Original Articles: Liver Failure and Liver Disease

OCD

HEPATOLOGY
September 2003 . Volume 38 . Number 3



Epidemiology of primary hepatic malignancies in U.S. children

Anil Darbari1 ,Keith M. Sabin2
Craig N. Shapiro2 ,Kathleen B. Schwarz1

   Abstract
The epidemiology of primary hepatic malignancies in U.S. children is poorly
characterized. We analyzed the incidence, mortality, and characteristics of
primary hepatic malignancies in U.S. residents less than 20 years of age.
Fatal primary hepatic malignancies in persons less than 20 years of age,
between 1979 and 1996, were identified using the multiple-cause-of-death
database (National Center for Health Statistics). Histologically confirmed
primary hepatic malignancies occurring between 1973 and 1997 were identified
using the Surveillance, Epidemiology, and End Results (SEER) database.
Between 1979 and 1996, 918 primary hepatic malignancy deaths (average,
0.7/1,000,000/year) were reported nationally among persons less than 20
years of age; rates were higher among Asians and among foreign-born
children. Between 1973 and 1997, 271 primary hepatic malignancy cases were
reported to SEER among persons less than 20 years of age, of which 184 (67%)
and 83 (31%) were hepatoblastoma and hepatocellular carcinoma, respectively.
Among children less than 5 years of age, hepatoblastoma accounted for 91% of
primary hepatic malignancy cases, whereas among those 15 to 19 years of age,
hepatocellular carcinoma accounted for 87% of cases. Five-year survival for
hepatoblastoma was 52%, compared with 18% for hepatocellular carcinoma. In
the SEER sites, between 1973 and 1977 and 1993 and 1997, hepatoblastoma
rates increased (0.6 to 1.2/1,000,000, respectively), while hepatocellular
carcinoma rates decreased (0.45 to 0.29/1,000,000, respectively). In
conclusion, histologically confirmed hepatocellular carcinoma was reported
in children less than 5 years of age, also, where hepatoblastoma is the
predominant primary hepatic malignancy. Hepatocellular carcinoma has worse
survival rates than hepatoblastoma, and its incidence has not increased.
Better maintenance of databases may provide information about associated
factors behind this unexpected occurrence. (HEPATOLOGY 2003;38:560-566.)

   Publishing and Reprint Information  From the 1Division of Pediatric
Gastroenterology and Nutrition, Department of Pediatrics, Johns Hopkins
University School of Medicine, Baltimore, MD; and 2Division of Viral
Hepatitis, Centers for Disease Control and Prevention, Atlanta, GA.
Received February 13, 2003.

Accepted June 15, 2003.
K.M.S. is currently with the Division of HIV/AIDS Prevention, Centers for
Disease Control and Prevention, Atlanta, GA.
Address reprint requests to: Anil Darbari, M.D., Assist. Prof., Division of
Pediatric Gastroenterology and Nutrition, Brady 320, Johns Hopkins
University School of Medicine, 600 North Wolfe St., Baltimore, MD 21287.
E-mail: [email protected] ; fax: 410-955-1464.
Copyright © 2003 by the American Association for the Study of Liver
Diseases.
0270-9139/03/3803-0006$30.00/0
doi:10.1053/jhep.2003.50375