Fibrolamellar hepatocellular carcinoma in children and adolescents

Howard M. Katzenstein, Mark D. Krailo, Marcio Malogolowkin, Jorge A. Ortega, Wenchun Qu, Edwin C. Douglass, James H. Feusner, Marieta Reynolds, John J. Quinn, Kurt Newman, Milton J. Finegold, Joel E. Haas, Martha G. Sensel, Robert P. Castleberry, Laura C. Bowman

Research output: Contribution to journalArticle

133 Citations (Scopus)

Abstract

BACKGROUND. Children with hepatocellular carcinoma (HCC) were treated on a prospective, randomized trial and were then analyzed to determine whether children with the fibrolamellar (FL) histologic variant of HCC have a more favorable presentation, increased surgical resectability, greater response to therapy, and improved outcome compared with children who have typical HCC. METHODS. Forty-six patients were enrolled on Pediatric Intergroup Hepatoma Protocol INT-0098 (Pediatric Oncology Group Study 8945/Children's Cancer Group Study 8881) between August 1989 and December 1992. After undergoing initial surgery or biopsy, children with Stage I HCC (n = 8 patients), Stage III HCC (n = 25 patients), and Stage IV HCC (n = 13 patients) were assigned randomly, regardless of histology, to receive treatment either with cisplatin, vincristine, and fluorouracil (n = 20 patients) or with cisplatin and continuous-infusion doxorubicin (n = 26 patients). RESULTS. Ten of 46 patients (22%) had the fibrolamellar variant of HCC (FL-HCC). For the entire cohort, the estimated 5-year event free survival (EFS) rate (± standard deviation) was 17% ± 6%. There was no difference in outcome among patients who were treated with either regimen. The 5-year EFS rate for patients with FL-HCC was no different the rate for patients with typical HCC (30% ± 15% vs. 14% ± 6%, respectively; P = 0.18), although the median survival was longer in patients with FL-HCC. There was no difference in the number of patients with advanced-stage disease, the incidence of surgical resectability at diagnosis, or the response to treatment between patients with FL-HCC and patients with typical HCC. CONCLUSIONS. Children with FL-HCC do not have a favorable prognosis and do not respond any differently to current therapeutic regimens than patients with typical HCC. Children with initially resectable HCC have a good prognosis irrespective of histologic subtype, whereas outcomes are poor uniformly for children with advancedstage disease. The use of novel chemotherapeutic agents and the incorporation of other treatment modalities are indicated to improve the dismal survival of pediatric patients with all histologic variants of advanced-stage HCC.

Original languageEnglish (US)
Pages (from-to)2006-2012
Number of pages7
JournalCancer
Volume97
Issue number8
DOIs
StatePublished - Apr 15 2003
Externally publishedYes

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Hepatocellular Carcinoma
Fibrolamellar hepatocellular carcinoma
Pediatrics
Cisplatin
Disease-Free Survival
Survival Rate
Therapeutics
Survival
Vincristine
Fluorouracil
Doxorubicin
Histology
Biopsy
Incidence

Keywords

  • Fibrolamellar
  • Hepatocellular carcinoma
  • Liver
  • Pediatrics

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Katzenstein, H. M., Krailo, M. D., Malogolowkin, M., Ortega, J. A., Qu, W., Douglass, E. C., ... Bowman, L. C. (2003). Fibrolamellar hepatocellular carcinoma in children and adolescents. Cancer, 97(8), 2006-2012. https://doi.org/10.1002/cncr.11292

Fibrolamellar hepatocellular carcinoma in children and adolescents. / Katzenstein, Howard M.; Krailo, Mark D.; Malogolowkin, Marcio; Ortega, Jorge A.; Qu, Wenchun; Douglass, Edwin C.; Feusner, James H.; Reynolds, Marieta; Quinn, John J.; Newman, Kurt; Finegold, Milton J.; Haas, Joel E.; Sensel, Martha G.; Castleberry, Robert P.; Bowman, Laura C.

In: Cancer, Vol. 97, No. 8, 15.04.2003, p. 2006-2012.

