Hepatocellular carcinoma and liver tumors in South African children: a case for increased prevalence.
BACKGROUND
The high regional incidence of hepatocellular carcinoma (HCC) in South Africa also may be present in children of the region, although the link to hepatitis B (HBV) appears less clear. The objective of this study was to assess the incidence and probable causes of HCC in South African children.


METHODS
Data were obtained from seven participating pediatric oncology units and from the tumor registry to review hepatic tumors in children in South Africa.


RESULTS
One hundred ninety-four children (ages 0-14 years) presented with malignant primary hepatic tumors (1988-2003). One hundred twelve tumors (57%) were hepatoblastoma (HB), 68 tumors (35%) were hepatocellular carcinoma (HCC) (including 9 patients with the fibrolamellar variant, 6 of which occurred in black children), 10 tumors (5%) were sarcoma of the liver, and 4 tumors were lymphoma. The ratio of HB to HCC (1.67) was markedly lower compared with other reports, suggesting a greater prevalence of HCC. Correlation with population statistics indicated an incidence of 1.066 malignant liver tumors per year per 10(6) children age < 14 years (HB, 0.61 per 10(6) children; HCC, 0.39 per 10(6)). Two-thirds of patients with HCC were positive for HBV surface antigen (HBsAg), and HCC occurred mostly in black African patients (93%). The mean age of onset was 1.47 years for HB and 10.48 years for HCC. A preponderance of males (3.5:1.0) was noted in the HBsAg-positive group that was not reflected elsewhere. Serum alpha-fetoprotein (AFP) levels were raised both in patients with HB (100%; most AFP levels were very high) and in patients with HCC (69%), although 15% of patients with HCC had low or normal AFP levels.


CONCLUSIONS
It appeared from the current results that HCC is more prevalent among children in South Africa compared with the children in more developed countries, although their rates were lower that the rates noted in adults. A collaborative approach will be required to improve their diagnosis and management.
Department of Pediatric Surgery, University of Stellenbosch, Tygerberg, South Africa. swm@sun.ac.za
Samuel W
SW
Moore
Alistair J W
AJ
Millar
G P
GP
Hadley
Gabriel
G
Ionescu
Mariana
M
Kruger
Janet
J
Poole
David
D
Stones
Linda
L
Wainwright
Milind
M
Chitnis
Glynn
G
Wessels
D000293:Adolescent; D017677:Age Distribution; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003906:Developing Countries; D005260:Female; D006801:Humans; D015994:Incidence; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D008297:Male; D015337:Multicenter Studies as Topic; D012042:Registries; D018570:Risk Assessment; D017678:Sex Distribution; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis