Abstract
BackgroundHepatocellular carcinoma (HCC) occurs rarely in children and adolescents (C&A), and its clinical characteristics, prognostic factors, and treatment were rarely explored. MethodsThis retrospective study focused on 65 HCC patients aged ≤20 years from August 1994 to August 2012. Cox regression models and Kaplan–Meier curves were used to investigate prognostic factors and compare overall survival (OS), respectively. ResultsWe found 61.5% of patients to have multiple tumors, 30.8% to have portal vein tumor thrombus, and 16.9% to have distant metastasis. Diameter of tumors was 10.2±4.1 cm. OS at 5 years was 15.8%. Multivariate analyses showed initial treatment (P < 0.001) to be a predictor for OS. For moderate-stage HCC, the median OS of patients who underwent resection was longer than that of patients who underwent transarterial chemoembolization (TACE) or supportive treatment (ST) (P < 0.001). For advanced-stage HCC, the median OS of patients who underwent TACE was longer than that of patients who underwent ST (P = 0.045). ConclusionsHCC in C&A tends to be more advanced than that in adults, and resection remains the mainstay of treatment for those patients. Moreover, compared with ST, TACE may benefit C&A with moderate- and advanced-stage HCC, which needs further study.
Highlights
Liver cancer is the second most common cause of cancerrelated deaths worldwide, and there are approximately 850,000 new cases per year worldwide.[1,2] Hepatocellular carcinoma (HCC) is the most common type of hepatic malignancy, but only 0.5–1% of those aged ≤20 years suffer from HCC.[3]Infection by the hepatitis B virus (HBV) is endemic in China
From 15 August 1994 to 15 August 2012, 72 patients aged ≤20 years were diagnosed with HCC by histological examination or at least two coincidental imaging techniques associated with increased alpha-fetoprotein (AFP) level in our Department of Hepatobiliary Oncology
HBV hepatitis B virus, ALT alanine aminotransferase, AST aspartate transaminase, ALB albumin, TBIL total bilirubin, AFP alpha-fetoprotein, TNM tumor-node-metastasis, ST supportive treatment, transarterial chemoembolization (TACE) transcatheter arterial chemoembolization supportive treatment [ST]: HR 0.298, 95% CI 0.150–0.592; resection vs. ST: HR 0.105, 95% CI 0.048–0.226, P < 0.001), metastasis (HR 2.360, 95% CI 1.156–4.815, P = 0.015), portal vein tumor thrombus (HR 2.725, 95% CI 1.484–5.004, P = 0.001), TBIL level (HR 1.947, 95% CI 1.094–3.465, P = 0.021), and AST level (HR 2.365, 95% CI 1.287–4.346, P = 0.004) were associated with overall survival (OS)
Summary
Infection by the hepatitis B virus (HBV) is endemic in China. The incidence of HCC in children and adolescents (C&A) is higher than that for hepatoblastoma, a pattern that is different from that reported in Western countries.[4,5] Unlike HCC in adults, which commonly arises in the setting of prolonged chronic hepatitis and cirrhosis,[6] tumors in C&A have been observed with HBV infection acquired perinatally or due to inherited metabolic disorders.[7,8] at the time of diagnosis, HCC in C&A is commonly associated with (i) huge hepatomas, (ii) tumor thrombus in the portal vein, and (iii) distant metastasis.[7,9] Taken together, such reports suggest that HCC in C&A may be different to that observed in adults.[4,8,10]. Hepatocellular carcinoma (HCC) occurs rarely in children and adolescents (C&A), and its clinical characteristics, prognostic factors, and treatment were rarely explored
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