title: Patterns of hepatoblastoma and hepatocellular carcinoma in children after universal hepatitis B vaccination in taiwan: a report from a single institution in southern Taiwan.
abstract: 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.
authors.affiliation: Department of Pediatrics, Division of Hematology/Oncology, Chang Gung University College of Medicine, Linko, Taiwan.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsiao
authors.forename: Jiin-Haur
authors.initials: JH
authors.lastname: Chuang
authors.forename: Mao-Ming
authors.initials: MM
authors.lastname: Tiao
authors.forename: Jiunn-Ming
authors.initials: JM
authors.lastname: Sheen
authors.forename: Chie-Song
authors.initials: CS
authors.lastname: Shieh
mesh_terms: 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
chemical_list: D006514:Hepatitis B Surface Antigens; D017325:Hepatitis B Vaccines; D000509:alpha-Fetoproteins