Surgical management of pediatric hepatocellular carcinoma: An analysis of the National Cancer Database
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In brief
In brief
This National Cancer Database analysis of 106 pediatric HCC patients demonstrates that margin-negative liver resection achieves comparable survival to transplantation in T1 disease, but positive margins significantly worsen outcomes across all stages. Early transplant evaluation is recommended for children at high risk of positive resection margins.
Written by the GCMD Library team from the article.
Abstract
Purpose
This study evaluates overall survival (OS) between liver transplantation (LT) and liver resection (LR), while assessing the effect of margin status, in children with hepatocellular carcinoma (HCC).
Methods
The National Cancer Database was queried (2004–2015) for children (<18 years) with non-metastatic HCC undergoing surgery.
Results
One hundred six children with HCC treated surgically (LT 34, LR 72) were identified. For T1 stage, no difference in OS was observed for LT vs. margin-negative liver resection [LR(−)] (log-rank, p = 0.47). For T2/T3/T4 stage, no difference in OS was observed for LT vs. LR(−) (log-rank, p = 0.08); both subgroups exhibited superior OS vs. margin-positive liver resection [LR(+)] (log-rank, LT vs. LR(+): p = 0.001 and LR(−) vs. LR(+): p = 0.04). On multivariable Cox regression: (i) histology (fibrolamellar vs. not) and T stage (T1 vs. T2/T3/T4) were not associated with OS (both p = 0.06), (ii) chemotherapy and size >5 cm were not associated with OS (both p ≥ 0.42), (iii) when compared to LT, both LR(−) (p = 0.03) and LR(+) (p = 0.001) were associated with increased likelihood of mortality.
Conclusion
Although margin-negative resection may be obtained with LT or LR, early LT consultation is warranted for children at high risk of LR(+) regardless of Milan criteria due to the negative impact of LR(+) on OS.
Type of study
Retrospective cohort study.
Level of evidence
III