In our cohort a serum AFP level at diagnosis of  more than 33,000ng/ml was associated with a poorer OS and a level of  more than 21,000ng/ml was associated with a poorer EFS (p = 0.044). Previously, serum  AFP levels of more than 100,000μg/L have been associated poorer outcomes in children with hepatoblastoma (28). The MaGIC analysis found that an elevated serum AFP level  of more than 10,000 was associated with a poorer outcome but it did not reach the threshold for statistical significance (18). Alpha fetoprotein as a tumour marker has been described as tumour-associated rather than tumour-specific, given that its production can be elevated in a variety of both benign and malignant conditions in children and that the persistence of elevated levels acquired in utero, which usually normalises by 10 months of age ex utero, can sometimes persist until 2 years of age. The elevation of serum AFP levels cannot therefore be considered diagnostic on its own and must be interpreted in concert with other factors (29).