title: Clinical characteristics and outcome of hepatocellular carcinoma in children and adolescents.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) rarely occurs in children and adolescents and has been reported to be highly hepatitis B related more than 10 years ago. However, after global vaccination for hepatitis B virus (HBV), the characteristics and outcome of pediatric HCC remain undefined.
  
  
  METHODS
  Patients with HCC admitted from 2004 to 2010 were retrospectively reviewed in a large tertiary hospital.
  
  
  RESULTS
  45 (1.97 %) pediatric HCC were diagnosed (age ≤18 years), with predominantly male patients (93.3 %). 32 (71.1 %) children were HBV positive, 30 of whom had vertical transmission from their mothers. HBV positivity was associated with liver cirrhosis and portal vein invasion, and thus compromised survival. Advanced disease prevented surgical resection due to large tumor size (>10 cm, 66.7 %), early metastasis (24.4 %), bilateral involvement (57.8 %) and portal vein invasion (46.7 %). The median survival for resectable, transarterial chemotherapy and embolization and untreated patients was 28.6, 4 and 5 months, respectively (p < 0.001). Patients with distal metastasis had significantly poorer survival rate than those without metastasis (p < 0.001).
  
  
  CONCLUSIONS
  Screening of children whose mothers are HBV carriers is important in early detection of pediatric HCC. HBV-associated HCC in pediatric patients, especially in endemic areas, should be detected earlier for more resectability and improvement of surgical prognosis.
authors.affiliation: Department of Hepatobiliary Surgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, 710061, Shaanxi province, PR China.
authors.forename: Xu-Feng
authors.initials: XF
authors.lastname: Zhang
authors.forename: Xue-Min
authors.initials: XM
authors.lastname: Liu
authors.forename: Tao
authors.initials: T
authors.lastname: Wei
authors.forename: Chang
authors.initials: C
authors.lastname: Liu
authors.forename: Mu-Xing
authors.initials: MX
authors.lastname: Li
authors.forename: Zhi-Da
authors.initials: ZD
authors.lastname: Long
authors.forename: Yi
authors.initials: Y
authors.lastname: Lv
mesh_terms: D000293:Adolescent; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000401:mortality / Q000821:virology; D002648:Child; D002675:Child, Preschool; D005260:Female; D017325:Hepatitis B Vaccines / Q000627:therapeutic use; D019694:Hepatitis B, Chronic / Q000150:complications / Q000517:prevention & control; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000821:virology; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D017325:Hepatitis B Vaccines