{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T20:31:50Z","timestamp":1786739510574,"version":"build-2736575974"},"reference-count":31,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2021,3,1]],"date-time":"2021-03-01T00:00:00Z","timestamp":1614556800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2020,11,7]],"date-time":"2020-11-07T00:00:00Z","timestamp":1604707200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Many studies have demonstrated that outcome in patients with hepatoblastoma is determined by tumor resectability and the presence or absence of metastatic disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To evaluate and disseminate information on diagnosis, treatment, and outcome of hepatoblastoma patients at a tertiary care hospital in Saudi Arabia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods:<\/jats:title>\n                    <jats:p>Twenty-four pediatric patients with hepatoblastoma were treated at our institution between January 2005 and December 2012. The majority of our patients were stage III and above, while one-third of them presented with metastatic disease. Four (16.7%) had vascular invasion. Two-thirds of our patients (n = 16, 66.7%) had alpha-fetoprotein (AFP) level above 100,000 ng\/mL. Twenty-one patients underwent surgery; two had upfront surgery before getting any chemotherapy, and 15 had surgery on schedule after pre-operative chemotherapy. Four patients had delayed surgery as the tumor was not resectable and received extra cycles of chemotherapy. Chemotherapy regimens used were based on SIOPEL study protocols until 2011 and Children's Oncology Group (COG) protocol from 2012 onwards. Relapse, progressive disease, or death from any cause were defined as events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Five-year overall survival (OS) of the cohort over a median follow-up time of 56.1 months was 70.6% \u00b1 9.4% with seven (29.2%) events of mortality. No significant difference was found for age at diagnosis (less than 2 years vs. more), stage of disease, AFP levels (less than 100,000 vs. more), vascular invasion, or presence of metastatic disease at presentation in terms of OS. However, children receiving upfront or scheduled as-per-protocol surgery fared better than those who had delayed surgery (as the tumor was not resectable and they received extra cycles of chemotherapy) or did not undergo any surgery (\n                      <jats:italic toggle=\"yes\">P-Value<\/jats:italic>\n                      .001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Favorable survival outcome could be achieved with complete tumor excision and adjuvant chemotherapy. Inability to perform surgical excision was the single most important predictor of mortality in our patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijpam.2020.11.001","type":"journal-article","created":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T12:09:20Z","timestamp":1605269360000},"page":"39-43","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Experience of treating pediatric hepatoblastoma at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia \u2013 Timely surgical intervention playing a key role"],"prefix":"10.4103","volume":"8","author":[{"given":"Ibrahim","family":"AlFawaz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basheer","family":"Ahmed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afshan","family":"Ali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mouhab","family":"Ayas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amani","family":"AlKofide","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zakaria","family":"Habib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khawar","family":"Siddiqui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-8-20240903","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1007\/s10147-013-0624-8","article-title":"International pediatric liver cancer pathological classification: current trend","volume":"18","author":"Tanaka","year":"2013","journal-title":"Int J Clin Oncol"},{"key":"R2-8-20240903","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1016\/0022-3468(75)90095-0","article-title":"Liver tumors in children in the particular reference to hepatoblastoma and hepatocellular carcinoma: American Academy of Pediatrics Surgical Section Survey-1974","volume":"10","author":"Exelby","year":"1975","journal-title":"J Pediatr Surg"},{"key":"R3-8-20240903","doi-asserted-by":"crossref","first-page":"3438","DOI":"10.1200\/JCO.2002.07.400","article-title":"Treatment of unresectable and metastatic hepatoblastoma: a pediatric oncology group phase II study","volume":"20","author":"Katzenstein","year":"2002","journal-title":"J Clin Oncol"},{"key":"R4-8-20240903","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.ejca.2003.06.003","article-title":"Risk- adapted treatment for childhood hepatoblastoma. final report of the second study of the International Society of Paediatric Oncology-SIOPEL 2","volume":"40","author":"Perilongo","year":"2004","journal-title":"Eur J Canc"},{"key":"R5-8-20240903","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1002\/1097-0142(19890901)64:5<1082::AID-CNCR2820640520>3.0.CO;2-G","article-title":"Histopa- thology and prognosis in childhood hepatoblastoma and hepatocarcinoma","volume":"64","author":"Haas","year":"1989","journal-title":"Cancer"},{"key":"R6-8-20240903","doi-asserted-by":"crossref","first-page":"3130","DOI":"10.1002\/1097-0142(20011215)92:12<3130::AID-CNCR10115>3.0.CO;2-#","article-title":"Small cell undifferentiated histology in hepatoblastoma may be unfavorable","volume":"92","author":"Haas","year":"2001","journal-title":"Cancer"},{"key":"R7-8-20240903","doi-asserted-by":"crossref","first-page":"2665","DOI":"10.1200\/JCO.2000.18.14.2665","article-title":"Randomized comparison of cisplatin\/vincristine\/fluorouracil and cisplatin\/ continuous infusion doxorubicin for treatment of pediatric hepatoblastoma: a report from the Children's Cancer Group and the Pediatric Oncology Group","volume":"18","author":"Ortega","year":"2000","journal-title":"J Clin Oncol"},{"key":"R8-8-20240903","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1002\/cncr.10632","article-title":"Pretreatment prognostic factors and treatment results in children with hepatoblastoma: a report from the German Cooperative Pediatric Liver Tumor Study HB 94","volume":"95","author":"Fuchs","year":"2002","journal-title":"Cancer"},{"key":"R9-8-20240903","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/S1470-2045(00)00018-8","article-title":"Liver tumour study group of the international society of paediatric O. 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