Long-term Survival and Relapse Patterns in Pediatric Hepatoblastoma: A 20-year Single-center Experience

Background: Despite advancements, managing high-risk and metastatic hepatoblastoma remains challenging. This study evaluates 2 decades of clinical experience to identify long-term prognostic drivers and the evolving role of event-free survival (EFS). Methods: This cohort consisted of 39 children with hepatoblastoma from 2004 to 2024. The clinical characteristics, PRETEXT, risk group, alpha-fetoprotein level, pulmonary metastasis, and treatment modalities were reviewed. The overall and event-free survival were estimated using the Kaplan-Meier method and log-rank tests. Univariable Cox regression was performed to evaluate the impact of pulmonary metastasis on EFS. Results: The mean age at diagnosis was 3.6±4.3 years. The 5-year OS and EFS rates were 81.2% and 75.0%, respectively. Six deaths and 9 events were recorded. OS was not significantly influenced by risk group ( P =0.093), PRETEXT stage ( P =0.177), and AFP ( P =0.214). Pulmonary metastasis at diagnosis was associated with poor EFS (log-rank P =0.048). In the univariable Cox model for EFS, pulmonary metastasis was associated with a higher risk for events (HR 3.83, 95% CI 0.91-16.10, P =0.067). Conclusions: Long-term overall survival was favorable in this cohort. Pulmonary metastasis emerged as the variable most closely linked to inferior event-free survival, whereas traditional clinical and staging variables were not significantly associated with overall survival.