P0969 - Improved Survival and Higher Rates of Surgical Resection associated with Hepatocellular Carcinoma in Children as Compared to Adults

Background: Hepatocellular adenocarcinoma (HCC) is the second most common primary hepatic malignancy in children, with a 5-year overall survival of 30%. Few studies have directly examined the similarities and differences between pediatric and adult HCC.

Methods: The 2017 National Cancer Database was queried for patients with HCC. Patients were stratified by age: pediatric 21(n=48, 355). Descriptive statistics and chi square were performed.

Results: The mean age at diagnosis in children was 15.5years(standard deviation 5.4) vs. 63.8years(11.6) for adults. There were less males in the pediatric group (52%vs.76%,p<0.001). The 1, 3, and 5-year overall survival for children was 80%, 59%, 47%, respectively, vs 56%, 34%, 26% in adults (p<0.001). Children had larger mean (SD) tumors [9.5cm(6.7) vs 6.2cm(5.7), p<0.001] and more metastasis (24% vs 11%, p<0.001). Children had significantly higher rate of surgery (72% vs 42%, p<0.001), lymph nodes examined (43% vs 24%, p<0.001), positive lymph nodes (35% vs 4%, p<0.001), and R0 resection (83% vs. 74%, p<0.001)(Table 1).

Multivariable regression identified fibrolamellar HCC [HR=0.58, 95%CI(0.39-0.86)], transplantation compared to resection [0.42(0.25, 0.70)], and any adjuvant therapy [0.80(0.71, 0.90)] with increased overall survival. Tumor size >10cm [1.36(1.19,1.55)], metastasis at diagnosis [1.91(1.46,2.50)], positive lymph nodes [1.91(1.54,2.36)], not achieving R0 resection [2.21(1.87,2.60)], and >grade 2[1.43(1.28,1.61)] were associated with decreased overall survival. Age was not predictive of overall survival.

Subgroup analysis performed on patients with fibrolamellar HCC found 54(29%) children and 129(0.3%) adults. The 1, 3, and 5-year overall survival for children was 88%, 57%, 43%, respectively, vs 81%, 70%, 61% in adults (p=0.65).

Conclusions: Despite higher prevalence of metastasis, positive lymph nodes, and larger tumor size, children with HCC have improved overall survival. Age did not significantly contribute to survivorship, suggesting that the higher proportion of fibrolamellar disease and more aggressive surgical approach account for the improved overall survival in children.