The role of liver resection in metastatic nephroblastoma: A systematic review and Meta-regression analysis

The impact of hepatic resection for liver metastases (LM) on the survival of pediatric patients with Wilms’ tumor (WT) is unclear. So far, there is a lack of studies investigating the best suited treatment for patients with WTLM, and the role of liver resection has rarely been investigated. Thus, the development of evidence-based guide‑ lines concerning indications of liver resection for WTLM remains difficult.
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The role of liver resection in metastatic nephroblastoma: A systematic review and Meta-regression analysisFuchsetal. BMC Cancer (2022) 22:76https://doi.org/10.1186/s12885-022-09182-3 RESEARCH Open AccessThe role ofliver resection inmetastaticnephroblastoma: asystematic reviewandMeta‑regression analysisJuriFuchs1, AnastasiaMurtha‑Lemekhova1, MarkusKessler2, PatrickGünther2and KatrinHoffmann1,3*  Abstract  Background:  The impact of hepatic resection for liver metastases (LM) on the survival of pediatric patients with Wilms’ tumor (WT) is unclear. So far, there is a lack of studies investigating the best suited treatment for patients with WTLM, and the role of liver resection has rarely been investigated. Thus, the development of evidence-based guide‑ lines concerning indications of liver resection for WTLM remains difficult. Aim:  To investigate the role of surgery in the therapy of WTLM. All available data on liver resections and subgroup outcomes of patients with WTLM are analyzed. Main research question is whether liver resection improves survival rates of patients with WTLM compared to non-surgical treatment. Methods:  A systematic literature search of MEDLINE, Web of Science, and Central provided the basis for this PRISMA- compliant systematic review. For the main analysis (I), all studies reporting on surgical treatment of pediatric WTLM were included. To provide a representative overview of the general outcome of WTLM patients, in analysis II all studies with cohorts of at least five WTLM patients, regardless of the kind of treatment, were reviewed and analyzed. A Multi‑ ple meta-regression model was applied to investigate the impact liver resection on overall survival. Results:  14 studies with reports of liver resection for WTLM were found (Analysis I). They included a total of 212 patients with WTLM, of which 93 underwent a liver resection. Most studies had a high risk of bias, and the quality was heterogenous. For the analysis II, eight studies with subgroups of at least five WTLM patients were found. The weighted mean overall survival (OS) of WTLM patients across the studies was 55% (SD 29). A higher rate of liver resec‑ tion was a significant predictor of better OS in a multiple meta-regression model with 4 covariates (I2 29.43, coeffi‑ cient 0.819, p = 0.038). Conclusions:  This is the first systematic review on WTLM. Given a lack of suited studies that specifically investigated WTLM, ecological bias was high in our analyses. Generating evidence is complicated in rare pediatric conditions and this study must be viewed in this context. Meta-regression analyses suggest that liver resection may improve survival of patients with WTLM compared to non-surgical treatment. Especially patients with persisting disease after*Correspondence: katrin.hoffmann@med.uni-heidelberg.de3 Division ofLiver surgery, Department ofGeneral, VisceralandTransplantation Surgery, University ofHeidelberg, Im NeuenheimerFeld 420, 69120Heidelberg, GermanyFull list of author information is available at the end of the articleJuri Fuchs, Anastasia Murtha-Lemekhova, Markus Kessler, Patrick Güntherand Katrin Hoffmann are members of the RELIVE Inititiave (GeneratingEvidence for Diagnosis and Therapy of RarE LIVEr Disease: the RELIVEInitiative for Systematic Reviews and Meta-Analyses). © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creat​iveco​mmons.​org/​licen​ses/​by/4.​0/. The Creative Commons Public Domain Dedication waiver (http://​creat​iveco​ mmons.​org/​publi​cdoma​in/​zero/1.​0/) applies to the data made available in this article, unless otherwise stated in a cr ...