# PRETEXT and CHIC risk groups (hepatoblastoma)

Source: https://onco.cc/terms/pretext-chic/  
OnCo record `pretext-chic` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

PRETEXT describes how many of the liver's four sections a child's hepatoblastoma occupies before any treatment, with letters for spread into veins, outside the liver, rupture or metastases; combined with age and the AFP level in the CHIC system it decides who has surgery straight away, who gets chemotherapy first, and who needs a transplant.

## Summary

What is measured: the extent of a hepatoblastoma and its risk group. How: contrast CT or MRI of the liver read against PRETEXT (I to IV by the number of contiguous liver sections free of tumour) with annotation factors V (hepatic veins or inferior vena cava), P (portal vein), E (contiguous extrahepatic spread), F (multifocal), R (rupture), C (caudate), N (nodes) and M (distant metastases, on chest CT); repeated after neoadjuvant chemotherapy as POST-TEXT to plan resection or transplant. Serum alpha-fetoprotein at diagnosis (under 100 ng/mL marks the small-cell undifferentiated type and a poor outlook; very high levels are also unfavourable) and age (under 3, 3 to 7, 8 and over) complete the CHIC stratification into very low, low, intermediate and high risk, which the PHITT trial used. What a result changes: very low risk (small tumour resected at diagnosis) gets surgery alone or minimal cisplatin; low risk gets cisplatin monotherapy with surgery after two cycles; intermediate risk gets cisplatin-based combinations; high risk (metastases, low AFP, PRETEXT IV with annotation factors) gets dose-dense cisplatin with doxorubicin and early referral for transplant when the tumour cannot be resected. Sodium thiosulfate is added to protect hearing from cisplatin. Germline APC (familial adenomatous polyposis) and 11p15 (Beckwith-Wiedemann) testing are considered. Where it matters: hepatoblastoma.

## Fields

- Kind: Term
- Last checked: 2026-09-17
- Also known as: PRETEXT; POST-TEXT; PRETEXT group; PRETEXT annotation factors; PRETEXT IV; CHIC; CHIC risk stratification; Children's Hepatic tumors International Collaboration; PHITT risk group; hepatoblastoma risk group; very low risk hepatoblastoma; high-risk hepatoblastoma

## Connected records

- terms: [Alpha-fetoprotein (AFP)](https://onco.cc/terms/afp/), [Extent of resection (RANO resect classes)](https://onco.cc/terms/extent-of-resection/), [Hereditary cancer syndromes](https://onco.cc/terms/hereditary-cancer-syndromes/)
- drugs: [Cisplatin](https://onco.cc/drugs/cisplatin/), [Doxorubicin](https://onco.cc/drugs/doxorubicin/)
- cancers: [Hepatoblastoma](https://onco.cc/cancers/hepatoblastoma/)

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JSON: https://onco.cc/api/v1/entities/pretext-chic.json