Surgical management of pediatric hepatocellular carcinoma: An analysis of the National Cancer Database.
J Pediatr Surg
; 56(4): 772-777, 2021 Apr.
Article
en En
| MEDLINE
| ID: mdl-32660779
ABSTRACT
PURPOSE:
This study evaluates overall survival (OS) between liver transplantation (LT) and liver resection (LR), while assessing the effect of margin status, in children with hepatocellular carcinoma (HCC).METHODS:
The National Cancer Database was queried (2004-2015) for children (<18â¯years) with non-metastatic HCC undergoing surgery.RESULTS:
One hundred six children with HCC treated surgically (LT 34, LR 72) were identified. For T1 stage, no difference in OS was observed for LT vs. margin-negative liver resection [LR(-)] (log-rank, pâ¯=â¯0.47). For T2/T3/T4 stage, no difference in OS was observed for LT vs. LR(-) (log-rank, pâ¯=â¯0.08); both subgroups exhibited superior OS vs. margin-positive liver resection [LR(+)] (log-rank, LT vs. LR(+) pâ¯=â¯0.001 and LR(-) vs. LR(+) pâ¯=â¯0.04). On multivariable Cox regression (i) histology (fibrolamellar vs. not) and T stage (T1 vs. T2/T3/T4) were not associated with OS (both pâ¯=â¯0.06), (ii) chemotherapy and size >5â¯cm were not associated with OS (both pâ¯≥â¯0.42), (iii) when compared to LT, both LR(-) (pâ¯=â¯0.03) and LR(+) (pâ¯=â¯0.001) were associated with increased likelihood of mortality.CONCLUSION:
Although margin-negative resection may be obtained with LT or LR, early LT consultation is warranted for children at high risk of LR(+) regardless of Milan criteria due to the negative impact of LR(+) on OS. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE III.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Trasplante de Hígado
/
Carcinoma Hepatocelular
/
Neoplasias Hepáticas
Tipo de estudio:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Límite:
Child
/
Humans
Idioma:
En
Revista:
J Pediatr Surg
Año:
2021
Tipo del documento:
Article
País de afiliación:
Estados Unidos