Survival
No patients died of relapse and therapy-associated complications at last follow-up. Twelve patients developed relapses. Total frequencies of recurrence were once in 5 patients, 2 in 3 patients, 3 in 2 patients, 4 in 1 patient and 6 in 1 patient respectively (Table 1). Among these, 11 patients developed local relapse (42.3%) and one patient displayed a distant relapse at right cerebral parietal lobe.
The five-year overall survival (OS) and RFS rates of the whole cohort were 100.0% and 55.2% with a median follow-up of 59.5 months (range, 16-155 months, Figure 1). The estimated 5-year RFS rates for stage Ⅲ and stage Ⅳ were 50.9% and 62.5%, respectively (P = 0.40). There was a trend towards better 5-year RFS for girls (64.2% ± 17.6%) compared with boys (40.0% ± 15.5%) (P = 0.02). The RFS between the two age groups(≤2 years vs >2 years) was not significantly different(P = 0.82)(Table 3). Regarding AFP level, the 5-year RFS rate was 56.3% for ≤60,000ng/ml, and this rate was higher than for >60,000 ng/ml (P = 0.91; Table 3). The 5-year RFS of patients with poor pathological response was impaired as compared with good pathological response (38.7% ± 13.0%; 11 of 20 patients versus 100%; 9 of 20 patients; P = 0.03). No risk factors were considered prognostically unfavorable in multivariate analysis.
Although no variables except gender were significantly associated with RFS (Table 2), good pathological responders, smaller initial tumor size and lower AFP level represented favorable prognostic factors in terms of RFS. Based on clinical significance of these three factors in combination with gender, the sum of the points(adverse factors: male or poor pathological responder or initial tumor size greater than 4.0 cm×3.0 cm or AFP >60000ng/ml) allotted correlated with the following risk groups: groupⅠ(n  = 11, 55.0%), 0-2 adverse factors; group Ⅱ  (n  = 9, 45.0%), 3-4 adverse factors. Table 4 showed two patients developed relapse in groupⅠand five patients had relapse in groupⅡ. Seven patients were in alive after salvage therapy. Boys accounted predominantly in group Ⅱ that might be responsible for the significant difference. We excluded sex in further analysis and stratified the cohort into two groups according to initial tumor size, pathological responders and AFP level. No relapse was observed in groupⅠwith 0-1 adverse risk factor. Seven patients developed relapse in group Ⅱ with 2-3 adverse risk factors (P = 0.07, Table 5).