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Hepatoblastoma — PRETEXT Group

PRE-Treatment EXTent of tumour - number of contiguous liver sections FREE of tumour determines the group.

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1 What is the Hepatoblastoma — PRETEXT Group?

The Hepatoblastoma — PRETEXT Group is a oncology scoring tool used in paediatric practice. PRE-Treatment EXTent of tumour - number of contiguous liver sections FREE of tumour determines the group. It scores 1 criteria and interprets the total across 4 bands, so the number always arrives with the severity it implies rather than on its own. In PediAid each criterion is shown as a labelled option with the weight it carries, so the total can be checked rather than taken on trust.

2 When to use it

  • Grading severity at the bedside in oncology
  • Recording an objective severity band in the case notes
  • Deciding when a total crosses the threshold for escalation
  • Re-scoring to track whether a child is improving or deteriorating
  • Checking the exact criteria of a score used infrequently

3 Formula & method

The score sums 1 criteria: Liver sections involved (of the four sections). Totals are then banded: 1 stage or more - PRETEXT I: pRETEXT I - upfront resection usually feasible; excellent prognosis; 2 stage or more - PRETEXT II: pRETEXT II - resectable at diagnosis or after neoadjuvant chemotherapy; 3 stage or more - PRETEXT III: pRETEXT III - neoadjuvant chemotherapy then re-evaluate (POST-TEXT); may need extended hepatectomy or transplant referral; 4 stage or more - PRETEXT IV: pRETEXT IV - all sections involved. Refer early for liver transplant evaluation alongside chemotherapy.
  • Annotation factors modify risk: V (hepatic vein/IVC), P (portal vein), E (extrahepatic contiguous), F (multifocal), R (tumour rupture), C (caudate), N (nodes), M (distant metastases).
  • AFP <100 ng/mL at diagnosis is an adverse prognostic feature.
  • Source: Roebuck DJ et al. 2005 PRETEXT: a revised staging system for primary malignant liver tumours of childhood. Pediatr Radiol 2007;37:123-32.
  • Source: Gupta S, Aitken JF, Bartels U et al. Paediatric cancer stage in population-based cancer registries: the Toronto consensus principles and guidelines. Lancet Oncol 2016;17:e163-72.

4 Frequently asked questions

How many criteria does the Hepatoblastoma — PRETEXT Group use?

1. They are Liver sections involved (of the four sections).

What do the bands of the Hepatoblastoma — PRETEXT Group mean?

The total is interpreted as: 1 stage or more - PRETEXT I: pRETEXT I - upfront resection usually feasible; excellent prognosis; 2 stage or more - PRETEXT II: pRETEXT II - resectable at diagnosis or after neoadjuvant chemotherapy; 3 stage or more - PRETEXT III: pRETEXT III - neoadjuvant chemotherapy then re-evaluate (POST-TEXT); may need extended hepatectomy or transplant referral; 4 stage or more - PRETEXT IV: pRETEXT IV - all sections involved. Refer early for liver transplant evaluation alongside chemotherapy.

Does the score replace clinical judgement?

No. It is a structured way to record and communicate severity. A clinician concerned about a child should act on that concern regardless of the total.

Where does this score come from?

Annotation factors modify risk: V (hepatic vein/IVC), P (portal vein), E (extrahepatic contiguous), F (multifocal), R (tumour rupture), C (caudate), N (nodes), M (distant metastases).

Does it work offline?

Yes. Score definitions are bundled with the PediAid app, so the score computes without a connection.

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For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.