title: Hepatocellular carcinoma in children: epidemiology and the impact of regional lymphadenectomy on surgical outcomes.
abstract: BACKGROUND
  Factors influencing survival in children with HCC have not been studied. The objective of this study was to identify prognostic factors in pediatric HCC, and to determine whether regional lymphadenectomy is associated with improved survival.
  
  
  METHODS
  We performed a retrospective cohort study using the Surveillance, Epidemiology and End Results (SEER) registry. All patients <20 years old diagnosed with HCC from 1973-2009 were included. Disease-specific survival was compared using Kaplan-Meier statistics and Cox proportional-hazards regression.
  
  
  RESULTS
  We identified 238 patients (139 Male: 99 Female). Overall, 112 (47%) received an operation (resection/transplantation). Observed mortality and adjusted hazard of disease-specific death was greater for females (HR=2.07, p=0.013) and older children. Among operative patients, 44% were documented to have a regional lymphadenectomy. Although demographic factors did not differ between lymphadenectomy and non-lymphadenectomy groups, patients who underwent lymphadenectomy had a greater proportion of metastatic disease (24% vs. 15%) and fibrolamellar HCC (53% vs. 31%). Five-year survival for lymphadenectomy patients was superior to non-lymphadenectomy (70% vs. 57%). Adjusted mortality for lymphadenectomy was also improved relative to non-lymphadenectomy (HR=0.26, p=0.013).
  
  
  CONCLUSIONS
  HCC in children is associated with poor survival, especially among children older than 4 years and girls. In surgical candidates, regional lymphadenectomy may be associated with improved survival.
authors.affiliation: Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA 98105, USA; Department of Surgery, University of Washington School of Medicine, Seattle, WA 98195, USA. Electronic address: jarodmc@u.washington.edu.
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; D017677:Age Distribution; D017668:Age of Onset; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000556:secondary / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000601:surgery; D016031:Liver Transplantation; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D017678:Sex Distribution; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Children; Hepatocellular carcinoma; Lymphadenectomy; Pediatric; Survival