Abstract: Objective To investigate the clinicopathological features and prognosis of hepatocellular carcinoma (HCC) in children and adolescents.Methods Thirty-two children and adolescents with HCC (27 males and 5 females) admitted to our hospital from January 2013 to December 2016 were ecrolled, with an average age of 14 (8, 16). Fifteen cases (46.9%) were diagnosed by ultrasound-guided liver biopsy, 12 cases (37.5%) were diagnosed by surgical biopsy, 5 cases (15.6%) were diagnosed by computed tomography (CT) and alpha fetoprotein (AFP). The survival rate was calculated and the clinilcal data was compared among patients with different clinical data. T test or Kruskal-Wallis H test was used to compare measurement data; Chi-square test was used to compare counting data. The survival rate was compared by Log-Rank test.Results Among 32 children and adolescents with HCC, 22 cases with hepatits B virus (HBV) infection and 10 cases without HBV infection. According to the clinical data of the 2 groups, the average ages of HBV positive group and HBV negative group were 15 (10, 16) years and 11 (8, 15) years, with statistical significance (Z=7.905, P<0.05). Thirteen cases (59.1%) with liver cirrhosis in HBV positive group and 2 cases (20.0%) with liver cirrhosis in HBV negative group, and the difference was statistically significant (χ²=4.219, P<0.05). The albumin (Alb) level and platelet (PLT) count in HBV positive group [37 (35, 40) g/l, 208 (170, 286)×10⁹/l] were significant lower than those in HBV negative group [43 (39, 46) g/l, 314 (245, 360)×10⁹/l], and the difference was statistically significant (Z=-5.012, -10.523, P<0.05). The median survival time of all subjects was 6 (4, 10) months, among which the 1-year, 3-year and 5-year survival rates were 34.4% (11/32), 15.6% (5/32) and 6.3% (2/32), respectively. Surgical resection, transcatheter arterial chemoembolization (TACE) and conservative treatment were performed in 14, 7 and 11 cases respectively, and the median survival time was 28 (10, 42) months, 5 (2, 8) months and 4 (1, 6) months, the differences were statistically significant (P<0.05). The 1-year survival rates of HBV positive group and HBV negative group were 56.3% (5/22) and 60.0% (6/10), with statistical significance (χ²=-4.234, P<0.05). The 1-year survival rates of patients with and without portal vein invasion were 22.7% (9/11) and 12.5% (2/16), with statistical significance (χ²=12.974, P<0.05). The 1-year survival rates of patients with and without distant metastasis were 100% (8/8) and 12.5% (3/24), with statistical significance (χ²=20.364, P<0.05). In view of the small number of cases involved, the differences of 3-year and 5-year survival rates were not analzed in this study.Conclusion HBV infection is still the most common cause for HCC in children and adolescents, and it is more likely to occur with cirrhosis. HCC in children and adolescents is highly malignant and progresses rapidly, inducing low surgical resection rate and poor prognosis. It is of vital importance to strengthen the screening of HCC as well as take active treatment for HBV infection in high-risk groups of children and adolescents.

Key words: Hepatocellular carcinoma, Children, Adolescents, Portal vein invasion, Distant metastasis