title: Vascular invasion is a prognostic indicator in hepatoblastoma.
abstract: BACKGROUND
  The data regarding vascular invasion as a prognostic factor in hepatoblastoma (HB) are conflicted. The purpose of this study is to examine the relationship between vascular invasion and outcomes.
  
  
  METHODS
  This is a retrospective review of patients <18 years old who underwent resection for hepatoblastoma from 1998 to 2015. Pathology reports were used to identify patients who had pathologic vascular invasion (VI), and those who did not (NVI).
  
  
  RESULTS
  Sixty-six children were identified with a median age at diagnosis of 21months (interquartile range: 10-33months). Pathologic vascular invasion was present in 42/66 (64%) patients. A significant difference (P=0.02) in 3-year overall survival (3YOS) was detected between NVI (95%) and VI (61%). Recurrent disease was present in 8/66 (12%) patients. A marginally significant difference (P=0.08) was found in 3-year recurrence free survival (3YRFS) between NVI (94%) and the VI (76%) groups. Patients with NVI had no metastatic disease, had a lower recurrence rate, universally responded to neoadjuvant chemotherapy, and were less likely to have small cell undifferentiated histology. Twenty-one children underwent orthotopic liver transplant (OLT), with no difference in 3YROS or 3YRFS.
  
  
  CONCLUSIONS
  Pathologic vascular invasion is associated with significantly worse 3YOS in HB, and lack of vascular invasion was associated with more favorable disease characteristics. The presence of pathologic vascular invasion did not confer a worse outcome in patients treated with liver transplantation in this cohort of patients.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Level III.
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Yan
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Commander
authors.affiliation: Department of Pediatric Radiology, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Prakash M
authors.initials: PM
authors.lastname: Masand
authors.affiliation: Section of Hematology/Oncology, Department of Pediatrics, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, United States.
authors.forename: Andras
authors.initials: A
authors.lastname: Heczey
authors.affiliation: Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, United States.
authors.forename: John A
authors.initials: JA
authors.lastname: Goss
authors.affiliation: Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, United States. Electronic address: sanjeevv@bcm.edu.
authors.forename: Sanjeev A
authors.initials: SA
authors.lastname: Vasudevan
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018197:Hepatoblastoma / Q000175:diagnosis / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008099:Liver / Q000098:blood supply* / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis
keywords: Hepatoblastoma; Liver resection; Orthotopic liver transplant; Vascular invasion