Hepatoblastoma (HB) is the most common primary liver malignancy in children, predominantly affecting those younger than 3 years of age. Although the overall survival rate has improved significantly over the past few decades, standardized clinical practice guidelines for HB in Korea have been lacking. This clinical practice guideline was developed to provide evidence-based recommendations for the diagnosis and treatment of HB in children. A multidisciplinary working group comprising pediatric hematologists/oncologists, radiologists, surgeons, pathologists, and methodologists systematically reviewed the literature published up to May 2023. For pretreatment imaging, both abdominal computed tomography and magnetic resonance imaging are useful for PRE-Treatment EXTent of disease (PRETEXT) staging, with each modality offering distinct advantages. PRETEXT staging at diagnosis is recommended as it provides valuable prognostic information. For standard-risk HB (PRETEXT I–III without metastasis and alpha-fetoprotein ≥100 ng/mL), cisplatinbased chemotherapy without doxorubicin is recommended over cisplatin-doxorubicin combination therapy, as it demonstrates equivalent survival outcomes with fewer adverse effects. In carefully selected patients who are eligible for complete resection at diagnosis, upfront surgery without neoadjuvant chemotherapy should be considered to spare unnecessary chemotherapy and its toxicities. For patients with residual pulmonary metastases after chemotherapy, pulmonary metastasectomy should be considered. Sodium thiosulfate administration following cisplatin should be considered to reduce ototoxicity, although the supporting evidence is derived predominantly from standard-risk patients and its availability in Korea remains limited. Regarding histological subtypes, well-differentiated fetal HB is associated with favorable outcomes and may be treated with surgery alone, whereas the small cell undifferentiated pattern is no longer classified as a HB subtype and requires immunohistochemical and molecular testing to distinguish it from malignant rhabdoid tumor and other small round cell tumors. This guideline represents the first evidence-based clinical practice guideline for pediatric HB in Korea. It aims to standardize the diagnostic and therapeutic approaches, ultimately improving outcomes for Korean children with HB. Given the rarity of this tumor, international collaboration and prospective data collection remain essential for future guideline updates.
Background: Women who experienced the Great East Japan Earthquake (GEJE) and subsequently became pregnant may have children who are more likely to exhibit emotional and behavioral problems. However, few longitudinal studies have investigated the developmental outcomes among children born to mothers who experienced natural disasters before pregnancy and continued to experience stress symptoms thereafter.Purpose: This study aimed to examine the association between maternal traumatic stress related to the GEJE and behavioral problems in their children.Methods: A total of 21,656 mother-child pairs were included in the analysis; 52.0% of the offspring were male. Maternal traumatic stress symptoms related to the GEJE were assessed using items evaluating recollection, emotional distress, somatic reactions, and avoidance behaviors (Cronbach α=0.681). Child behavioral outcomes at 2 and 3 years of age were assessed using the Child Behavior Checklist for Ages 1½–5 (CBCL/1½–5). Missing data were addressed by multiple imputation, and a multivariable logistic regression was performed with adjustment for maternal psychological distress, social isolation, sleep problems, parity, breastfeeding, disaster-related exposure, parental history of mental illness, and socioeconomic characteristics. Covariate selection was guided by a directed acyclic graph.Results: Compared with mothers who reported no traumatic stress symptoms, those reporting one or 2 symptoms had a higher odds of their children exhibiting internalizing (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.06–1.69), externalizing (OR, 1.29; 95% CI, 1.07–1.55) and total problems (OR, 1.38; 95% CI, 1.11–1.72) at age 2 and internalizing (OR, 1.38; 95% CI, 1.13–1.69), externalizing (OR, 1.21; 95% CI, 1.01–1.45) and total problems (OR, 1.37; 95% CI, 1.10–1.71) at age 3. Mothers reporting 3 or 4 symptoms showed stronger associations, a pattern consistent with a dose-response relationship supported by a formal test for trends for most outcomes. These findings were consistent with those of sensitivity analyses using continuous CBCL scores.Conclusion: These findings suggest that maternal mental health support beyond pregnancy may be important for women of reproductive age in disaster-affected areas and could help inform preventive strategies addressing the intergenerational effects of trauma following largescale disasters such as the GEJE.
