incidence trends and a nomogram for predicting overall survival in children with hepatoblastoma: A population-based analysis

BACKGROUND

In recent years, the incidence of pediatric hepatoblastoma has increased significantly. The aims of our study were to analyze the incidence trends, identify independent risk factors affecting the prognosis, and create a nomogram based on these risk factors to guide clinical treatment.

METHODS

The Clinicopathological data from children diagnosed with hepatoblastoma between 2000 and 2018 were extracted from the SEER database to analyze the incidence trends. Independent risk factors were screened by COX, LASSO and BSR to construct a nomogram. X-tile software was used to determine the optimal threshold and to identify high-risk and low-risk groups. Kaplan-Meier method was used to draw the subgroup survival curve.

RESULTS

A total of 810 children with hepatoblastoma were included in this study. The APC was 1.6 % (95 % confidence interval [CI] -0.6 %-3.9 %, P < 0.05). Race, age, tumor size, type of surgery, and chemotherapy were independent risk factors. The time-varying AUC (>0.7) and time-varying c index (>0.7) indicate that nomogram has good discriminative ability. The calibration graphs show that the predicted results of the modal graphs are in good agreement with the actual observed results in the training and validation queues. In addition, DCA demonstrated the value of nomogram in clinical application and differentiation.

CONCLUSION

The incidence of hepatoblastoma in children has increased. We construct a nomogram to predict prognosis and guide treatment. The combination of surgery and chemotherapy is highly likely to extend survival and improve patient outcomes.

Rare Malignant Liver Tumors: Current Insights and Imaging Challenges

Rare malignant liver tumors (RMLTs) comprise a diverse group of neoplasms with distinct imaging features and significant diagnostic challenges due to their low prevalence and overlap with more common hepatic lesions. This review highlights the main radiologic characteristics of selected rare malignant liver tumors-including fibrolamellar hepatocellular carcinoma, hepatic lymphoma, hepatocellular carcinoma in non-cirrhotic liver, mucinous cystic neoplasm, intraductal papillary neoplasm of the bile duct, epithelioid hemangioendothelioma, angiosarcoma, malignant hepatic adenoma, neuroendocrine tumor, hepatocholangiocarcinoma, hepatoblastoma, undifferentiated embryonal sarcoma, and infantile hepatic hemangioendothelioma-focusing on their presentation in computed tomography and magnetic resonance imaging. Recognizing specific imaging findings, such as arterial hyperenhancement, biliary communication, target and lollipop signs, and tumor morphology, can help narrow differential diagnoses and guide appropriate clinical management. Despite advancements in imaging, histopathologic confirmation is often required due to nonspecific features. Improved radiologic awareness of these rare entities is essential to facilitate early diagnosis and individualized treatment planning.

International multidisciplinary consensus recommendations on clinical application of three-dimensional visualization in precision surgery for pediatric liver tumors

BACKGROUND

Pediatric liver tumors are predominantly primary malignant tumors, and complete tumor resection with sufficient preservation of liver tissue is crucial for improving prognosis. However, due to the delicate anatomical structure of the pediatric liver and the relatively large size of the tumors, especially in difficult cases, the surgical challenges are substantial. While precision liver surgery are widely applied in clinical practice, pediatric cases require more customized approaches. The application of three-dimensional (3D) visualization technology is crucial for enhancing surgical accuracy, allowing for precise preoperative planning and intraoperative guidance.

METHODS

This consensus was collaboratively developed by 36 experts from eight countries, using the Glaser's state-of-the-art method to review and refine the draft.

RESULTS

The final consensus resulted in 15 international multidisciplinary consensus recommendations on clinical application of 3D visualization in precision surgery for pediatric liver tumors.

CONCLUSION

This consensus will standardize the application of 3D visualization technology in precision surgery for pediatric liver tumors to improve outcomes and reduce risks.

