Predictors for Recurrence in Hepatoblastoma: Single-center Study

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.

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 - age, AFP level, PRETEXT stage, histology, surgical approach, vascular involvement, surgical margin status, and SIOPEL high-risk category - were evaluated for their association with tumor recurrence using Fisher's exact test. Data were analyzed.

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 (P = 0.038) and the requirement for liver transplantation (P = 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.

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.