Clinical Report: Hepatocellular Carcinoma in Pediatric and Adolescent Populations
Overview
This retrospective study of 65 pediatric and adolescent patients with hepatocellular carcinoma (HCC) highlights distinct clinical features, including high rates of hepatitis B virus infection and advanced disease at diagnosis. Initial treatment modality, particularly surgical resection and transarterial chemoembolization (TACE), was identified as a significant predictor of overall survival.
Background
Hepatocellular carcinoma (HCC) is a rare malignancy in individuals aged 20 years or younger, accounting for only 0.5–1% of cases in this age group. Unlike adult HCC, pediatric and adolescent HCC often arises in the context of perinatal hepatitis B virus (HBV) infection or inherited metabolic disorders, with tumors frequently presenting as large masses with portal vein invasion or distant metastases. Treatment guidelines for this population are lacking, and the role of transarterial chemoembolization (TACE) remains controversial. Understanding prognostic factors is critical to improving management strategies.
Data Highlights
Characteristic
Value
Number of patients
65
Median age (years)
16.8 (range 8–20)
Male patients
52 (80%)
HBV infection
81.5%
Multiple tumors
61.5%
Distant metastasis
16.9%
Portal vein tumor thrombus
30.8%
Mean tumor diameter (cm)
10.2 ± 4.1
AFP-positive patients
90.8%
Overall survival rates
1 year: 50.1%, 3 years: 27.5%, 5 years: 15.8%
Key Findings
HBV infection was present in 81.5% of pediatric and adolescent HCC patients, indicating a strong association with endemic HBV.
At diagnosis, 61.5% had multiple tumors, 30.8% had portal vein tumor thrombus, and 16.9% had distant metastases, reflecting advanced disease presentation.
Univariate analysis identified TNM stage, initial treatment type, metastasis, portal vein tumor thrombus, total bilirubin, and AST levels as factors associated with overall survival.
Multivariate analysis demonstrated that initial treatment modality (resection or TACE versus supportive treatment) was the only independent predictor of overall survival.
Surgical resection was associated with the best survival outcomes, followed by TACE, while supportive treatment had the poorest prognosis.
Distribution of TNM stage influenced treatment allocation, with early-stage patients more likely to undergo surgery and advanced-stage patients more likely to receive TACE or supportive care.
Clinical Implications
Clinicians should consider early surgical resection as the preferred curative approach for pediatric and adolescent HCC when feasible, given its association with improved survival. TACE may offer a survival benefit over supportive care in patients with unresectable disease, although its role requires further clarification. Early diagnosis and staging are critical to optimize treatment selection and improve outcomes in this population.
Conclusion
Hepatocellular carcinoma in pediatric and adolescent patients presents with distinct clinical features and advanced disease at diagnosis. Initial treatment choice, particularly surgical resection and TACE, significantly impacts overall survival, underscoring the need for tailored management strategies in this group.
References
Sun Yat-sen University Cancer Center Study (1994-2012) -- Clinical Features and Management of Pediatric HCC
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