Histopathological and radiological clues in the treatment and prognosis of hepatoblastoma

Aim of the study: Wnt/Beta-catenin pathway plays a key role in liver development and regeneration. An abnormal activation in this pathway leads to the development of hepatoblastoma. We aimed to evaluate the prognostic role of beta-catenin expression in the hepatoblastoma patients. Material-Method: Hospital records of hepatoblastoma patients who had undergone operation between May 2004- November 2018 were retrospectively reviewed. Demographics, PRETEXT classifications, risk groups, adjuvant-neoadjuvant chemotherapy regimens, chemotherapy responses, recurrence and survival rates were evaluated. Radiological findings were re-evaluated by a radiologist for vascular tumor involvement. The cases were grouped according to the cytoplasmic or nuclear expression of the beta-catenin protein. Fisher Exact Test was used for comparison. p value <0.05 was considered significant. Results: There were 41 patients. Thirteen patients were excluded for unavailability of records in 4, negative/unclear BC expressions in 7, and fatality due to chemotherapy toxicity in 2. Cytoplasmic expression of BC was observed in 16 patients whereas 12 patients displayed Nuclear expression. Demographics were similar in both groups. PRETEXT staging, risk stratification, vascular involvement, recurrence and survival of patients were summarized in table. Beta-catenin Cytoplasmic (n) Nuclear (n) p Median age (months) 18 mo (+/-) 16 mo (+/-) PRETEXT (n:28) 1 0 1 2 4 5 3 7 5 4 5 1 Hepatic Ven Involvement (n:26) 0.016 V+ 11/14 3/12 V- 3/14 9/12 Portal Ven Involvement (n:26) 0.45 P+ 6 4 P- 8 8 Risk group (n:28) >0.05 Standard 1 4 High 15 8 Chemotherapy response (n:27) 0.0046 No neoadjuvant 2/15 4/12 ≥%50 4/15 8/12 <%50 9/15 0/12 Transplantation (n:8/28) 7/16 1/12 0.035 Conclusion: To our knowledge, this is the first study emphasizing the importance of intracellular localization of BC expression that may provide insights for the management of HB as cytoplasmic immunohistostaining of BC protein is associated with poorer outcome, need for extensive surgeries and probably earlier consideration for transplantation.