Research output: Contribution to journalArticle

Katzenstein, HM, Krailo, MD, Malogolowkin, M, Ortega, JA, Qu, W, Douglass, EC, Feusner, JH, Reynolds, M, Quinn, JJ, Newman, K, Finegold, MJ, Haas, JE, Sensel, MG, Castleberry, RP & Bowman, LC 2003, 'Fibrolamellar hepatocellular carcinoma in children and adolescents', Cancer, vol. 97, no. 8, pp. 2006-2012. https://doi.org/10.1002/cncr.11292
Katzenstein HM, Krailo MD, Malogolowkin M, Ortega JA, Qu W, Douglass EC et al. Fibrolamellar hepatocellular carcinoma in children and adolescents. Cancer. 2003 Apr 15;97(8):2006-2012. https://doi.org/10.1002/cncr.11292
Katzenstein, Howard M. ; Krailo, Mark D. ; Malogolowkin, Marcio ; Ortega, Jorge A. ; Qu, Wenchun ; Douglass, Edwin C. ; Feusner, James H. ; Reynolds, Marieta ; Quinn, John J. ; Newman, Kurt ; Finegold, Milton J. ; Haas, Joel E. ; Sensel, Martha G. ; Castleberry, Robert P. ; Bowman, Laura C. / Fibrolamellar hepatocellular carcinoma in children and adolescents. In: Cancer. 2003 ; Vol. 97, No. 8. pp. 2006-2012.
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abstract = "BACKGROUND. Children with hepatocellular carcinoma (HCC) were treated on a prospective, randomized trial and were then analyzed to determine whether children with the fibrolamellar (FL) histologic variant of HCC have a more favorable presentation, increased surgical resectability, greater response to therapy, and improved outcome compared with children who have typical HCC. METHODS. Forty-six patients were enrolled on Pediatric Intergroup Hepatoma Protocol INT-0098 (Pediatric Oncology Group Study 8945/Children's Cancer Group Study 8881) between August 1989 and December 1992. After undergoing initial surgery or biopsy, children with Stage I HCC (n = 8 patients), Stage III HCC (n = 25 patients), and Stage IV HCC (n = 13 patients) were assigned randomly, regardless of histology, to receive treatment either with cisplatin, vincristine, and fluorouracil (n = 20 patients) or with cisplatin and continuous-infusion doxorubicin (n = 26 patients). RESULTS. Ten of 46 patients (22{\%}) had the fibrolamellar variant of HCC (FL-HCC). For the entire cohort, the estimated 5-year event free survival (EFS) rate (± standard deviation) was 17{\%} ± 6{\%}. There was no difference in outcome among patients who were treated with either regimen. The 5-year EFS rate for patients with FL-HCC was no different the rate for patients with typical HCC (30{\%} ± 15{\%} vs. 14{\%} ± 6{\%}, respectively; P = 0.18), although the median survival was longer in patients with FL-HCC. There was no difference in the number of patients with advanced-stage disease, the incidence of surgical resectability at diagnosis, or the response to treatment between patients with FL-HCC and patients with typical HCC. CONCLUSIONS. Children with FL-HCC do not have a favorable prognosis and do not respond any differently to current therapeutic regimens than patients with typical HCC. Children with initially resectable HCC have a good prognosis irrespective of histologic subtype, whereas outcomes are poor uniformly for children with advancedstage disease. The use of novel chemotherapeutic agents and the incorporation of other treatment modalities are indicated to improve the dismal survival of pediatric patients with all histologic variants of advanced-stage HCC.",
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T1 - Fibrolamellar hepatocellular carcinoma in children and adolescents

AU - Katzenstein, Howard M.

AU - Krailo, Mark D.

AU - Malogolowkin, Marcio

AU - Ortega, Jorge A.

AU - Qu, Wenchun

AU - Douglass, Edwin C.

AU - Feusner, James H.

AU - Reynolds, Marieta

AU - Quinn, John J.

AU - Newman, Kurt

AU - Finegold, Milton J.

AU - Haas, Joel E.

AU - Sensel, Martha G.

AU - Castleberry, Robert P.

AU - Bowman, Laura C.

