Sandbox:staging

# Neuroblastoma Staging

## International Neuroblastoma Staging System (INSS)
The staging of neuroblastoma is based on the International Neuroblastoma Staging System (INSS).

## International Neuroblastoma Risk Group Staging System (INRGSS)
According to the newly proposed International Neuroblastoma Risk Group Staging System (INRGSS), there are four stages of neuroblastoma based on the extent of dissemination and image findings.

# Risk Stratification
- Neuroblastoma patients are risk stratified into a low risk group, an intermediate risk group, and a high risk group based on the tumor INSS stage, the patient's age, tumor grade, and the amplification of MYCN gene.
- Low risk neuroblastoma groups include:
- Patients with stage 1 tumor irrespective of the age, grade, and molecular pathway
- Patients with stage 2A/2B (>50% resected), irrespective of age, irrespective of the grade, MYCNnot amplified
- Patients with Stage 4S, 1 , MYCN not amplified
- Intermediate risk neuroblastoma groups include:
- Group 1
- Patients with stage 2A/2B (<50% resected or Bx only) tumor, 0-12 years of age, irrespective of the grade, MYCNnot amplified
- Patients with stage 3 tumor, 1, MYCNnot amplified
- Patients with stage 3 tumor, 1-12 years of age, favorable histology, MYCNnot amplified
- Patients with symptomatic stage 4S, 1, MYCNnot amplified
- Group 2
- Patients with stage 3 tumor, <365 days of age, unfavorable histology, DNA index=1, MYCNnot amplified
- Patients with stage 4 tumor, 1, MYCN not amplified
- Patients with stage 4S tumor, <365 days of age, unfavorable histology, DNA index=1, MYCN not amplified
- Group 3
- Patients with stage 4 tumor, <365 days of age, unfavorable histology, DNA index=1, MYCN not amplified
- Patients with stage 3 tumor, 365-547 days of age, unfavorable histology, MYCN not amplified
- Patients with stage 4 tumor, 365-547 days of age, favorable histology, DNA index >1, MYCN not amplified
- High risk neuroblastoma groups include:
- Patients with stage 2A/2B, 3, 4, or 4S tumor, irrespective of the age, irrespective of the grade, MYCN amplified
- Patients with stage 3 tumor,  547 days of age, unfavorable histology, MYCN not amplified
- Patients with stage 4 tumor, 365-547 days of age, unfavorable histology, DNA index=1, MYCN not amplified
- Patients with stage 4 tumor, >547 days of age, irrespective the grade and MYCN amplification state
-  Jump up to: 1.0 1.1 Neuroblastoma. Wikipedia (2015)  Accessed on October, 5 2015
-  Jump up to: 2.0 2.1 Davidoff AM (2012). "Neuroblastoma". Semin Pediatr Surg. 21 (1): 214. doi:10.1053/j.sempedsurg.2011.10.009. PMC 3261589. PMID 22248965.CS1 maint: PMC format (link) .mw-parser-output cite.citation{font-style:inherit}.mw-parser-output q{quotes:"\"""\"""'""'"}.mw-parser-output code.cs1-code{color:inherit;background:inherit;border:inherit;padding:inherit}.mw-parser-output .cs1-lock-free a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-limited a,.mw-parser-output .cs1-lock-registration a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-subscription a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration{color:#555}.mw-parser-output .cs1-subscription span,.mw-parser-output .cs1-registration span{border-bottom:1px dotted;cursor:help}.mw-parser-output .cs1-hidden-error{display:none;font-size:100%}.mw-parser-output .cs1-visible-error{display:none;font-size:100%}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration,.mw-parser-output .cs1-format{font-size:95%}.mw-parser-output .cs1-kern-left,.mw-parser-output .cs1-kern-wl-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right,.mw-parser-output .cs1-kern-wl-right{padding-right:0.2em}