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Article: Hepatitis B virus seropositivity is a poor prognostic factor of pediatric hepatocellular carcinoma: a population-based study in Hong Kong and Singapore

TitleHepatitis B virus seropositivity is a poor prognostic factor of pediatric hepatocellular carcinoma: a population-based study in Hong Kong and Singapore
Authors
Keywordshepatocellular carcinoma
pediatric
hepatitis B virus
vaccination
surveillance
Issue Date2020
PublisherFrontiers Research Foundation. The Journal's web site is located at http://www.frontiersin.org/oncology
Citation
Frontiers in Oncology, 2020, v. 10, p. article no. 570479 How to Cite?
AbstractBackground: Hepatocellular carcinoma (HCC) is a rare hepatic malignancy in children. Hepatitis B virus (HBV) infection is a key predisposing factor in endemic regions but its impact on outcome has not been studied. We aim to evaluate the prognostic implication of HBV seropositivity and role of cancer surveillance in children with HCC from East Asian populations with national HBV vaccination. Methods: Review of population-based databases for patients (< 18 years old) diagnosed with HCC from 1993 to 2017 in two Southeast Asian regions with universal HBV vaccination (instituted since 1988 and 1987 in Hong Kong and Singapore, respectively). Results: Thirty-nine patients were identified (Hong Kong, 28; Singapore, 11). Thirty were male; median age at diagnosis was 10.8 years (range, 0.98–16.6). Abdominal pain was the commonest presentation while five patients were diagnosed through surveillance for underlying condition. Alpha-fetoprotein was raised in 36 patients (mean, 500,598 ng/ml). Nineteen had bilobar involvement, among the patients in whom pretreatment extent of disease (PRETEXT) staging could retrospectively be assigned, 3 had stage I, 13 had stage II, 4 had stage III, and 11 had stage IV disease. Seventeen had distant metastasis. HBsAg was positive in 19 of 38 patients. Two patients had fibrolamellar HCC. Upfront management involved tumor resection in 16 (liver transplantation, 2), systemic chemotherapy in 21, interventional procedures in 6 [transarterial chemoembolization (TACE), 5, radiofrequency ablation (RFA), 1], and radiotherapy in 4 (selective internal radiation, 3, external beam radiation, 1). Five-year event-free survival (EFS) and overall survival (OS) were 15.4 ± 6.0 and 26.1 ± 7.2%, respectively. Patient’s HBsAg positivity, metastatic disease and inability to undergo definitive resection represent poor prognostic factors in univariate and multivariable analyses. Patients diagnosed by surveillance had significantly better outcome. Conclusion: Pediatric HCC has poor outcome. HBV status remains relevant in the era of universal HBV vaccination. HBV carrier has inferior outcome and use of surveillance may mitigate disease course.
