乙型肝炎病毒血清陽性是小兒肝細胞癌的不良預後因素：在

StephenW

Hepatitis B Virus Seropositivity Is a Poor Prognostic Factor of Pediatric Hepatocellular Carcinoma: a Population-Based Study in Hong Kong and Singapore
Anthony P Y Liu  1 , Shui-Yen Soh  2 , Frankie W C Cheng  3 , Herbert H Pang  4 , Chung-Wing Luk  5 , Chak-Ho Li  6 , Karin K H Ho  7 , Edwin K W Chan  8 , Albert C Y Chan  9 , Patrick H Y Chung  9 , Miriam S Kimpo  10 , Summaiyya H Ahamed  11 , Amos Loh  12 , Alan K S Chiang  1
Affiliations
Affiliations

    1
    Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong.
    2
    Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore.
    3
    Department of Paediatrics, Prince of Wales Hospital, Hong Kong, Hong Kong.
    4
    School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong.
    5
    Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, Hong Kong.
    6
    Department of Paediatrics and Adolescent Medicine, Tuen Mun Hospital, Hong Kong, Hong Kong.
    7
    Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong, Hong Kong.
    8
    Department of Surgery, Prince of Wales Hospital, Hong Kong, Hong Kong.
    9
    Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Hong Kong, Hong Kong.
    10
    Division of Pediatric Hematology/Oncology & Bone Marrow and Cord Blood Transplantation, University Children's Medical Institute, National University Hospital, Singapore, Singapore.
    11
    Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore.
    12
    Department of Paediatric Surgery, KK Women's and Children's Hospital, Singapore, Singapore.

    PMID: 33330043 PMCID: PMC7716753 DOI: 10.3389/fonc.2020.570479

Abstract

Background: 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.

Keywords: hepatitis B virus; hepatocellular carcinoma; pediatric; surveillance; vaccination.

Copyright © 2020 Liu, Soh, Cheng, Pang, Luk, Li, Ho, Chan, Chan, Chung, Kimpo, Ahamed, Loh and Chiang.

StephenW

乙型肝炎病毒血清陽性是小兒肝細胞癌的不良預後因素：在香港和新加坡的一項基於人群的研究
劉德耀1，蘇瑞恩2，鄭經緯3，彭于晏4，陸仲榮5，李澤豪6，何文in 7，陳德溫8，陳偉業9，帕特里克·HY Chung 9，Miriam S Kimpo 10，Summaiyya H Ahamed 11，Amos Loh 12，Alan KS Chiang 1
隸屬關係
隸屬關係

    1個
    香港大學，瑪麗醫院，香港大學兒科學與青少年醫學系。
    2
    新加坡，新加坡KK婦女兒童醫院兒科。
    3
    香港威爾斯親王醫院兒科。
    4
    香港大學公共衛生學院，香港，香港。
    5
    香港伊麗莎白女王醫院兒科。
    6
    香港屯門醫院兒科和青少年醫學科。
    7
    香港香港瑪格麗特公主醫院兒科和青少年醫學科。
    8
    香港威爾斯親王醫院外科。
    9
    香港大學瑪麗醫院，香港大學外科。
    10
    新加坡國立大學醫院兒童醫學研究所兒科血液學/腫瘤學與骨髓和臍帶血移植科。
    11
    新加坡KK婦女兒童醫院診斷和介入影像科。
    12
    新加坡，新加坡KK婦女兒童醫院小兒外科。

    PMID：33330043 PMCID：PMC7716753 DOI：10.3389 / fonc.2020.570479

抽象

背景：肝細胞癌（HCC）是兒童罕見的肝惡性腫瘤。乙型肝炎病毒（HBV）感染是流行地區的關鍵誘發因素，但尚未研究其對結果的影響。我們旨在評估HBV血清陽性的預後意義和癌症監測在東亞國家HBV預防接種人群中的HCC兒童中的作用。

方法：回顧了1993年至2017年在東南亞兩個地區進行普遍HBV疫苗接種（分別自1988年和1987年在香港和新加坡成立）的診斷為HCC的患者（<18歲）的人群數據庫。

結果：鑑定出三十九名患者（香港，28；新加坡，11）。男性為30；診斷時的中位年齡為10.8歲（範圍為0.98-16.6）。腹部疼痛是最常見的表現，而通過監測潛在病情診斷出五名患者。 36名患者甲胎蛋白升高（平均500,598 ng / ml）。 19例患者中有雙葉受累，可追溯分配疾病的治療程度（PRETEXT），其中I期3例，II期13例，III期4例，IV期11例。十七例有遠處轉移。 HBsAg陽性38例中的19例。兩名患者患有纖維狀肝癌。前期管理涉及16例腫瘤切除術（肝移植2例），全身化學療法21例，介入治療6例[經動脈化學栓塞（TACE），5例射頻消融（RFA）1例]和放射療法4例（選擇性內照射， 3，外部光束輻射，1）。五年無事件生存率（EFS）和總體生存率（OS）分別為15.4±6.0和26.1±7.2％。在單變量和多變量分析中，患者的HBsAg陽性，轉移性疾病和無法進行明確的切除術是不良的預後因素。經監測診斷的患者預後明顯好轉。

結論：小兒肝癌預後不良。在普遍接種HBV疫苗的時代，HBV的地位仍然很重要。 HBV攜帶者的預後較差，使用監視可能會減輕疾病進程。

關鍵詞：乙型肝炎病毒；肝細胞癌；兒科監視疫苗接種。

版權所有©2020 Liu，Soh，Cheng，Pang，Luk，Li，Ho，Chan，Chan，Chung，Kimpo，Ahamed，Loh和Chiang。

StephenW

https://www.frontiersin.org/articles/10.3389/fonc.2020.570479/pdf