Background: We aimed to retrospectively investigate the role of neoadjuvant chemotherapy in low-risk patients with hepatoblastoma (HB) who underwent curative resection between February 2009 and December 2017. We also verified the feasibility of the risk stratification system to select the optimal patients for upfront resection. Procedure: We compared 5-year overall survival (OS) and event-free survival (EFS) between the upfront surgery (US) (n=26) and neoadjuvant chemotherapy (NC) (n=104) groups at three oncology centers in Beijing, China. To reduce the effect of covariate imbalances, propensity score matching (PSM) was used. We explored whether preoperative chemotherapy affected surgical outcomes and identified the risk factors for events and death, including resection margin status, PRETreatment EXTent of disease stages, age, sex, pathology classification, and α-fetoprotein levels. Results: The median follow-up period was 64 months (interquartile range 60–72). After PSM, 22 pairs of patients were identified and the patient characteristics were similar for all variables included in propensity score matching. In the US group, the 5-year EFS and OS rates were 81.8% and 86.3%, respectively. In the NC group, 5-year EFS and OS rates were 81.8% and 90.9%, respectively. No significant differences in EFS or OS were observed between the groups. Pathological classification was the only risk factor for death and disease progression, tumor recurrence, diagnosis of other malignant neoplasms, and death from any cause ( p=0.007 and p=0.032, respectively). Conclusion: Upfront resection can achieve long-term disease control in low-risk patients with resectable HB, thus reducing the cumulative toxicity of platinum-based chemotherapy drugs.

Background: Granulocyte colony-stimulating factors (G-CSF) can be used as prophylaxis for febrile neutropenia (FN) in adults. There is no meta-analysis about the effects of pegfilgrastim on the occurrence of FN in pediatric/adolescent cancer patients. Purpose: To determine the effect of pegfilgrastim on FN in pediatric and adolescent cancer patients. Methods: PubMed, Embase, and the Cochrane library were searched for studies published prior to April 7, 2020. The outcome was the occurrence of FN. For analyses showing high heterogeneity (I2>50% and Q-test P<0.10), the random-effect model was used; otherwise, the fixed-effect model was used. Results: Eight studies were included, comprising 167 patients and 550 courses of treatment. Pegfilgrastim decreased the rate of FN compared with controls (ES=0.26, 95%CI: 0.15-0.36, P<0.001); this was observed in prospective and retrospective studies. There was no difference between pegfilgrastim and filgrastim for the rate of FN in children receiving chemotherapy (OR=0.68, 95%CI: 0.20-2.23, P=0.520). Pegfilgrastim decreased the rate of grade 4 FN compared with controls (ES=0.40, 95%CI: 0.16-0.63, P=0.017); this was observed when analyzing the courses of treatment, but not the patients. Pegfilgrastim had no impact on treatment delays due to FN (ES=0.05, 95%CI: -0.00-0.10, P=0.061). Pegfilgrastim decreased the rate of severe neutropenia compared with controls (ES=0.39, 95%CI: 0.04-0.74, P=0.031). Conclusion: Compared with the control, pegfilgrastim significantly decreases the occurrence of FN, grade 4 FN, and severe neutropenia in pediatric patients receiving chemotherapy. Pegfilgrastim had no impact on treatment delays due to FN.