PY - 2003/4/15

Y1 - 2003/4/15

N2 - BACKGROUND. Children with hepatocellular carcinoma (HCC) were treated on a prospective, randomized trial and were then analyzed to determine whether children with the fibrolamellar (FL) histologic variant of HCC have a more favorable presentation, increased surgical resectability, greater response to therapy, and improved outcome compared with children who have typical HCC. METHODS. Forty-six patients were enrolled on Pediatric Intergroup Hepatoma Protocol INT-0098 (Pediatric Oncology Group Study 8945/Children's Cancer Group Study 8881) between August 1989 and December 1992. After undergoing initial surgery or biopsy, children with Stage I HCC (n = 8 patients), Stage III HCC (n = 25 patients), and Stage IV HCC (n = 13 patients) were assigned randomly, regardless of histology, to receive treatment either with cisplatin, vincristine, and fluorouracil (n = 20 patients) or with cisplatin and continuous-infusion doxorubicin (n = 26 patients). RESULTS. Ten of 46 patients (22%) had the fibrolamellar variant of HCC (FL-HCC). For the entire cohort, the estimated 5-year event free survival (EFS) rate (± standard deviation) was 17% ± 6%. There was no difference in outcome among patients who were treated with either regimen. The 5-year EFS rate for patients with FL-HCC was no different the rate for patients with typical HCC (30% ± 15% vs. 14% ± 6%, respectively; P = 0.18), although the median survival was longer in patients with FL-HCC. There was no difference in the number of patients with advanced-stage disease, the incidence of surgical resectability at diagnosis, or the response to treatment between patients with FL-HCC and patients with typical HCC. CONCLUSIONS. Children with FL-HCC do not have a favorable prognosis and do not respond any differently to current therapeutic regimens than patients with typical HCC. Children with initially resectable HCC have a good prognosis irrespective of histologic subtype, whereas outcomes are poor uniformly for children with advancedstage disease. The use of novel chemotherapeutic agents and the incorporation of other treatment modalities are indicated to improve the dismal survival of pediatric patients with all histologic variants of advanced-stage HCC.

AB - BACKGROUND. Children with hepatocellular carcinoma (HCC) were treated on a prospective, randomized trial and were then analyzed to determine whether children with the fibrolamellar (FL) histologic variant of HCC have a more favorable presentation, increased surgical resectability, greater response to therapy, and improved outcome compared with children who have typical HCC. METHODS. Forty-six patients were enrolled on Pediatric Intergroup Hepatoma Protocol INT-0098 (Pediatric Oncology Group Study 8945/Children's Cancer Group Study 8881) between August 1989 and December 1992. After undergoing initial surgery or biopsy, children with Stage I HCC (n = 8 patients), Stage III HCC (n = 25 patients), and Stage IV HCC (n = 13 patients) were assigned randomly, regardless of histology, to receive treatment either with cisplatin, vincristine, and fluorouracil (n = 20 patients) or with cisplatin and continuous-infusion doxorubicin (n = 26 patients). RESULTS. Ten of 46 patients (22%) had the fibrolamellar variant of HCC (FL-HCC). For the entire cohort, the estimated 5-year event free survival (EFS) rate (± standard deviation) was 17% ± 6%. There was no difference in outcome among patients who were treated with either regimen. The 5-year EFS rate for patients with FL-HCC was no different the rate for patients with typical HCC (30% ± 15% vs. 14% ± 6%, respectively; P = 0.18), although the median survival was longer in patients with FL-HCC. There was no difference in the number of patients with advanced-stage disease, the incidence of surgical resectability at diagnosis, or the response to treatment between patients with FL-HCC and patients with typical HCC. CONCLUSIONS. Children with FL-HCC do not have a favorable prognosis and do not respond any differently to current therapeutic regimens than patients with typical HCC. Children with initially resectable HCC have a good prognosis irrespective of histologic subtype, whereas outcomes are poor uniformly for children with advancedstage disease. The use of novel chemotherapeutic agents and the incorporation of other treatment modalities are indicated to improve the dismal survival of pediatric patients with all histologic variants of advanced-stage HCC.

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