Hepatoblastoma and hepatocellular carcinoma in children

After nation-wide hepatitis B vaccination in Taiwan, the authors reviewed retrospectively their experience to investigate how the histopathology type of pediatric malignant hepatic tumors changed and whether the survival rate was improved with current surgical technique and adjuvant chemotherapy.

Cases of hepatoblastoma and hepatocellular carcinoma were retrospectively analyzed and divided into 2 groups by time of diagnosis. Group I was those who received treatments during 1978 to 1990. Group II was those treated during 1991 to 2001.

There were 20 cases of hepatoblastoma and 15 cases of hepatocellular carcinoma. Male predominance was noted in both groups (male:female, 12:8 and 9:6, respectively). The patients with hepatoblastoma were younger than those with hepatocellular carcinoma (mean/range, 9/2-36 months and 10/0.7-15 years, respectively). Cases of hepatocellular carcinoma were all hepatitis B carriers. The ratio of hepatoblastoma:hepatocellular carcinoma increased from 11:12 in group I to 9:3 in group II. Three-year survival rate of hepatoblastoma was zero in group I and 55% (5/9) in group II. Three-year survival rate of hepatocellular carcinoma was zero in both groups. Operative mortality was 9% (2/23) in group I and zero in group II.

Since the institution of national program of universal hepatitis B vaccination, the incidence of hepatocellular carcinoma in children have declined in Taiwan. The improved survival of hepatoblastoma resulted from better surgical technique and chemotherapy.