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Table 1. Children's Oncology Group (COG) Neuroblastoma Low-, Intermediate-, and High-Risk Group Assignment Schema Used for COG-9641 and COG-A3961 Studiesa

INSS StageAgeMYCNStatusINPC ClassificationDNA PloidybRisk Group
INPC = International Neuroblastoma Pathologic Classification; INSS = International Neuroblastoma Staging System.
a The COG-9641 and COG-A3961 trials established the current standard of care for neuroblastoma patients in terms of risk group assignment and treatment strategies.
b DNA Ploidy: DNA Index (DI) > 1 is favorable, = 1 is unfavorable; hypodiploid tumors (with DI < 1) will be treated as a tumor with a DI > 1 (DI < 1 [hypodiploid] to be considered favorable ploidy).
c INSS stage 2A/2B symptomatic patients with spinal cord compression, neurologic deficits, or other symptoms should be treated with immediate chemotherapy for four cycles.
d INSS stage 3 or stage 4 patients with clinical symptoms as listed above should receive immediate chemotherapy.
e INSS stage 4S infants with favorable biology and clinical symptoms should be treated with immediate chemotherapy until asymptomatic (2–4 cycles). Clinical symptoms include: respiratory distress with or without hepatomegaly or cord compression and neurologic deficit or inferior vena cava compression and renal ischemia; or genitourinary obstruction; or gastrointestinal obstruction and vomiting; or coagulopathy with significant clinical hemorrhage unresponsive to replacement therapy.
10–21 yAnyAnyAnyLow
2A/2Bc<365 dAnyAnyAnyLow
≥365 d–21 yNonamplifiedAny-Low
≥365 d–21 yAmplifiedFavorable-Low
≥365 d–21 yAmplifiedUnfavorable-High
3d<365 dNonamplifiedAnyAnyIntermediate
<365 dAmplifiedAnyAnyHigh
≥365 d–21 yNonamplifiedFavorable-Intermediate
≥365 d–21 yNonamplifiedUnfavorable-High
≥365 d–21 yAmplifiedAny-High
4d<548 d[15,16,17]NonamplifiedAnyAnyIntermediate
<365 dAmplifiedAnyAnyHigh
≥548 d–21 yAnyAny-High
4Se<365 dNonamplifiedFavorable>1Low
<365 dNonamplifiedAny=1Intermediate
<365 dNonamplifiedUnfavorableAnyIntermediate
<365 dAmplifiedAnyAnyHigh


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  14. Navarro S, Amann G, Beiske K, et al.: Prognostic value of International Neuroblastoma Pathology Classification in localized resectable peripheral neuroblastic tumors: a histopathologic study of localized neuroblastoma European Study Group 94.01 Trial and Protocol. J Clin Oncol 24 (4): 695-9, 2006.
  15. Schmidt ML, Lal A, Seeger RC, et al.: Favorable prognosis for patients 12 to 18 months of age with stage 4 nonamplified MYCN neuroblastoma: a Children's Cancer Group Study. J Clin Oncol 23 (27): 6474-80, 2005.
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  17. George RE, London WB, Cohn SL, et al.: Hyperdiploidy plus nonamplified MYCN confers a favorable prognosis in children 12 to 18 months old with disseminated neuroblastoma: a Pediatric Oncology Group study. J Clin Oncol 23 (27): 6466-73, 2005.

WebMD Public Information from the National Cancer Institute

Last Updated: February 25, 2014
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