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Surgical management of pediatric hepatocellular carcinoma: An analysis of the National Cancer Database
- Source :
- Journal of pediatric surgery. 56(4)
- Publication Year :
- 2020
-
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 ( 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, p = 0.47). For T2/T3/T4 stage, no difference in OS was observed for LT vs. LR(−) (log-rank, p = 0.08); both subgroups exhibited superior OS vs. margin-positive liver resection [LR(+)] (log-rank, LT vs. LR(+): p = 0.001 and LR(−) vs. LR(+): p = 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 p = 0.06), (ii) chemotherapy and size > 5 cm were not associated with OS (both p ≥ 0.42), (iii) when compared to LT, both LR(−) (p = 0.03) and LR(+) (p = 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
- Subjects :
- medicine.medical_specialty
Carcinoma, Hepatocellular
medicine.medical_treatment
Milan criteria
Liver transplantation
Gastroenterology
03 medical and health sciences
0302 clinical medicine
030225 pediatrics
Internal medicine
medicine
Hepatectomy
Humans
Stage (cooking)
Child
Retrospective Studies
business.industry
Proportional hazards model
Liver Neoplasms
Cancer
Retrospective cohort study
General Medicine
medicine.disease
Liver Transplantation
Treatment Outcome
030220 oncology & carcinogenesis
Hepatocellular carcinoma
Pediatrics, Perinatology and Child Health
T-stage
Surgery
Neoplasm Recurrence, Local
business
Subjects
Details
- ISSN :
- 15315037
- Volume :
- 56
- Issue :
- 4
- Database :
- OpenAIRE
- Journal :
- Journal of pediatric surgery
- Accession number :
- edsair.doi.dedup.....0fd59864a85ffe88ae0f3a8b40ce2581