Abstract: Objective Surgical pathology is the gold standard for the diagnosis of hepatoblastoma, but when the tumor is large and the general condition is poor, even the biopsy will put the child at greater risk. Wethether neoadjuvant chemotherapy can be carried out according to clinical diagnosis is still lack of research reports. The purpose of this study was to investigate the feasibility of neoadjuvant chemotherapy based on elevated serum alpha-fetoprotein (AFP) and liver imaging in the clinical practice of pediatric hepatoblastoma. Methods A retrospective analysis was made on clinical data of 80 children with primary hepatic space-occupying lesions admitted to a single center in the past 5 years, including 50 cases of hepatoblastoma and 30 cases of non-hepatoblastoma. Among the 50 children with hepatoblastoma, those who had pathological evidence before neoadjuvant chemotherapy were classified as the pathological treatment group, and those who started chemotherapy according to the clinical diagnosis of hepatoblastoma based on the elevation of AFP were assigned to the empirical chemotherapy group. The consistency of clinical diagnosis with pathological diagnosis and the survival of the two groups were. Results According to the elevation of serum AFP, the liver primary occupying lesions in children was clinically determined as hepatoblastoma. The sensitivity and specificity were 98 % and 100 %. There was no significant difference in overall survival (OS) and event-free survival (EFS) between the two groups by the log-rank test. Conclusions The diagnosis of hepatoblastoma based on the elevated serum AFP can be used to guide the preoperative neoadjuvant chemotherapy in children with poor surgical tolerance and to minimize the risk of treatment.

Key words: Alpha fetoprotein; liver primary occupying; hepatoblastoma; child