Improved survival and higher rates of surgical resection associated with hepatocellular carcinoma in children as compared to young adults. Issue 12 (11th August 2022)

• Record Type: Journal Article
• Authors: Commander, Sarah Jane; Cerullo, Marcelo; Arjunji, Neha; Leraas, Harold J.; Thornton, Steven; Ravindra, Kadiyala; Tracy, Elisabeth T.
• Is Part Of: International journal of cancer. Volume 151:Issue 12(2022)
• Page Start: 2206
• Page End: 2214
• Publication Date: 2022-08-11
• Subjects: hepatocellular carcinoma -- liver resection -- liver tumors -- national cancer database -- pediatric surgical oncology; Cancer -- Periodicals; Cancer -- Prevention -- Periodicals; 616.994
• DOI: 10.1002/ijc.34215
• Languages: English
• ISSNs: 0020-7136

Abstract

Abstract: Hepatocellular adenocarcinoma (HCC) is the second most common primary hepatic malignancy in children with a 5‐year overall survival of 30%. Few studies have examined the similarities and differences between pediatric and adult HCC. This article aims to examine the relationship between tumor characteristics, treatments and outcomes in pediatric and adult patients with HCC. The 2019 National Cancer Database was queried for patients with HCC. Patients were stratified by age: pediatric <21 years (n = 214) and young adults 21 to 40 (n = 1102). Descriptive statistics and chi square were performed. The mean age at diagnosis was 15.5 years (SD 5.6) in the pediatric and 33 years (5.3) in the adult group. Children had a comparable rate of metastasis (30% vs 28%, P = .47) and increased fibrolamellar histology (32% vs 9%). Surgical resection was more common in children compared to adults (74% vs 62%, P < .001), children also had more lymph nodes examined (39% vs 19%, P < .001), positive lymph nodes (35% vs 17%, P = .02) and surgical resection when metastasis were present at diagnosis (46% vs 18%, P < .001). The 1‐, 3‐ and 5‐year overall survival was higher for pediatric patients than adults (81%, 65%, 55%, vs 70%, 54%, 48%). Despite higher prevalence of fibrolamellar histology, greater number of positive lymph nodes and comparable rates of metastasis at diagnosis, children with HCC have improved overall survival compared to adults. Age did not significantly contribute to survivorship, so it is likely that the more aggressive surgical approach contributed to the improved overall survival in pediatric patients. Abstract : What's new? Although hepatocellular adenocarcinoma treatment strategies in pediatric patients are commonly based on the clinical management of adult patients, the pathogenesis of the disease is quite different and may affect tumor biology. This query of the 2019 National Cancer Database for patients stratified by age shows that despite the higher prevalence of fibrolamellar histology, greater number of positive lymph nodes and comparable rates of metastasis at diagnosis, children with hepatocellular adenocarcinoma had improved survival compared to adults. Age did not significantly contribute to survivorship, suggesting that aggressive surgical management accounted for the improved survival.