{"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":1793602013767,"version":"4.5.0"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2021,11,29]],"date-time":"2021-11-29T00:00:00Z","timestamp":1638144000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"China Health Promotion Foundation NST project","award":["2020"],"award-info":[{"award-number":["2020"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>After a complete remission to treatment for hepatoblastoma, some children still have recurrence. We identified and explored the factors that influence recurrence after complete remission in a retrospective study.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>Of 197 children with hepatoblastoma, 140 (71.1%) achieved initial complete remission and were enrolled in factor analysis. Variables consisted of age, sex, PRE-Treatment EXTent of tumor (PRETEXT) stage, pathologic type, metastatic disease, serum alpha-fetoprotein level, vascular involvement, and surgical margin status. We employed univariate and multivariate analyses to assess the relationship between each factor and tumor recurrence.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of 140 children who achieved initial complete remission, 42 (30%) had recurrent hepatoblastoma. The 5-year overall survival rates for the non-recurrence and recurrence group were 99.0% and 78.6%, respectively. The overall 1-year, 3-year, and 5-year recurrence-free survival (RFS) rates were 77.8%, 69.8%, and 69.8%, respectively. All recurrences occurred within 2 years from complete remission. The RFS rate was significantly higher in children younger than 3 years and in those with mixed pathological type, PRETEXT II and III, without metastatic disease, without vascular involvement, and microscopic negative margin than in that of children older than 3 years, with epithelial pathological type, PRETEXT IV, metastatic disease, vascular involvement, and macroscopic positive margin (<jats:italic>P<\/jats:italic> &lt; 0.001, = 0.020, &lt; 0.001, = 0.004, = 0.002, and &lt; 0.001, respectively). The independent risk factors for recurrence after complete remission were age \u22653 years, PRETEXT IV, and metastatic disease (<jats:italic>P<\/jats:italic> &lt; 0.05).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>Age, PRETEXT stage, metastatic disease, vascular involvement, pathologic type, and surgical margin status might be associated with recurrent hepatoblastoma after complete remission; meanwhile, age \u22653 years, PRETEXT IV, and metastatic disease are independent risk factors of recurrence. Further research is needed on the causes of tumor recurrence, which may improve the long-term outcomes of children with hepatoblastoma.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0259503","type":"journal-article","created":{"date-parts":[[2021,11,29]],"date-time":"2021-11-29T18:38:50Z","timestamp":1638211130000},"page":"e0259503","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":16,"title":["Factors influencing recurrence after complete remission in children with hepatoblastoma: A 14-year retrospective study in China"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7464-3098","authenticated-orcid":true,"given":"Fan","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiling","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huimin","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongsheng","family":"Huang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,11,29]]},"reference":[{"issue":"3","key":"pone.0259503.ref001","doi-asserted-by":"crossref","first-page":"560","DOI":"10.1053\/jhep.2003.50375","article-title":"Epidemiology 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Younes","year":"2020","journal-title":"Eur J Pediatr Surg"},{"issue":"10","key":"pone.0259503.ref005","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1007\/s00247-014-3000-6","article-title":"Relapse surveillance in AFP-positive hepatoblastoma: re-evaluating the role of imaging","volume":"44","author":"Y Rojas","year":"2014","journal-title":"Pediatr Radiol"},{"issue":"4","key":"pone.0259503.ref006","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1016\/j.ejca.2012.10.003","article-title":"Relapses in hepatoblastoma patients: clinical characteristics and outcome\u2014experience of the International Childhood Liver Tumour Strategy Group (SIOPEL)","volume":"49","author":"M Semeraro","year":"2013","journal-title":"Eur J Cancer"},{"issue":"1","key":"pone.0259503.ref007","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 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