Impact of microscopically margin-positive resection on survival in children with hepatoblastoma after hepatectomy: a retrospective cohort study

  • Xianghai Ren
  • Haibo Li
  • Mei Diao
  • Hang Xu
  • Long LiEmail author
Original Article



Impact of R1 (microscopically margin-positive) resection on survival of patients with hepatoblastoma (HB) remains debatable. This study aimed to compare the long-term outcomes of R0 (microscopically margin-negative) and R1 resection for HB in children after hepatectomy.


We retrospectively reviewed files of children with HB who underwent resection at our institution between September 1, 2005, and November 30, 2017. Survival analyses and prognostic factors were evaluated using Kaplan–Meier curves and Cox regression models.


Of 259 patients, 218 (84.2%) underwent R0 and 41 (15.8%) R1 resection. After adjusting for confounding factors, R1 resection demonstrated non-significantly lower overall survival (OS: hazard ratio [HR] = 0.75; 95% CI 0.34–1.64) and shorter event-free survival (EFS: HR = 0.97; 95% CI 0.53–1.78) rates than R0 resection. However, stratified analysis showed significantly increased risk of poor OS and EFS in patients with metastasis and mixed epithelial/mesenchymal pathologic subtype in R1 compared with R0 resection (P values for interactions < 0.05). There was no significant difference between R0 resection with metastasis and R1 resection with metastasis in the incidence of local recurrence (P = 0.494); however, a significant difference in the incidence of local recurrence was seen between R0 and R1 resection for subgroups with mixed pathologic subtypes (P = 0.035).


With effective chemotherapy, microscopic margin status may not be associated with survival outcome in children with HB undergoing hepatectomy. However, stratified analysis showed that R1 resection might be associated with decreased survival in children with mixed epithelial/mesenchymal HB, compared with R0 resection, and not affect survival outcomes in those with an epithelial subtype and without metastasis.


Hepatoblastoma Hepatectomy Metastasis Positive surgical margins Survival rate 



No funding was received.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

10147_2019_1573_MOESM1_ESM.pdf (62 kb)
Supplementary file1 (PDF 62 kb)


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Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  1. 1.Graduate School of Peking Union Medical CollegeChinese Academy of Medical SciencesBeijingPeople’s Republic of China
  2. 2.Department of Pediatric SurgeryCapital Institute of PediatricsBeijingPeople’s Republic of China

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