title: Surgical treatment of primary liver tumors in children: outcomes analysis of resection and transplantation in the SEER database.
abstract: Adjusted survival outcomes following hepatic resection and transplantation for pediatric liver tumors have not been compared. To address this question, we conducted a retrospective cohort study using the SEER registry. While SEER lacks certain specifics regarding staging, chemotherapy, comorbidities, and recurrence, important hypothesis-generating data are available and were analyzed using Kaplan-Meier statistics and Cox proportional hazards regression. All SEER patients under the age of 20 yr undergoing surgery for HB (n = 318) or HCC (n = 80) between 1998 and 2009 were included. Of HB patients, 83.3% underwent resection and 16.7% transplantation. Advanced disease, vascular invasion, and satellite lesions were more common among transplant patients. Unadjusted five-yr survival was equivalent, as was the adjusted hazard of death for transplant relative to resection (HR = 0.58, p = 0.63). Of HCC patients, 75.0% underwent resection and 25.0% transplantation. Transplant patients had a higher prevalence of vascular invasion and satellite lesions. Five-yr survival was 53.4% after resection and 85.3% after transplant, and the adjusted hazard of death was significantly lower after transplantation (HR = 0.05, p = 0.045). While transplantation is generally reserved for unresectable tumors, the favorable survival seen in HCC patients suggests that liberalized transplant criteria might improve survival, although further prospective data are needed.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, USA; Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA.
authors.forename: Jarod P
authors.initials: JP
authors.lastname: McAteer
authors.forename: Adam B
authors.initials: AB
authors.lastname: Goldin
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Healey
authors.forename: Kenneth W
authors.initials: KW
authors.lastname: Gow
mesh_terms: D000293:Adolescent; D006528:Carcinoma, Hepatocellular / Q000601:surgery* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D018197:Hepatoblastoma / Q000601:surgery / Q000628:therapy; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000601:surgery* / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D015995:Prevalence; D016016:Proportional Hazards Models; D012008:Recurrence; D012189:Retrospective Studies; D018426:SEER Program; D016896:Treatment Outcome; D014481:United States
keywords: hepatoblastoma; hepatocellular carcinoma; liver transplantation; pediatric; survival