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Цель: сравнить особенности гепатоцеллюлярного рака у детей и взрослых, а также оценить возможность экстраполяции опыта лечения взрослых пациентов на педиатрическую практику. Материал и методы. Проведен анализ литературы, посвященной изучению и лечению гепатоцеллюлярного рака у детей и взрослых. Отдельное внимание уделено сравнению патоморфологических и молекулярно-генетических особенностей болезни и подходов к медикаментозному и хирургическому лечению, в частности иммунотерапии и трансплантации печени. Результаты. Для гепатоцеллюлярного рака у детей характерно превалирование фиброламеллярного гистологического подтипа, наличие характерных молекулярно-генетических маркеров, большие размеры первичной опухоли. У детей целесообразно применять методы лечения, заимствованные у взрослых, - таргетную и иммунотерапию. Подходы к хирургическому лечению, в частности показания к трансплантации печени, у детей должны отличаться. Заключение. Дальнейший перенос опыта лечения взрослых пациентов на детскую популяцию позволит улучшить результаты лечения детей с гепатоцеллюлярным раком. Работа в рамках международных исследовательских групп необходима для оптимизации лечения детей с гепатоцеллюлярным раком.
Ключевые слова:
печень, гепатоцеллюлярная карцинома, дети, детская онкология, опухоли печени у детей, liver, hepatocellular carcinoma, children, pediatric oncology, pediatric liver tumors
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Aim: to compare the features of hepatocellular carcinoma in children and adult patients and to assess the possibility of translating the experience of adult patients treating in pediatric oncology. Мethods. The literature dedicated to pediatric and adult hepatocellular carcinoma investigation and treatment has been analyzed. Pathomorphology, molecular genetic features of disease, the drug and surgical treatment approaches, in particular immunotherapy and liver transplantation were carefully compared in both groups. Results. For pediatric hepatocellular carcinoma the analysis revealed that: fibrolamellar subtype as well as large size of primary tumor are more common; typical molecular genetic markers are presented. It is advisable to use the adopted adults treatment methods such as targeted and immunotherapy in children. In particular, the hepatocellular carcinoma surgery, and the indications for liver transplantation in children should be different from adults. Conclusion. Further translation of the adult patients treating experience will help to improve outcome in children with hepatocellular carcinoma. In order to optimize the treatment of pediatric hepatocellular carcinoma it is necessary to continue the investigations in international research groups.
Keywords:
печень, гепатоцеллюлярная карцинома, дети, детская онкология, опухоли печени у детей, liver, hepatocellular carcinoma, children, pediatric oncology, pediatric liver tumors