Outcome of staging chest CT and identification of factors associated with lung metastasis in children with hepatoblastoma

Objectives: To evaluate the outcome of staging chest CT and to identify clinicoradiological factors predictive of lung metastasis in patients with hepatoblastoma based on the 2017 PRE-Treatment EXTent of tumor (PRETEXT) system. Methods: This bi-center study retrospectively identified patients diagnosed with hepatoblastoma between January 1998 and September 2019 in two tertiary hospitals. The primary outcome was the proportion of the patients who had lung metastasis at staging chest CT. The diagnostic accuracy of staging chest CT was calculated based on the 2017 PRETEXT criteria. The secondary outcome was the identification of factors predictive of lung metastasis using multivariable logistic regression. Results: In total, 123 patients (median age, 1 year; interquartile range, 0–4 years; 59 female) were included. Among those, 28% (35/123; 95% confidence interval [CI], 21–37%) had lung metastasis at staging chest CT. The overall accuracy of staging chest CT was 96.8%. The proportion of lung metastasis in patients with stage I, II, III, and IV was 0%, 24% (12 of 49; 95% CI, 14–38%), 23% (9 of 40; 95% CI, 12–38%), and 56% (14 of 25; 95% CI, 37–73%), respectively. Multifocality (adjusted odds ratio, 6.7; 95% CI, 2.7–17.5; p <.001) and male sex (adjusted odds ratio, 3.1; 95% CI, 1.2–8.6; p =.02) were associated with the presence of lung metastasis. Conclusions: Twenty-eight percent of the patients with hepatoblastoma had lung metastasis at staging chest CT. Multifocality and male sex were predictive factors for lung metastasis on staging chest CT. Key Points: • The proportion of lung metastasis in patients with hepatoblastoma was 28%. • The overall accuracy of staging chest CT was 97% based on the 2017 PRETEXT system. • Hepatic tumor multifocality and male sex were predictors of lung metastasis.