{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T18:37:38Z","timestamp":1792175858881,"version":"4.4.0"},"reference-count":37,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2023,4,12]],"date-time":"2023-04-12T00:00:00Z","timestamp":1681257600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Not all the significant progress made in the management of children with hepatoblastoma (HB) has translated into improved outcomes in limited\u2010resource settings. There are limited data on outcomes in children with HB from India.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>All patients diagnosed with HB between July 2013 and December 2020 were risk\u2010stratified and treated as per International Liver Tumor Strategy Group (SIOPEL). Patients with standard\u2010risk HB received cisplatin monotherapy and those with high\u2010risk HB received alternating cycles of cisplatin and the combination of carboplatin plus doxorubicin. Data regarding demographic details, chemotherapy, surgery, liver transplantation, outcomes, prognostic factors, and toxicity were collected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of 157 patients with HB, 117 (74%) were high risk, 31 (20%) were standard risk, and nine (6%) unknown. Patients with standard\u2010risk disease had excellent outcomes, with 3\u2010year event\u2010free survival (EFS) and overall survival (OS) of 96% and 100%, respectively. Among high\u2010risk HB, six underwent orthotopic liver transplantation of which four were alive at last follow\u2010up. The 3\u2010year EFS and OS of patients with high\u2010risk disease was 56% and 66%, respectively. Outcomes of patients with PRETEXT IV (3\u2010year EFS: 42%, 3\u2010year OS: 50%) and metastatic disease (3\u2010year EFS: 30%, 3\u2010year OS: 50%) were dismal. Patients with serum alpha\u2010fetoprotein (AFP) reduction greater than 90% following two courses of chemotherapy had favorable outcomes; 3\u2010year EFS: 80% versus 58% (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a0.013) and 3\u2010year OS: 95% vs. 68% (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a0.01). Only two (6%) of 31 patients with relapse\/refractory HB were alive at a median follow\u2010up of 36\u00a0months, and both had received salvage chemotherapy and surgery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>While children with standard\u2010risk HB had excellent outcomes, those with high\u2010risk disease continue to do poorly. Serial monitoring of serum AFP values is a cost\u2010effective and reliable predictor of outcomes. Orthotopic liver transplantation remains a viable option for inoperable disease in resource\u2010limited settings as well.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pbc.30302","type":"journal-article","created":{"date-parts":[[2023,4,13]],"date-time":"2023-04-13T01:07:06Z","timestamp":1681348026000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Treatment outcomes and prognostic factors in children with hepatoblastoma using a risk\u2010stratified approach"],"prefix":"10.1002","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2587-9181","authenticated-orcid":false,"given":"Shyam","family":"Srinivasan","sequence":"first","affiliation":[{"name":"Division of Pediatric Oncology Tata Memorial Centre Homi Bhabha National Institute  Mumbai Maharashtra 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