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Increased risk of hepatoblastoma among immature children with a lower birth weight
1Department of Child Ecology, National Children's Medical Research Center, Tokyo, Japan.
Insights
Hepatoblastoma risk increases with lower birth weight, especially for infants under 1000g. Recent increases in childhood hepatoblastoma may stem from improved survival of very low birth weight infants and perinatal care factors.
Area of Science:
- Pediatric Oncology
- Perinatal Medicine
- Epidemiology
Background:
- Hepatoblastoma incidence has risen in very low birth weight infants.
- A potential link between low birth weight and hepatoblastoma requires investigation.
Purpose of the Study:
- To clarify the relationship between low birth weight and hepatoblastoma risk.
- To analyze trends in hepatoblastoma incidence among low birth weight infants in Japan.
Main Methods:
- Comparative analysis of hepatoblastoma cases and live births in Japan (1969-1994).
- Stratification by birth weight categories and birth year periods.
- Calculation of relative risks for hepatoblastoma based on birth weight.
Main Results:
- Hepatoblastoma patients showed higher percentages in birth weight categories of 1500-1999g and 2000-2499g compared to the general live birth population.
- A significant increase in hepatoblastoma cases with birth weights <1500g and <1000g was observed after 1988.
- Relative risk of hepatoblastoma was highest for birth weights <1000g (15.64), followed by 1500-1999g (2.71) and 1000-1499g (2.53), compared to birth weights ≥2500g.
Conclusions:
- Lower birth weight is associated with a significantly higher risk of hepatoblastoma.
- The recent increase in hepatoblastoma may be attributed to increased survival of extremely premature infants and perinatal care practices.
- No association found between low birth weight hepatoblastoma and congenital malformations or small-for-date status.
Abstract:
Hepatoblastomas among children with very low birth weights have significantly increased recently, according to the data from the Japan Children's Cancer Registry for the years 1985-1993. We then analyzed more Registry data for 1969-1994 to clarify the possible relationship between low birth weight and hepatoblastoma. The percentage of low birth weights was compared between 543 hepatoblastoma children in the Registry and all live births in Japan in four successive periods during the 26 years from 1969 to 1994, in relation to the given birth year. The percentage of children with birth weights of 1500-1999 g among hepatoblastomas was higher, at 2.94-1.60%, than that among all live births in each of the four periods (0.79-0.92%), and the percentage of children with birth weights of 2000-2499 g was slightly higher. The percentage of children with birth weights of <1500 g and, especially, <1000 g, has increased rapidly among children born after 1988 (1.60 and 6.40%, respectively), when most very low birth weight infants began to survive. Compared with children with a birth weight of 2500 g or more, the relative risks of hepatoblastoma among children with birth weights of <1000, 1000-1499, 1500-1999, and 2000-2499 g were 15.64 (P < 0.001), 2.53 (P = 0.129), 2.71 (P = 0.001), and 1.21 (P = 0.381), respectively, suggesting the lower the birth weight, the higher the risk of hepatoblastoma. There was no association between hepatoblastomas with a low birth weight and either age at diagnosis or congenital malformations or light-for-date weight. The risk of hepatoblastoma for low birth weight children may be inherently high, especially for lower birth weights, and the recent rapid increase may be a result of an increase in the number of more immature infants with a more sensitive liver and also more frequent exposure to risk factors related to perinatal treatment.