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Clinical heterogeneity of pediatric hepatocellular carcinoma
Author(s) -
D'Souza Amber M.,
Towbin Alexander J.,
Gupta Anita,
Alonso Maria,
Nathan Jaimie D.,
Bondoc Alex,
Tiao Greg,
Geller James I.
Publication year - 2020
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.28307
Subject(s) - medicine , hepatocellular carcinoma , liver transplantation , sorafenib , chemotherapy , neoadjuvant therapy , cohort , retrospective cohort study , surgery , stage (stratigraphy) , adjuvant therapy , oncology , transplantation , gastroenterology , cancer , breast cancer , paleontology , biology
Background Hepatocellular carcinoma (HCC) is often a chemoresistant neoplasm with a poor prognosis. Pediatric HCC may reflect unique biological and clinical heterogeneity. Procedure An IRB‐approved retrospective institutional review of patients with HCC treated between 2004 and 2015 was undertaken. Clinical, radiographic, and histologic data were collected from all patients. Results Thirty‐two patients with HCC, median age 11.5 years (range 1‐20) were identified. Seventeen patients had a genetic or anatomic predisposition. Histology was conventional HCC (25) and fibrolamellar HCC (7). Evans staging was 1 (12); 2 (1); 3 (10); 4 (9). Sixteen patients underwent resection at diagnosis and five patients after neoadjuvant chemotherapy. Surgical procedures included liver transplantation (LT, 11), hemihepatectomy (9), and segmentectomy (1). Eighteen patients had medical therapy (13 neoadjuvant, 5 adjuvant). Most common initial medical therapy included sorafenib alone (7) and cisplatin/doxorubicin‐based therapy (8). Overall, 14 (43.8%) patients survived with a median follow‐up of 58.8 months (range 26.5‐157.6). Cause of death was most often linked to lack of primary tumor surgery (11). Of the survivors, Evans stage was 1 (11), 2 (1), and 3 (2, both treated with LT). Four of 18 patients (22%) who received medical therapy, 8 of 17 patients with a predisposition (47%), and 14 of 21 patients (66%) who underwent surgery remain alive. Conclusions Genetic and anatomic predisposing conditions were seen in over half of this cohort. Evans stage 1 or 2 disease was linked to improved survival. LT trended toward improved survival. Use of known chemotherapy agents may benefit a smaller group of pediatric HCC and warrants formal prospective study through cooperative group trials.