Liver Tumors (Hepatoblastoma/HCC)

Hepatoblastoma, the dominant pediatric liver malignancy, typically presents before age 10 with markedly elevated AFP (>100 ng/mL diagnostic threshold) [e291-c1, e291-c2]. PRETEXT staging drives treatment: PRETEXT I lesions without vascular involvement may undergo upfront anatomic resection, with pure fetal histology requiring no adjuvant therapy and conferring 100% survival [e291-c15, e291-c16, e291-c18]. Most patients receive neoadjuvant cisplatin-based chemotherapy; maximal tumor shrinkage occurs within two cycles, after which resectability assessment or transplant referral is mandatory [e291-c23, e291-c24]. Multifocal or PRETEXT IV disease necessitates early transplant evaluation, though recent data show nearly half of PRETEXT IV lesions are resectable conventionally [e291-c25, e291-c39]. Pulmonary metastases—the predominant metastatic site—require complete surgical clearance by cycle 4; ICG fluorescence imaging detects occult lesions missed on CT in ~15% of cases, improving parenchymal-sparing resection [e291-c17, e2866-c8, e11848-c11]. Salvage therapy for relapse remains non-standardized, but cisplatin re-challenge yields ~80% survival versus 25% without platinum . Intraoperative transfusion associates with increased mortality, likely via post-resection coagulopathy from unbalanced red cell administration [e11811-c7, e11811-c11]. Pediatric HCC, chemoresistant and biologically distinct, shows 50–60% 5-year OS post-resection but near-zero disease-free survival at 18 months; transplant offers superior outcomes in select cases [e10161-c3, e10161-c4, e10161-c6].