The Pretreatment Extent of Disease (PRETEXT) system for hepatocellular carcinoma can be used to describe the extent seen in imaging studies. This can help standardize the anatomic staging of the tumor before treatment and can be used to monitor the response to therapy.
Anatomic parameters:
(1) liver lobes (2) and sectors (4):
(1a) left lobe, lateral: Couinaud segments 2 and 3
(1b) left lobe, medial: Couinaud segment 4
(1c) right lobe, anterior: Couinaud segments 5 and 8
(1d) right lobe, posterior: Couinaud segments 6 and 7
(2) hepatic veins (left, middle, right) and inferior vena cava
(3) portal veins (left, right, main)
(4) extracapsular structures (which I am assuming includes regional lymph nodes)
(5) distant sites
|
Tumor Extent |
Descriptor Code |
|---|---|
|
within liver (see below) |
I to IV (15 combinations) |
|
inferior vena cava and/or all 3 hepatic veins |
V |
|
portal veins (main, or both left and right branches) |
P |
|
extracapsular, nonvenous (other than V or P) |
E |
|
distant metastases |
M |
|
Extent Within Liver |
Description |
|
I |
3 adjoining sectors free |
|
II |
2 adjoining sectors free |
|
III |
1 sector free |
|
IV |
0 sectors free |
|
left lateral |
left medial |
right anterior |
right posterior |
Code |
|---|---|---|---|---|
|
positive |
0 |
0 |
0 |
I |
|
0 |
0 |
0 |
positive |
I |
|
0 |
0 |
positive |
0 |
II (? A1) |
|
0 |
positive |
0 |
0 |
II (? A2) |
|
0 |
0 |
positive |
positive |
II A1 |
|
positive |
positive |
|
0 |
II A2 |
|
positive |
0 |
0 |
positive |
II B |
|
positive |
0 |
positive |
0 |
III (?) |
|
0 |
positive |
positive |
0 |
III (?) |
|
0 |
positive |
0 |
positive |
III (?) |
|
|
positive |
positive |
positive |
III A1 |
|
positive |
positive |
positive |
0 |
III A2 |
|
positive |
0 |
positive |
positive |
III B1 |
|
positive |
positive |
0 |
positive |
III B2 |
|
positive |
positive |
positive |
positive |
IV |
where:
• 6 of the 15 combinations were not demonstrated in Figure 1 (indicated by "?"). I coded these based on the number of adjoining free sectors.
If all of the combinations are considered (based on Figure 1, Aronson et al):
|
Zone 1 |
Zone 2 |
Zone 3 |
Zone 4 |
Group |
|---|---|---|---|---|
|
0 |
0 |
0 |
0 |
0 |
|
positive |
0 |
0 |
0 |
1 |
|
0 |
positive |
0 |
0 |
2 |
|
0 |
0 |
positive |
0 |
2 |
|
0 |
0 |
0 |
positive |
1 |
|
positive |
positive |
0 |
0 |
2 |
|
positive |
0 |
positive |
0 |
3 |
|
positive |
0 |
0 |
positive |
2 |
|
0 |
positive |
positive |
0 |
3 |
|
0 |
positive |
0 |
positive |
3 |
|
0 |
0 |
positive |
positive |
2 |
|
positive |
positive |
positive |
0 |
3 |
|
positive |
positive |
0 |
positive |
3 |
|
positive |
0 |
positive |
positive |
3 |
|
0 |
positive |
positive |
positive |
3 |
|
positive |
positive |
positive |
positive |
4 |
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
ICD-10: ,
