{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T19:55:04Z","timestamp":1781812504395,"version":"3.54.5"},"reference-count":33,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100012319","name":"National Center for Global Health and Medicine","doi-asserted-by":"publisher","award":["24A2001"],"award-info":[{"award-number":["24A2001"]}],"id":[{"id":"10.13039\/100012319","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Gastro and Hepatol"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Fontan\u2010associated liver disease (FALD) is a long\u2010term complication after Fontan surgery, and the development of hepatocellular carcinoma (HCC) in relatively young patients has become a major clinical concern. This study aimed to clarify the diagnostic triggers, clinicopathological characteristics, treatment strategies, and outcomes of FALD\u2010HCC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 297 patients with FALD who visited our department between 2003 and 2025. Among them, 28 patients (9.4%) developed HCC. Diagnostic triggers, tumor characteristics, initial treatment modalities, and clinical courses were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>HCC developed at a median age of 32.6\u2009years, with an interval of 26.1\u2009years after Fontan surgery. Diagnosis was triggered by tumor marker elevation, including alpha\u2010fetoprotein and\/or des\u2010gamma\u2010carboxy prothrombin, in 46.4% of patients, routine surveillance imaging in 35.7%, and symptom\u2010driven imaging in 17.9%. Most patients had a single tumor, frequently located in the peripheral liver. At diagnosis, 71.5% were classified as stage I or II disease. Histological evaluation, available in selected cases, revealed variable tumor differentiation and advanced fibrosis in noncancerous liver tissue. Initial treatments included hepatic resection, transcatheter arterial chemoembolization, stereotactic body radiotherapy, proton beam therapy, systemic therapy, or palliative care alone in patients with advanced liver failure. Three\u2010year survival rates were favorable, reaching 100% in patients treated with hepatic resection or stereotactic body radiotherapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>When FALD\u2010HCC was detected at an early stage through surveillance, a broad range of treatment options, including locoregional therapies, could be applied and were associated with favorable clinical outcomes. Although selection bias limits direct comparison, treatment of FALD\u2010HCC should be considered.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgh.70280","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T10:10:17Z","timestamp":1770804617000},"page":"1052-1064","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Clinical Outcomes of Fontan\u2010Associated Hepatocellular Carcinoma: a Single\u2010Center Retrospective Study"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1248-4324","authenticated-orcid":false,"given":"Tomomi","family":"Kogiso","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Institute of Gastroenterology Tokyo Women's Medical University  Tokyo 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