Ginsenoside Rg1: A bioactive therapeutic agent for diverse liver diseases

Diverse liver diseases are characterised by late diagnosis and rapid progression and have become one of the major threats to human health. To delay the transition from benign tissue lesions to a substantial organ injury, scientists have gradually applied natural compounds derived from plants as a complementary therapy in the field of hepatology. Ginseng (Panax ginseng C. A. Meyer) is a tonic traditional Chinese herbal medicine, and natural products, including ginsenoside Rg1 (G-Rg1), which is a kind of 20(S)-protopanaxatriol saponin with a relatively high biological activity, can be isolated from the roots or stems of ginseng. Given these information, this review aimed to summarise and discuss the metabolic mechanisms of G-Rg1 in the regulation of diverse liver diseases and the measures to improve its bioavailability. As a kind of monomer in Chinese medicine with multitarget pharmacological effects, G-Rg1 can provide significant therapeutic benefits in the alleviation of alcoholic liver disease, nonalcoholic fatty liver disease, liver fibrosis, viral hepatitis, etc., which mainly rely on the inhibition of apoptosis, strengthening endogenous anti-inflammatory and antioxidant mechanisms, activation of immune responses and regulation of efflux transport signals, to improve pathological changes in the liver caused by lipid deposition, inflammation, oxidative stress, accumulation of hepatotoxic product, etc. However, the poor bioavailability of G-Rg1 must be overcome to improve its clinical application value. In summary, focusing on the hepatoprotective benefits of G-Rg1 will provide new insights into the development of natural Chinese medicine resources and their pharmaceutical products to target the treatment of liver diseases.

Characterization of an Activated Metabolic Transcriptional Program in Hepatoblastoma Tumor Cells Using scRNA-seq

Hepatoblastoma is the most common primary liver malignancy in children, with metabolic reprogramming playing a critical role in its progression due to the liver's intrinsic metabolic functions. Enhanced glycolysis, glutaminolysis, and fatty acid synthesis have been implicated in hepatoblastoma cell proliferation and survival. In this study, we screened for altered overexpression of metabolic enzymes in hepatoblastoma tumors at tissue and single-cell levels, establishing and validating a hepatoblastoma tumor expression metabolic score using machine learning. Starting from the Mammalian Metabolic Enzyme Database, bulk RNA sequencing data from GSE104766 and GSE131329 datasets were analyzed using supervised methods to compare tumors versus adjacent liver tissue. Differential expression analysis identified 287 significantly regulated enzymes, 59 of which were overexpressed in tumors. Functional enrichment in the KEGG metabolic database highlighted a network enriched in amino acid metabolism, as well as carbohydrate, steroid, one-carbon, purine, and glycosaminoglycan metabolism pathways. A metabolic score based on these enzymes was validated in an independent cohort (GSE131329) and applied to single-cell transcriptomic data (GSE180665), predicting tumor cell status with an AUC of 0.98 (sensitivity 0.93, specificity 0.94). Elasticnet model tuning on individual marker expression revealed top tumor predictive markers, including FKBP10, ATP1A2, NT5DC2, UGT3A2, PYCR1, CKB, GPX7, DNMT3B, GSTP1, and OXCT1. These findings indicate that an activated metabolic transcriptional program, potentially influencing epigenetic functions, is observed in hepatoblastoma tumors and confirmed at the single-cell level.

Metabolic and Epigenetic Mechanisms in Hepatoblastoma: Insights into Tumor Biology and Therapeutic Targets

BACKGROUND

Hepatoblastoma, the most common pediatric liver malignancy, is characterized by significant molecular heterogeneity and poor prognosis in advanced stages. Recent studies highlight the importance of metabolic reprogramming and epigenetic dysregulation in hepatoblastoma pathogenesis. This review aims to explore the metabolic alterations and epigenetic mechanisms involved in hepatoblastoma and how these processes contribute to tumor progression and survival.

METHODS

Relevant literature on metabolic reprogramming, including enhanced glycolysis, mitochondrial dysfunction, and shifts in lipid and amino acid metabolism, as well as epigenetic mechanisms like DNA methylation, histone modifications, and non-coding RNAs, was reviewed. The interplay between these pathways and their potential as therapeutic targets were examined.

RESULTS

Hepatoblastoma exhibits metabolic shifts that support tumor growth and survival, alongside epigenetic changes that regulate gene expression and promote tumor progression. These pathways are interconnected, with metabolic changes influencing the epigenetic landscape and vice versa.

CONCLUSIONS

The dynamic interplay between metabolism and epigenetics in hepatoblastoma offers promising avenues for therapeutic intervention. Future research should focus on integrating metabolic and epigenetic therapies to improve patient outcomes, addressing current gaps in knowledge to develop more effective treatments.