Abstract
Introduction. Hepatocellular carcinoma (HCC) is a rare pediatric cancer accounting for 0.5% of all pediatric malignancies. This study examines a large cohort of HCC patients in an effort to define the factors impacting clinical outcomes in pediatric HCC patients compared to adults. Methods. Demographic and clinical data on 63,771 HCC patients (257 pediatric patients ≤ 19 and 63,514 adult patients age ≥ 20) were abstracted from the SEER database (1973–2011). Results. HCC was more common among males (59.5% pediatric and 75.1% adults) and Caucasians (50.4% and 50.5%), p < 0.05. Children more often presented with fibrolamellar variant HCC (24.1% versus 0.3%, p = 0.71) and advanced HCC, including distant disease (33.1% versus 20.8%, p < 0.001), and tumors > 4 cm in size (79.6% versus 62.0%, p = 0.02). Pediatric HCC patients undergoing surgery (13.107 versus 8.324 years, p < 0.001) had longer survival than adult HCC patients. Overall mortality was lower (65.8% versus 82.0%, p < 0.001) in the pediatric HCC group. Conclusion. HCC is a rare pediatric malignancy that presents most often as an advanced tumor, >4 cm in Caucasian males. Children with HCC achieve significantly longer mean overall survival compared to adults with HCC, primarily attributable to the more favorable fibrolamellar histologic variant, and more aggressive surgical intervention, which significantly improves survival.
Highlights
Hepatocellular carcinoma (HCC) is a rare pediatric cancer accounting for 0.5% of all pediatric malignancies
A higher percentage of pediatric HCC occurred among Hispanic patients, while much lower percentage of African Americans were affected. These results are consistent with previous retrospective studies conducted by McAteer et al and Allan et al, in which over 60% of pediatric HCC occurred in Caucasians [2, 10]. These results suggest that Caucasian males in the pediatric population are at highest risk for HCC, and pediatricians should maintain a higher degree of suspicion for HCC when these patients present with suspicious or nonspecific signs and symptoms
This study identified that pediatric patients present with more advanced disease and larger tumor sizes compared to adult HCC patients
Summary
Hepatocellular carcinoma (HCC) is a rare pediatric cancer accounting for 0.5% of all pediatric malignancies. HCC was more common among males (59.5% pediatric and 75.1% adults) and Caucasians (50.4% and 50.5%), p < 0.05. HCC is a rare pediatric malignancy that presents most often as an advanced tumor, >4 cm in Caucasian males. Children with HCC achieve significantly longer mean overall survival compared to adults with HCC, primarily attributable to the more favorable fibrolamellar histologic variant, and more aggressive surgical intervention, which significantly improves survival. Hepatocellular carcinoma (HCC) is the second most common primary hepatic malignancy in children following hepatoblastoma and accounts for approximately one-third of all primary hepatic malignancies in children and approximately 0.5% of all pediatric malignancies [2]. HCC has been observed in young children with inherited metabolic disorders and in older children with maternal transmission of hepatitis B infection [5,6,7,8]
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