title: Prognostic factors in fibrolamellar hepatocellular carcinoma in young people.
abstract: OBJECTIVE
  Fibrolamellar hepatocellular carcinoma (FL-HCC) arises in pediatric/adolescent patients without cirrhosis. We retrospectively evaluated the impact of resection, nodal status, metastasis, and PRETEXT stage on overall survival (OS).
  
  
  METHODS
  With IRB approval, we reviewed records of 25 consecutive pediatric patients with FL-HCC treated at our institution from 1981 to 2011. We evaluated associations between OS and PRETEXT stage, nodal involvement, metastasis, and complete resection.
  
  
  RESULTS
  Median age at diagnosis was 17.1years (range, 11.6-20.5). Median follow-up was 2.74years (range, 5-9.5). Five (28%) patients had PRETEXT stage 1 disease, 10 (56%) had stage 2, 2 (11%) had stage 3, and 2 (11%) had stage 4 disease. On presentation, 17 (68%) patients had N1 disease, and 7 (28%) had parenchymal metastases. Complete resection was achieved in 17 (80.9%) of 21 patients who underwent resection. Five-year OS was 42.6%. Survival was positively associated with complete resection (P =0.003), negative regional lymph nodes (P =0.044), and lower PRETEXT stage (P <0.001), with a trend for metastatic disease (P =0.05).
  
  
  CONCLUSIONS
  In young patients with FL-HCC, lower PRETEXT stage and complete resection correlated with prolonged survival, while metastatic disease and positive lymph node status were associated with poor prognosis. Thus, we recommend complete resection and regional lymphadenectomy whenever possible.
authors.affiliation: Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: David G
authors.initials: DG
authors.lastname: Darcy
authors.affiliation: Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Marcus M
authors.initials: MM
authors.lastname: Malek
authors.affiliation: Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Rachel
authors.initials: R
authors.lastname: Kobos
authors.affiliation: Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: David S
authors.initials: DS
authors.lastname: Klimstra
authors.affiliation: Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Ronald
authors.initials: R
authors.lastname: DeMatteo
authors.affiliation: Pediatric Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: laquaglm@mskcc.org.
authors.forename: Michael P
authors.initials: MP
authors.lastname: La Quaglia
mesh_terms: D000293:Adolescent; D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000601:surgery; D002648:Child; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000401:mortality* / Q000601:surgery; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult
keywords: Adolescent; Fibrolamellar; Hepatocellular carcinoma; Pediatric; Prognostic