HEPATOCELLULAR-CARCINOMA IN CHILDREN - CLINICAL REVIEW AND COMPARISONWITH ADULT CASES

Background: Hepatocellular carcinoma (HCC) in children was rarely repo rted and usually included with hepatoblastoma in most studies of pedia tric liver malignancies despite different clinical behaviors. The auth ors report their experience in pediatric HCC and discuss its differenc es from adult HCC. Methods: A retrospective review of radiographic, la boratory, pathological, and therapeutic data in 55 children with HCC w as performed. The liver function was graded by modified Child's classi fication. Kaplan-Meier survival curves in various therapeutic and Chil d's groups were plotted, and log-rank test was used to detect differen ces among survival curves. Results: Although children with HCC mostly presented with advanced disease at diagnosis, disturbances of liver fu nction were unremarkable. Sixty-eight percent of cases concurred with liver cirrhosis. The median survivals for resectable, chemotherapeutic , and untreated HCCs were 23, 3, and 2 months, respectively. Resectabl e HCC significantly posed a much better prognosis. However, the resect ability was unsatisfactory (18.2%). Resection was limited because of a natomic unfeasibility including bilateral involvement (62.5%), portal vein thrombi (41.7%), distant metastasis (29.1%), paraaortic lymphaden opathy (18.8%), inferior vena cava thrombi (16.7%), and hilar invasion (6.3%). Distant metastasis was the most ominous for survival in child ren with unresectable HCC. Conclusions: HCC behaved somewhat different ly between children and adults. Surgical resection represented the bes t hope of long-term survival. The outcome in children could not keep u p with that in adults because of a diagnostic delay. Hence, alpha-feto protein and sonography screening in carrier children should be worthwh ile. Copyright (C) 1998 by W.B. Saunders Company.