Abstract
BackgroundHepatocellular carcinoma (HCC) is a rare hepatic malignancy in children. Hepatitis B virus (HBV) infection is a key predisposing factor in endemic regions but its impact on outcome has not been studied. We aim to evaluate the prognostic implication of HBV seropositivity and role of cancer surveillance in children with HCC from East Asian populations with national HBV vaccination.MethodsReview of population-based databases for patients (< 18 years old) diagnosed with HCC from 1993 to 2017 in two Southeast Asian regions with universal HBV vaccination (instituted since 1988 and 1987 in Hong Kong and Singapore, respectively).ResultsThirty-nine patients were identified (Hong Kong, 28; Singapore, 11). Thirty were male; median age at diagnosis was 10.8 years (range, 0.98–16.6). Abdominal pain was the commonest presentation while five patients were diagnosed through surveillance for underlying condition. Alpha-fetoprotein was raised in 36 patients (mean, 500,598 ng/ml). Nineteen had bilobar involvement, among the patients in whom pretreatment extent of disease (PRETEXT) staging could retrospectively be assigned, 3 had stage I, 13 had stage II, 4 had stage III, and 11 had stage IV disease. Seventeen had distant metastasis. HBsAg was positive in 19 of 38 patients. Two patients had fibrolamellar HCC. Upfront management involved tumor resection in 16 (liver transplantation, 2), systemic chemotherapy in 21, interventional procedures in 6 [transarterial chemoembolization (TACE), 5, radiofrequency ablation (RFA), 1], and radiotherapy in 4 (selective internal radiation, 3, external beam radiation, 1). Five-year event-free survival (EFS) and overall survival (OS) were 15.4 ± 6.0 and 26.1 ± 7.2%, respectively. Patient’s HBsAg positivity, metastatic disease and inability to undergo definitive resection represent poor prognostic factors in univariate and multivariable analyses. Patients diagnosed by surveillance had significantly better outcome.ConclusionPediatric HCC has poor outcome. HBV status remains relevant in the era of universal HBV vaccination. HBV carrier has inferior outcome and use of surveillance may mitigate disease course.
Highlights
Hepatocellular carcinoma (HCC) is an uncommon but aggressive malignancy in the pediatric age group [1]
The Hong Kong cohort was based on data prospectively contributed by all five local pediatric oncology units (Queen Mary Hospital, Prince of Wales Hospital, Tuen Mun Hospital, Queen Elizabeth Hospital, Princess Margaret Hospital) through the Hong Kong Paediatric Haematology Oncology Study Group between 1996 and 2017 and the Singaporean cohort was based on data contributed by the two major pediatric oncology units (KK Women’s and Children’s Hospital, National University Health System) between 1993 and 2017
Etiologies that predispose to the development of HCC in children vary geographically and ethnically, including mainly inborn errors of metabolism, biliary atresia and chronic viral hepatitis [9]
Summary
Hepatocellular carcinoma (HCC) is an uncommon but aggressive malignancy in the pediatric age group [1]. Chronic hepatitis B virus (HBV) infection is endemic in Southeast Asia and has been the most important contributing factor to pediatric HCC in these regions through vertical maternal-fetal transmission of the virus. The prognostic significance of HBV seropositivity in pediatric HCC as well as the impact of surveillance in children with known chronic liver conditions have not been well described. We report the outcome of pediatric HCC from Hong Kong and Singapore exploiting populationbased databases accruing childhood cancer data since the 1990s. Disease characteristics between patients with and without HBV infection are compared and the impact of HBV seropositivity as well as cancer surveillance on patient outcome is evaluated. We aim to evaluate the prognostic implication of HBV seropositivity and role of cancer surveillance in children with HCC from East Asian populations with national HBV vaccination
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
