fig1

Figure 1. Incorporation of molecular factors into the risk stratification system of childhood liver cancer. The current CHIC-HS (Children’s Hepatic tumors International Collaboration-Hepatoblastoma Stratification) staging system^[37] is based on clinical characteristics, such as PRETEXT (pretreatment extent of disease), alpha-fetoprotein (AFP), and the PRETEXT annotation factors vascular involvement (V: hepatic vein/inferior vena cava; P: portal vein), extrahepatic tumor extension (E), multifocality (F), and tumor rupture (R). New molecular risk stratification systems are based on specific gene/miR expression signatures^{[11,16,27,31,32]}, epigenetic patterns^[27], or mutations in nuclear factor and erythroid 2 like 2 (NFE2L2) and the telomerase reverse-transcriptase (TERT) promoter^[26], which are currently validated within the Pediatric Hepatic International Tumor Trial (PHITT). The combination of both clinical and molecular factors will improve clinical management and prediction of outcome in childhood liver cancer patients in the future.