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Comparison of childhood hepatic malignancies in a hepatitis B hyper-endemic area
Jeng-Chang Chen1, Ming-Ling Chang, Jer-Nan Lin
1Department of Surgery, Chang Gung Children's Hospital, 5 Fu-Shin Street, Kweishan, 333, Taoyuan, Taiwan, China.
Insights
Hepatocellular carcinoma (HCC) and hepatoblastoma (HB) in children present distinct clinical behaviors and outcomes. While HB responds to chemotherapy, HCC shows higher recurrence, impacting survival rates.
Area of Science:
- Pediatric oncology
- Hepatobiliary diseases
- Cancer research
Background:
- Hepatocellular carcinoma (HCC) and hepatoblastoma (HB) are rare but significant pediatric liver cancers.
- Distinguishing between HCC and HB in children is crucial for appropriate treatment and prognosis.
Purpose of the Study:
- To delineate the clinical, laboratory, and radiological differences between pediatric HCC and HB.
- To compare survival outcomes and the impact of treatment modalities on these two distinct liver tumors.
Main Methods:
- Retrospective analysis of 73 pediatric HCC and 54 HB cases from 1979-1997 in Taiwan.
- Statistical comparison of demographic, laboratory, radiological data, and survival curves.
Main Results:
- HCC presented at a later age (mean 10.6 vs 2.5 years) with higher rates of hepatitis B infection, liver cirrhosis, and portal vein thrombi.
- Stage I HCC had poorer survival than stage I HB due to a higher recurrence rate.
- Chemotherapy improved resectability and survival in HB, including advanced stages.
Conclusions:
- Clinical features can help differentiate pediatric HCC from HB.
- Chemotherapy followed by resection is a viable strategy for HB, potentially achieving survival comparable to early-stage HB.
- Further research is needed to confirm the optimal role of chemotherapy in advanced HB management.
Aim:
To examine the differences of clinical behaviors between hepatocellular carcinomas (HCC) and hepatoblastomas (HB) in children.
Methods:
From 1979 to 1997, we collected 73 HCC and 54 HB from two major medical centers in Taiwan. Demog-raphic, laboratory and radiological data, and survival curves were statistically compared.
Results:
HCC clinically differed from HB in mean age (10.6 vs 2.5 years; P<0.001), status of hepatitis B infection (56/56 vs 4/35, P<0.001) and accompanying liver cirrhosis (26/40 vs 0/30, P<0.001), portal vein thrombi (22/56 vs 5/38, P = 0.006) and para-aortic lymphadenopathy (10/56 vs 1/38, P = 0.026). Due to a higher recurrence rate (7/12 vs 2/13, P = 0.041), stage I HCC compared poorly in survivals with stage I HB (P = 0.0183). Chemotherapy could only benefit HB as evidenced by 66.7% of resectability conversion and improve survivals for advanced HB, even with unsuccessful conversion. The survival difference between stage I HB and advanced HB with delayed complete resection was of borderline insignificance (P = 0.0507).
Conclusion:
HCC and HB were preliminarily distinguishable by some clinical clues. Delayed resection after chemotherapy was only possible for HB. However, further studies are needed to strengthen our observation that appropriate reliance upon chemotherapy to subsequently resect advanced HB could achieve the comparable survival to that of stage I HB.
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