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Version 25
Data Item #1192: Pretext Clinical Staging

* indicates required field

Length: 1
Source of Standard: NAACCR/SEER
Section Name: Stage/Prognostic Factors
Year Implemented: 2025
Version Implemented: 25
Record Types: C, A, I, M

XML NAACCR ID: pretextClinicalStaging

Parent XML Element: Tumor

Required Status:

NPCR Collect: . - No recommendations
CoC Collect: . - No recommendations
SEER Collect: RS* - Required, site specific; when available
CCCR Collect: . - No recommendations

Description:

PRETEXT stands for PRE-Treatment Extent of tumor. This field describes the extent of involvement within the four lobes of the liver at time of a pediatric liver tumor diagnosis. It is based off clinical imaging and was originally designed to standardize imaging evaluation and risk stratification of hepatoblastoma before neoadjuvant chemotherapy or tumor resection.

Rationale:

After initially being created by the International Childhood Liver Tumours Strategy Group (SIOPEL) in 1990, PRETEXT was introduced for use within the United States in 2014 by the Children’s Oncology Group (COG) once radiographic imaging became more sophisticated and exploratory surgery at diagnosis was no longer advisable. It is used as a central component of risk stratification schemes that define treatment of hepatoblastoma.

General Notes:

Source documents: imaging

Item Data Type:

numeric

Allowable Values

1-4, 8, 9

Codes:

1

One section involved; three adjoining sections are tumor free

Stage I, Pretext 1

2

One or two sections involved; two adjoining sections are tumor free

Stage 2, Pretext 2

3

Two or three sections involved; one adjoining section is tumor free

Stage 3, Pretext 3

4

Four sections involved

Stage 4, Pretext 4

8

Not applicable: Information not collected for this case
(If this information is required by your standard setter, use of code 8 may result in an edit error.)

9

Not documented in medical record

Cannot be determined by pathologist

PRETEXT not assessed or unknown if assessed

Code Notes:

Note 1: Effective years

  • This SSDI is effective for diagnosis years 2024+
  • For cases diagnosed 2018-2023, this SSDI must be blank

Note 2: Criteria for coding

  • This SSDI is based on imaging findings only**. Do not** code any findings from surgical resection in this data item. Evaluation must also be done prior to any neoadjuvant therapy

Note 3: Pretext Staging-Segments of the liver

  • Caudate liver: Segment I
    Note: Involvement of the caudate liver is at minimum Stage 2
  • Left lateral section: Segments II & III
  • Left medial section: Segments IVA & IVB
  • Right anterior section: Segments V & VIII
  • Right posterior section: Segments VI & VII