{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T05:15:22Z","timestamp":1778130922984,"version":"3.51.4"},"reference-count":23,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to investigate the prevalence, pattern of liver involvement at diagnosis of pediatric acute leukemia, and its associations with clinical features and prognosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>From January 2016 to December 2017, 304 consecutive children newly diagnosed with acute leukemia (190 pre-B acute lymphoblastic leukemia (ALL), 25 T-ALL, and 89 acute myeloid leukemia (AML)), were enrolled. Liver involvement was defined as hepatomegaly (HM), hepatocellular injury (HI), hepatic dysfunction (HD) and cholestasis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The prevalence of liver involvement varied significantly across leukemia subtypes: T-ALL (80.0%), pre-B-ALL (64.0%), and AML (37.0%) (P&amp;lt;0.001). HM was the most common isolated manifestation in all subtypes. Lower platelet counts were significantly associated with HM and HI in pre-B-ALL, and with HD in T-ALL (all P &amp;lt; 0.05). HI was positively correlated with age in pre-B-ALL (median age: 9.0 vs. 4.0 years, P &amp;lt; 0.001), while HM was associated with higher white blood cell (WBC) counts in T-ALL (228.0 vs. 10\u00d710\n                      <jats:sup>9<\/jats:sup>\n                      \/L, P\u00a0=\u00a00.035). HD showed a trend of association with elevated WBC counts in AML (P\u00a0=\u00a00.054). Liver involvement was not associated with early treatment response or long-term survival in ALL. In AML, however, complex hepatic injury and WBC count emerged as independent adverse prognostic factors: AML patients without liver involvement had the best 5-year overall survival (OS: 87.5\u00a0\u00b1\u00a04.4%) and event-free survival (EFS: 80.4\u00a0\u00b1\u00a05.3%), whereas those with complex hepatic injury had the poorest outcomes (5-year OS: 58.3\u00a0\u00b1\u00a014.2%, EFS:50.0\u00a0\u00b1\u00a014.4%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Liver involvement exhibits subtype-specific patterns in pediatric acute leukemia and is associated with age, WBC and platelet counts. Notably, complex hepatic injury may serve as a potential adverse prognostic marker for pediatric AML.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1749226","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T04:50:03Z","timestamp":1778129403000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Liver involvement in pediatric acute leukemia: subtype differences and complex hepatic injury as a novel marker for AML risk stratification"],"prefix":"10.3389","volume":"16","author":[{"given":"Yu-juan","family":"Xue","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Peking University People\u2019s Hospital, Peking University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Peking University People\u2019s Hospital, Peking University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ai-dong","family":"Lu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Peking University People\u2019s Hospital, Peking University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue-ping","family":"Jia","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Peking University People\u2019s Hospital, Peking University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhi-xiao","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Peking University People\u2019s Hospital, Peking University","place":["Beijing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Peking University People\u2019s Hospital, 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