Progress in the study of therapeutic strategies for hepatoblastoma in children

Table 1 Pre-treatment staging system

Stage	Specifics
PRETEXT/POST-TEXT I	Only one liver section is involved by the tumor
PRETEXT/POST-TEXT II	Tumor involves two contiguous sections of the liver
PRETEXT/POST-TEXT III	Tumor involves three liver sections, or two non-contiguous sections
PRETEXT/POST-TEXT IV	Tumor involves all four liver sections

Pre-treatment extent of disease and post-chemotherapy pre-surgical stages are based on the number of liver sections involved by the tumor before and after preoperative chemotherapy. PRETEXT: Pre-treatment extent of disease; POST-TEXT: Post-chemotherapy pre-surgical.

Table 2 Evan’s surgical stage

Stage	Specifics
I	Complete gross resection with clear margins
II	Gross total resection with microscopic residual disease at margin of resection
III	Gross total resection with nodal involvement or tumor spill or incomplete resection with gross residual intrahepatic disease
IV	Metastatic disease with either complete or incomplete resection

Evans surgical staging system assesses the extent of tumor resection and presence of metastasis in hepatoblastoma patients.

Table 3 Risk stratification criteria for hepatoblastoma

Risk group	Stratification criteria
Very low risk	Postoperative COG stage I with well-differentiated fetal histology
Low risk	Meets any of the following	Serum AFP ≥ 100 ng/mL, PRETEXT stage I or II, and absence of high-risk features
		Portal vein involvement (P+)
		Inferior vena cava or hepatic vein involvement (V+)
		Distant metastasis (M+)
		Extrahepatic abdominal disease (E+)
		Tumor rupture or intraperitoneal hemorrhage (H+)
		Lymph node involvement (N+)
	Postoperative COG stage I or II with non-pure fetal and non-small-cell undifferentiated histology
Intermediate risk	Meets any of the following	Preoperative PRETEXT stage III
		Postoperative COG stage I or II with small-cell undifferentiated histology
		Postoperative COG stage III
High risk	Meets any of the following	Serum AFP < 100 ng/mL
		Preoperative PRETEXT stage IV
		Postoperative COG stage IV
		Portal vein (P+) or inferior vena cava/hepatic vein involvement (V+)

COG: Children’s Oncology Group; AFP: Alpha-fetoprotein; PRETEXT: Pre-treatment extent of disease; P⁺: Portal vein involvement; V⁺: Hepatic vein or inferior vena cava involvement; M⁺: Distant metastasis; E⁺: Extrahepatic abdominal disease; H⁺: Tumor rupture or intraperitoneal hemorrhage; N⁺: Lymph node involvement.