Comparison of childhood hepatic malignancies in a hepatitis B hyper-endemic area

Abstract

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.

Figure 1

Age distribution of childhood hepatocellular carcinomas (HCC) and hepatoblastomas (HB).

Figure 2

Cumulative survival curves for patients with liver malignancies in each intergroup stage. A: HCC (I vs III, P = 0.0011; III vs VI, P = 0.0002; log rank test); B: HB (I vs II, P = 0.0019; II vs III, P = 0.8783; III vs VI, P = 0.5365; log rank test).

Figure 3

Cumulative survival curves for eventually unresected HCC and HB (stages III and IV). HB-untreated compared poorly in survival with HB-chemotherapy only, HCC-untreated and HCC-chemotherapy only (P = 0.0015, 0.0040 and 0.0015; log rank test).