Persistent Identifierhttp://hdl.handle.net/10722/301125
ISSN
2020 Impact Factor: 6.244
2020 SCImago Journal Rankings: 1.834
PubMed Central ID
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLiu, APY-
dc.contributor.authorSoh, SY-
dc.contributor.authorCheng, FWC-
dc.contributor.authorPang, HH-
dc.contributor.authorLuk, CW-
dc.contributor.authorLi, CH-
dc.contributor.authorHo, KKH-
dc.contributor.authorChan, EKW-
dc.contributor.authorChan, ACY-
dc.contributor.authorChung, PHY-
dc.contributor.authorKimpo, MS-
dc.contributor.authorAhamed, SH-
dc.contributor.authorLoh, A-
dc.contributor.authorChiang, AKS-
dc.date.accessioned2021-07-27T08:06:29Z-
dc.date.available2021-07-27T08:06:29Z-
dc.date.issued2020-
dc.identifier.citationFrontiers in Oncology, 2020, v. 10, p. article no. 570479-
dc.identifier.issn2234-943X-
dc.identifier.urihttp://hdl.handle.net/10722/301125-
dc.description.abstractBackground: Hepatocellular carcinoma (HCC) is a rare hepatic malignancy in children. Hepatitis B virus (HBV) infection is a key predisposing factor in endemic regions but its impact on outcome has not been studied. We aim to evaluate the prognostic implication of HBV seropositivity and role of cancer surveillance in children with HCC from East Asian populations with national HBV vaccination. Methods: Review of population-based databases for patients (< 18 years old) diagnosed with HCC from 1993 to 2017 in two Southeast Asian regions with universal HBV vaccination (instituted since 1988 and 1987 in Hong Kong and Singapore, respectively). Results: Thirty-nine patients were identified (Hong Kong, 28; Singapore, 11). Thirty were male; median age at diagnosis was 10.8 years (range, 0.98–16.6). Abdominal pain was the commonest presentation while five patients were diagnosed through surveillance for underlying condition. Alpha-fetoprotein was raised in 36 patients (mean, 500,598 ng/ml). Nineteen had bilobar involvement, among the patients in whom pretreatment extent of disease (PRETEXT) staging could retrospectively be assigned, 3 had stage I, 13 had stage II, 4 had stage III, and 11 had stage IV disease. Seventeen had distant metastasis. HBsAg was positive in 19 of 38 patients. Two patients had fibrolamellar HCC. Upfront management involved tumor resection in 16 (liver transplantation, 2), systemic chemotherapy in 21, interventional procedures in 6 [transarterial chemoembolization (TACE), 5, radiofrequency ablation (RFA), 1], and radiotherapy in 4 (selective internal radiation, 3, external beam radiation, 1). Five-year event-free survival (EFS) and overall survival (OS) were 15.4 ± 6.0 and 26.1 ± 7.2%, respectively. Patient’s HBsAg positivity, metastatic disease and inability to undergo definitive resection represent poor prognostic factors in univariate and multivariable analyses. Patients diagnosed by surveillance had significantly better outcome. Conclusion: Pediatric HCC has poor outcome. HBV status remains relevant in the era of universal HBV vaccination. HBV carrier has inferior outcome and use of surveillance may mitigate disease course.-
dc.languageeng-
dc.publisherFrontiers Research Foundation. The Journal's web site is located at http://www.frontiersin.org/oncology-
dc.relation.ispartofFrontiers in Oncology-
dc.rightsThis Document is Protected by copyright and was first published by Frontiers. All rights reserved. It is reproduced with permission.-
dc.rightsThis work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.-
dc.subjecthepatocellular carcinoma-
dc.subjectpediatric-
dc.subjecthepatitis B virus-
dc.subjectvaccination-
dc.subjectsurveillance-
dc.titleHepatitis B virus seropositivity is a poor prognostic factor of pediatric hepatocellular carcinoma: a population-based study in Hong Kong and Singapore-
dc.typeArticle-
dc.identifier.emailLiu, APY: apyliu@hku.hk-
dc.identifier.emailPang, HH: herbpang@hku.hk-
dc.identifier.emailChan, ACY: acchan@hku.hk-
dc.identifier.emailChung, PHY: chungphy@hku.hk-
dc.identifier.emailChiang, AKS: chiangak@hku.hk-
dc.identifier.authorityLiu, APY=rp01357-
dc.identifier.authorityPang, HH=rp01857-
dc.identifier.authorityChan, ACY=rp00310-
dc.identifier.authorityChung, PHY=rp02002-
dc.identifier.authorityChiang, AKS=rp00403-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.3389/fonc.2020.570479-
dc.identifier.pmid33330043-
dc.identifier.pmcidPMC7716753-
dc.identifier.scopuseid_2-s2.0-85097221970-
dc.identifier.hkuros323736-
dc.identifier.hkuros328946-
dc.identifier.volume10-
dc.identifier.spagearticle no. 570479-
dc.identifier.epagearticle no. 570479-
dc.identifier.isiWOS:000595583200001-
dc.publisher.placeSwitzerland-

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