Infographic: Survival in children with hepatoblastoma and pulmonary metastatic disease at diagnosis based on extent of metastases and need for surgical clearance

Infographic · May 2026 · 2 min read

In brief

Multicenter study of 62 children with hepatoblastoma and lung metastases demonstrates that long-term survival is achievable regardless of metastatic burden extent. Combined neoadjuvant chemotherapy and surgical metastasectomy successfully cleared pulmonary disease in 95% of patients, with survival rates comparable between extensive (>10 lesions) and limited metastatic disease.

Written by the GCMD Library team from the infographic.

A three-column comparison layout with illustrated diagrams of surgical procedures. Each column contains a procedural illustration at the top, followed by statistical data presented in colored text blocks. The left column uses blue tones, the middle uses green, and the right uses purple/pink accents. Icons and percentage indicators highlight key outcomes.

Stephanie F Polites, Robert A Vierkant, Jennifer H Aldrink, Timothy B Lautz, Mecklin V Ragan, Audra Reiter, Stephanie Y Chen, Eugene S Kim, Hannah N Rinehardt, Marcus Malek, Andrew M Fleming, Andrew J Murphy, Jonathan P Roach, Sridharan Radhakrishnan, Nelson Piche, Yasmin Osman, Harold N Lovvorn 3rd, Elisabeth T Tracy, Juan Favela, Hau D Le, John Marquart, Brian Craig, Dave R Lal, Natashia Seemann, Robin Petroze, Barrie S Rich, Richard D Glick, Leigh Selesner, Ashley Yoo, Elizabeth Fialkowski, Erin G Brown, Chloe Boehmer, Roshni Dasgupta, Max R Langham Jr, Gregory M Tiao, Zachary J Kastenberg

Purpose: This study analyzed the effect of pulmonary metastatic burden at diagnosis and response to chemotherapy on disease-free and overall survival in patients with hepatoblastoma (HB), hypothesizing that long-term survival can be achieved in the setting of extensive pulmonary metastatic disease requiring metastasectomy.

Methods: An analysis of a multicenter dataset including children with HB and pulmonary metastatic disease at diagnosis was performed. Patients who presented with >10 pulmonary metastases were defined as having extensive metastatic disease. Kaplan Meier and univariate Cox Proportional Hazards analyses assessed disease-free survival (DFS) and overall survival (OS), analyzing the effect of pulmonary metastatic disease extent and modality of clearance.

Results: Among 315 patients with HB, pulmonary metastatic disease at diagnosis (n = 62) was associated with poorer DFS and OS (both p > 0.05). Of patients with pulmonary metastases, 23 (37 %) had extensive disease. Clearance of metastases occurred in 59 (95 %) patients: 32 (54 %) with chemotherapy alone and 27 (46 %) with chemotherapy and metastasectomy. Survival was similar between patients with >10 vs. ≤10 lung metastases and between those who had clearance of lung metastases by chemotherapy alone vs. chemotherapy and metastasectomy (all p > 0.05). Among 16 patients who required liver transplantation, all patients who underwent surgical clearance of metastatic disease were alive at last follow-up.

Conclusion: Among patients with HB who had pulmonary metastatic disease at diagnosis, long-term survival is possible regardless of the extent of pulmonary disease. A combination of neoadjuvant chemotherapy and metastasectomy can be utilized to achieve lung clearance.

The text in the image