Hepatocellular carcinoma in children: Clinical review and comparison with adult cases
Hepatocellular carcinoma in children: Clinical review and comparison with adult cases
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DOI：
10.1016/s0022-3468(98)90005-7
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发表时间：
1998-09-01
影响因子：
2.4
通讯作者：
Lee, PH
中科院分区：
文献类型：
--
作者：
Chen, JC;Chen, CC;Lee, PH
背景：儿童肝细胞癌（HCC）很少被报道，在大多数儿童肝脏恶性肿瘤的研究中，尽管临床表现不同，但通常与肝母细胞瘤合并。作者报告了他们治疗儿童HCC的经验，并讨论了其与成人HCC的区别。方法：回顾性分析55例HCC患儿的影像学、实验室、病理和治疗资料。采用改良Child分级法对肝功能进行分级。绘制不同治疗组和儿童组的Kaplan-Meier生存曲线，并采用log-rank检验检测生存曲线之间的差异。结果：HCC患儿在诊断时多表现为晚期，但肝功能障碍不明显。68%的病例并发肝硬化。可切除、化疗和未治疗hcc的中位生存期分别为23个月、3个月和2个月。可切除的HCC预后明显较好。然而，可切除性不理想（18.2%）。由于解剖上的不可行性，切除受到限制，包括双侧受累（62.5%）、门静脉血栓（41.7%）、远处转移（29.1%）、主动脉旁淋巴结病（18.8%）、下腔静脉血栓（16.7%）和肺门侵入（6.3%）。对于不能切除的HCC患儿来说，远处转移是最危险的。结论：HCC在儿童和成人中的表现有所不同。手术切除是长期生存的最大希望。由于诊断的延迟，儿童的结果无法跟上成人。因此，对携带胎儿的儿童进行甲胎蛋白和超声筛查是值得的。版权所有(C) 1998由W.B. Saunders公司。
Background: Hepatocellular carcinoma (HCC) in children was rarely reported and usually included with hepatoblastoma in most studies of pediatric liver malignancies despite different clinical behaviors. The authors report their experience in pediatric HCC and discuss its differences from adult HCC.Methods: A retrospective review of radiographic, laboratory, pathological, and therapeutic data in 55 children with HCC was performed. The liver function was graded by modified Child's classification. Kaplan-Meier survival curves in various therapeutic and Child's groups were plotted, and log-rank test was used to detect differences among survival curves.Results: Although children with HCC mostly presented with advanced disease at diagnosis, disturbances of liver function were unremarkable. Sixty-eight percent of cases concurred with liver cirrhosis. The median survivals for resectable, chemotherapeutic, and untreated HCCs were 23, 3, and 2 months, respectively. Resectable HCC significantly posed a much better prognosis. However, the resectability was unsatisfactory (18.2%). Resection was limited because of anatomic unfeasibility including bilateral involvement (62.5%), portal vein thrombi (41.7%), distant metastasis (29.1%), paraaortic lymphadenopathy (18.8%), inferior vena cava thrombi (16.7%), and hilar invasion (6.3%). Distant metastasis was the most ominous for survival in children with unresectable HCC.Conclusions: HCC behaved somewhat differently between children and adults. Surgical resection represented the best hope of long-term survival. The outcome in children could not keep up with that in adults because of a diagnostic delay. Hence, alpha-fetoprotein and sonography screening in carrier children should be worthwhile. Copyright (C) 1998 by W.B. Saunders Company.