Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada.
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Cancer. 2021 Mar 1;127(5):769-776. doi: 10.1002/cncr.33319. Epub 2020 Nov 16.
Pediatric hepatic cancer is a rare malignancy, comprising only approximately 2% of all cancers diagnosed in children aged <15 years. The authors sought to describe trends in pediatric hepatic cancer incidence and survival in Ontario, Canada; the United States; and Australia.
Children aged <15 years who were diagnosed with hepatic cancer from 1985 through 2013 were ascertained through population-based registries and followed from the time of diagnosis until December 31, 2015. Age-standardized incidence and 5-year relative survival were calculated for each jurisdiction. Multivariable flexible parametric survival models were used to explore predictors of hepatic cancer mortality.
A total of 794 children were identified in Ontario (148 children), the United States (400 children), and Australia (246 children). The average annual incidence increased by 2.2% (95% CI, 0.5%-4.0%) in Australia, 2.1% (95% CI, 0.9%-3.3%) in the United States, and 1.3% (95% CI, -0.4% to 3.0%) in Ontario. The 5-year relative survival rate improved from 60% to 82% (P = .08) in Ontario and 62% to 78% (P = .02) in the United States between the diagnostic periods 1985 through 1994 and 2005 through 2013, whereas in Australia the rate remained constant (between 74% and 77%) during the study period. On multivariable analysis, there was no significant difference noted with regard to the hazard of death between jurisdictions (P = .06). Older age, the presence of metastatic disease, and being diagnosed with hepatocellular carcinoma were found to be associated with mortality.
The incidence of hepatic cancer in children appears to have increased over the last 30 years in Australia and North America. Survival differences between Australia; Ontario, Canada; and the United States observed in the 1980s and 1990s were no longer apparent and only marginal geographical differences in the hazard of mortality were observed.
小儿肝癌是一种罕见的恶性肿瘤，约占所有 15 岁以下儿童癌症的 2%。作者旨在描述加拿大安大略省、美国和澳大利亚小儿肝癌发病率和生存率的变化趋势。
通过人群为基础的登记处确定了 1985 年至 2013 年间诊断为肝癌的年龄<15 岁的儿童，并从诊断之日起随访至 2015 年 12 月 31 日。为每个司法管辖区计算了年龄标准化发病率和 5 年相对生存率。采用多变量灵活参数生存模型探讨肝癌死亡率的预测因素。
在安大略省（148 例）、美国（400 例）和澳大利亚（246 例）共发现 794 例儿童。澳大利亚的肝癌年平均发病率增加了 2.2%（95%CI，0.5%-4.0%），美国增加了 2.1%（95%CI，0.9%-3.3%），安大略省增加了 1.3%（95%CI，-0.4%至 3.0%）。在 1985 年至 1994 年和 2005 年至 2013 年期间，安大略省的 5 年相对生存率从 60%提高到 82%（P=0.08），美国从 62%提高到 78%（P=0.02），而在研究期间，澳大利亚的生存率保持不变（在 74%至 77%之间）。多变量分析显示，各司法管辖区之间的死亡风险无显著差异（P=0.06）。年龄较大、存在转移性疾病和诊断为肝细胞癌与死亡率相关。
在过去 30 年中，澳大利亚和北美地区儿童肝癌的发病率似乎有所增加。在 20 世纪 80 年代和 90 年代观察到的澳大利亚、安大略省（加拿大）和美国之间的生存率差异不再明显，仅观察到死亡率的地理差异略有差异。
