During the years 1976 through 1985, 55 cases of primary malignant tumor of liver in infants and children were treated. Of the 55, 30 were histologically proved to have hepatocellular carcinoma (HCC), and ten to have hepatoblastoma (HB). HCC was diagnosed in another 14 children based on clinical findings. There was one case of liposarcoma. Distinguishing features of primary malignant tumor of the liver of children in Taiwan include: (1) a significantly greater number of HCC than HB (4.4:1); (2) a 100% (25/25) positive rate of hepatitis B surface antigen (HBsAg) with family clustering for HCC; (3) 71% of the HCC patients also suffered from liver cirrhosis; (4) male prepon-derance in incidence of HCC. All of these results strongly supported the idea that vertical transmission of hepatitis B virus infection from the mother plays an important role in the development of HCC in this area. a 60% resectable rate and 40% survival rate were observed in HB, but for HCC, the resectability was <10%. Only two children were cured of HCC. Among those without tumor resection, all, except two, children died within 1 year. No difference in survival time was observed between those who had chemotherapy and those who did not. Early diagnosis and complete excision of the tumor remains the only way to long-term survival. Monitoring of α-fetoprotein in high-risk children, followed by more intensive investigation for those with elevation, is mandatory for early detection of the tumor.
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