{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:38:57Z","timestamp":1787071137586,"version":"build-2736575974"},"reference-count":21,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T00:00:00Z","timestamp":1774051200000},"content-version":"unspecified","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":[[2026,7]]},"abstract":"<jats:title>\n                    A\n                    <jats:sc>BSTRACT<\/jats:sc>\n                  <\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Hepatoblastoma is the most common primary liver malignancy in children, and advances in multimodal therapy have significantly improved survival outcomes. Despite the improvements, tumor recurrence remains a major clinical challenge and continues to adversely affect long-term survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>This is a retrospective study of all children who underwent hepatic resection for hepatoblastoma from January 2015 to June 2024. All children had alpha-fetoprotein (AFP) and contrast-enhanced computed tomography (CECT) chest, abdomen, and pelvis at the time of diagnosis. All children underwent neoadjuvant chemotherapy as per SIOPEL protocol followed by hepatic resections. Depending on the CECT findings, postchemotherapy either hepatectomy (right\/left\/central) or liver transplantation was performed. Postsurgery chemotherapy schedule was completed. Children were followed up after 3 months and subsequently at 6 monthly intervals for 3 years. On follow-up AFP and USG were done, and in cases of elevated AFP levels or doubtful lesion on USG, CECT chest, abdomen, and pelvis were done. Eight potential risk factors \u2013 age, AFP level, PRETEXT stage, histology, surgical approach, vascular involvement, surgical margin status, and SIOPEL high-risk category \u2013 were evaluated for their association with tumor recurrence using Fisher\u2019s exact test. Data were analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Twenty-five children were included in the study, of which 14 were boys and 11 were girls. The mean age at the time of surgery was 27 months. The mean follow-up period was 38 months. Eleven children underwent hepatectomy (right\/left\/central) while 4 underwent liver transplantation. Tumor recurrence was observed in five patients (20%), with all cases presenting as distant metastases involving the lungs or mediastinal lymph nodes. Vascular (either portal or hepatic vein) involvement (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.038) and the requirement for liver transplantation (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.016) were significantly associated with recurrence, whereas age, AFP, PRETEXT, histology, surgical margin, and SIOPEL high risk were not associated with increased risk of the recurrence. The overall survival rate was 88%. Survival was significantly low (40%) in patients with recurrence while patients without recurrence had 100% survival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Vascular involvement and liver transplantation emerged as the key predictors of hepatoblastoma recurrence. The factors such as age, AFP level, PRETEXT stag, histopathology, tumor margin positivity, and high risk as per the SIOPEL guidelines were not associated with tumor recurrence. Recurrence was predominantly distant and associated with increased mortality. Larger multicenter studies are needed to validate these findings and to further refine risk-stratified management strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jiaps.jiaps_411_25","type":"journal-article","created":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T14:01:18Z","timestamp":1774447278000},"page":"567-572","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Predictors for Recurrence in Hepatoblastoma: Single-center Study"],"prefix":"10.4103","volume":"31","author":[{"given":"Lajja","family":"Jivani","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. M.","family":"Zameer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinay","family":"Chandrashekar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Rakhesh","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"D\u2019Cruz","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Narayana Health, Bengaluru, Karnataka, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,3,21]]},"reference":[{"key":"R1-20260706","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1097\/00000478-198212000-00001","article-title":"Hepatoblastoma. A clinical and pathologic study of 54 cases","volume":"6","author":"Lack","year":"1982","journal-title":"Am J Surg Pathol"},{"key":"R2-20260706","doi-asserted-by":"crossref","first-page":"e1912070","DOI":"10.1001\/jamanetworkopen.2019.12676","article-title":"Assessment of survival of pediatric patients with hepatoblastoma who received chemotherapy following liver transplant or liver resection","volume":"2","author":"Feng","year":"2019","journal-title":"JAMA Netw Open"},{"key":"R3-20260706","doi-asserted-by":"crossref","first-page":"e0259503","DOI":"10.1371\/journal.pone.0259503","article-title":"Factors influencing recurrence after complete remission in children with hepatoblastoma: A 14-year retrospective study in China","volume":"16","author":"Li","year":"2021","journal-title":"PLoS One"},{"key":"R5-20260706","first-page":"517","article-title":"Predictors of survival in pediatric hepatoblastoma patients undergoing transplantation: A report from the pediatric liver unresectable tumor 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profiling identifies distinct molecular subtypes and prognostic stratification","volume":"48","author":"Cairo","year":"2008","journal-title":"Hepatology"},{"key":"R18-20260706","first-page":"497","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":"27","author":"Fuchs","year":"2017","journal-title":"Eur J Pediatr Surg"},{"key":"R19-20260706","first-page":"666","article-title":"Liver transplantation in children with hepatoblastoma: A review of the SPLIT (studies of pediatric liver transplantation) experience","volume":"256","author":"Meyers","year":"2012","journal-title":"Ann Surg"},{"key":"R20-20260706","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s00383-022-05356-z","article-title":"Surgical management in hepatoblastoma: Points to take","volume":"39","author":"Murawski","year":"2023","journal-title":"Pediatr Surg 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