Evaluation of surgical strategies and long-term outcomes in pediatric hepatocellular carcinoma
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In brief
In brief
This retrospective study of 15 pediatric HCC patients demonstrates that surgical intervention—either resection or transplantation—achieves favorable outcomes when performed in specialized centers. Fibrolamellar variant was most common, and transplant recipients showed 75% survival, supporting aggressive surgical management in children.
- Pediatric HCC represents only 1% of all pediatric tumors, with fibrolamellar variant being most common (53.3%) in this series.
- Median AFP in pediatric HCC was notably low (3.9 ng/mL), contrasting with typical adult presentations and hepatoblastoma.
- Liver transplantation achieved 75% survival rate in this cohort, demonstrating viability as treatment option for pediatric HCC.
- Underlying metabolic disease (tyrosinemia type 1) and hepatitis B cirrhosis were identified in 20% of cases, highlighting screening importance.
- Multidisciplinary surgical management in experienced centers yields better outcomes in children compared to adult HCC populations.
Written by the GCMD Library team from the article.
Abstract
Purpose
Hepatocellular carcinoma (HCC), the second most common pediatric malignant liver tumor after hepatoblastoma, represents 1% of all pediatric tumors.
Methods
A retrospective study was conducted on children with HCC treated at our center from March 2002 to October 2022, excluding those with inadequate follow-up or records. Demographic data, initial complaints, alpha-fetoprotein (AFP) values, underlying disease, size and histopathological features of the masses, chemotherapy, and long-term outcomes were analyzed.
Results
Fifteen patients (8 boys, 7 girls) with a mean age of 11.4 ± 4.1 years (0.8–16.4 years) were analyzed. The majority presented with abdominal pain, with a median AFP of 3.9 ng/mL. Hepatitis B cirrhosis in one patient (6.6%) and metabolic disease (tyrosinemia type 1) in two patients (13.3%) were the underlying diseases. Histopathological diagnoses were fibrolamellar HCC (n:8; 53.3%), HCC (n:6; 40%). Four of the 15 patients underwent liver transplantation, and 9 underwent surgical resection. Due to late diagnosis, two patients were considered inoperable (13.3%). The survival rate for the four patients who underwent liver transplantation was found to be 75%.
Conclusion
Surgical treatment of various variants of HCC can be safely performed in experienced centers with a multidisciplinary approach, and outcomes are better than in adults.