{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T06:46:53Z","timestamp":1793602013514,"version":"4.5.0"},"reference-count":23,"publisher":"Wiley","issue":"23","license":[{"start":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T00:00:00Z","timestamp":1699920000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100020187","name":"Macy Easom Cancer Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100020187","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["1F32CA278313\u201001"],"award-info":[{"award-number":["1F32CA278313\u201001"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Hepatoblastoma (HB) is the most common primary hepatic malignancy in childhood. Relapse occurs in more than 50% of high\u2010risk patients with a high mortality due to ineffective salvage therapies. The purpose of this study is to identify risk factors for relapsed HB and predictors of survival in a single tertiary referral center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective chart review showed 129 surgically treated HB patients from October 2004 to July 2020. Of the cohort, 22 patients presented with relapsed HB. Relapse was defined as re\u2010appearance of malignancy after 4\u2009weeks of normalized AFP and disappearance of all tumors on imaging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Patients with relapsed HB had a 5\u2010year overall survival (OS) of 45.4% compared to 93.1% in those without relapse (<jats:italic>p<\/jats:italic>\u2009=\u20090.001). When comparing PRETEXT IV, microvascular invasion, metastatic disease, and age on multivariate logistic regression, only PRETEXT IV was an independent risk factor for relapsed HB with an OR of 2.39 (95% CI: 1.16\u20134.96; <jats:italic>p<\/jats:italic>\u2009=\u20090.019). Mixed epithelial and mesenchymal HB (12\/19, 63.2%) was the most common histology of primary tumors while pure epithelial HB (13\/15, 86.6%) was the most common relapsed histology. Combination of surgical and medical therapy for relapsed disease was predictive of survival with an HR of 16.3 (95% CI: 1.783\u2013149.091; <jats:italic>p<\/jats:italic>\u2009=\u20090.013) compared to only chemotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study demonstrates that PRETEXT IV staging is an independent predictor of relapsed disease. The most common relapsed histology was epithelial, suggesting a potential selection or resistance of this component. Surgical resection is a critical component of multimodal therapy for relapsed HB.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.6705","type":"journal-article","created":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T12:05:05Z","timestamp":1699963505000},"page":"21270-21278","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Navigating relapsed hepatoblastoma: Predictive factors and surgical treatment strategy"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8716-3125","authenticated-orcid":false,"given":"Andres F.","family":"Espinoza","sequence":"first","affiliation":[{"name":"Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Surgical Oncology Program and Liver Tumor Program, Dan L. Duncan Cancer Center Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalyani R.","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Pathology and Immunology Texas Children's Hospital, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Priya B.","family":"Shetty","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology Texas Children's Hospital, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9093-0388","authenticated-orcid":false,"given":"Richard S.","family":"Whitlock","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Surgical Oncology Program and Liver Tumor Program, Dan L. Duncan Cancer Center Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavel","family":"Sumazin","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology Texas Children's Hospital, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinjian","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology Texas Children's Hospital, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8094-0972","authenticated-orcid":false,"given":"Stephen F.","family":"Sarabia","sequence":"additional","affiliation":[{"name":"Department of Pathology and Immunology Texas Children's Hospital, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Urbicain","sequence":"additional","affiliation":[{"name":"Department of Pathology and Immunology Texas Children's Hospital, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andras","family":"Heczey","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology Texas Children's Hospital, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakash","family":"Masand","sequence":"additional","affiliation":[{"name":"Singleton Department of Pediatric Radiology Texas Children's Hospital, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah E.","family":"Woodfield","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Surgical Oncology Program and Liver Tumor Program, Dan L. Duncan Cancer Center Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolores H.","family":"L\u00f3pez\u2010Terrada","sequence":"additional","affiliation":[{"name":"Department of Pathology and Immunology Texas Children's Hospital, Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjeev A.","family":"Vasudevan","sequence":"additional","affiliation":[{"name":"Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Surgical Oncology Program and Liver Tumor Program, Dan L. 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