Patterns of hepatoblastoma and hepatocellular carcinoma in children after universal hepatitis B vaccination in taiwan: a report from a single institution in southern Taiwan.
BACKGROUND
To retrospectively evaluate clinical features, treatment, and outcome of patients with hepatoblastoma (HB) and hepatocellular carcinoma (HCC).


METHODS
From January 1994 to December 2007, 16 patients of HB and 13 cases of HCC were reviewed.


RESULTS
The mean age of HB patients was much younger than HCC patients (1.2 vs. 11.5 y). There was an 84.6% positive rate for hepatitis B surface antigen in HCC, but none for HB. Mean serum alpha-fetoprotein level was higher with HCC (654,158 ng/mL) than the HB patients (352,843 ng/mL), especially higher in HCC with lung metastasis. Among the HB patients, 12 (75%) had thrombocytosis and 6 (37.5%) had microcytic anemia with high or normal ferritin, whereas only 3 of 13 with HCC (23.1%) had thrombocytosis and none had microcytic anemia. All HBs were resectable either before or after chemotherapy, but only 4 (30.8%) HCCs were resectable. Five-year disease-free survival rate was significantly higher in HB (87%) than in HCC (30%, P<0.001).


CONCLUSIONS
Hepatitis B infection was still the most important factor associated with HCC in children even after the national vaccination program against hepatitis B. Extreme thrombocytosis, anemia, alpha-fetoprotein levels are important factors associated with difference in long-term outcomes in children with HB and HCC.
Hsiao
Chih-Cheng
CC
Department of Pediatrics, Division of Hematology/Oncology, Chang Gung University College of Medicine, Linko, Taiwan.
Chuang
Jiin-Haur
JH
Tiao
Mao-Ming
MM
Sheen
Jiunn-Ming
JM
Shieh
Chie-Song
CS
D000740:Anemia / Q000209:etiology; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000821:virology*; D002648:Child; D002675:Child, Preschool; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis / Q000517:prevention & control; D006514:Hepatitis B Surface Antigens / Q000097:blood; D017325:Hepatitis B Vaccines; D018197:Hepatoblastoma / Q000150:complications / Q000401:mortality / Q000821:virology*; D006801:Humans; D007223:Infant; D012189:Retrospective Studies; D016019:Survival Analysis; D013624:Taiwan; D013922:Thrombocytosis / Q000209:etiology; D000509:alpha-Fetoproteins / Q000032:analysis
D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D000509:alpha-Fetoproteins