A Population-Based Analysis of Hepatocellular Carcinoma in Children: Identifying Optimal Surgical Treatment
1Vanderbilt University Medical Center, Nashville, TN, 2Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN
Meeting: 2020 American Transplant Congress
Abstract number: D-148
Keywords: Hepatocellular carcinoma, Liver transplantation, Pediatric, Survival
Session Information
Date: Saturday, May 30, 2020
Session Name: Poster Session D: Liver: Pediatrics
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: Hepatocellular carcinoma (HCC) constitutes 0.5% of childhood malignancies and exhibits poor prognosis. Complete tumor extirpation either by partial liver resection (LR) or liver transplantation (LT) is the only curative treatment. Due to the poor initial outcomes of LT, LR has remained the mainstay of treatment for all but select children fulfilling the Milan criteria (originally designed for adults).
*Methods: Retrospective cohort study of pediatric HCC patients (<18 years) registered in the SEER database between 2004-2015. Cancer-specific survival (CSS) was analyzed using the Kaplan-Meier method with log-rank tests for between-group comparisons. Multivariable Cox proportional hazards regression evaluated the effects of patient characteristics of patients undergoing surgery with curative intent on cancer-specific mortality.
*Results: Out of 127 children with HCC, 46 did not undergo surgery (36.2%), 32 underwent LT (25.2%), and 49 underwent LR (38.6%). Overall 5-year CSS rates were 15%, 87%, and 63%, respectively. LT exhibited superior CSS vs. LR (P=0.007). In patients with T1 stage, LT showed equivalent CSS when compared to LR (5-year CSS: 100% vs. 92% [Fig. A]), while for patients with T2 and T3 stage, LT exhibited superior CSS (5-year CSS: 100% vs. 62% [Fig. B], and 5-year CSS: 65% vs. 13% [Fig. C], respectively). No patient with T4 stage received LT. On multivariable analysis, T3/T4 stage (HR: 13.63, 95%CI: 2.9-64.07; P=0.001), and LR (HR: 7.51, 95%CI: 2.07-27.29; P=0.002) were associated with increased risk of cancer-specific mortality. Histological type and lymph node status were not associated with likelihood of cancer-specific mortality.
*Conclusions: Our findings suggest that children with non-metastatic HCC beyond Milan criteria show a favorable prognosis after LT when compared to LR. Early inclusion of a LT consultation after initial diagnosis is warranted, especially in children with unresectable HCC or when complete tumor extirpation with LR is not feasible.
To cite this abstract in AMA style:
Ziogas IA, Matsuoka LK, Montenovo MI, Izzy M, Benedetti DJ, III HNLovvorn, Gillis LA, Alexopoulos SP. A Population-Based Analysis of Hepatocellular Carcinoma in Children: Identifying Optimal Surgical Treatment [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/a-population-based-analysis-of-hepatocellular-carcinoma-in-children-identifying-optimal-surgical-treatment/. Accessed November 25, 2020.« Back to 2020 American Transplant Congress