Clinical Staging

Aspects of staging worthy of note include the postoperative presence of microscopic residual disease with stage 1 and the imprecision of "incomplete gross excision" for separating stage 2A from stage 1; however, since all stage-1 and stage-2A neuroblastomas are grouped into the same low-risk category, the practical implication of exact stage classification (using the extent of post-operative disease) for these two entities is nil. In contrast, risk-group assignment and major management decisions are dependent on staging distinctions that have an uncertain biologic basis in several clinical settings: (a) stage 2A and one subtype of stage 3 (intermediate risk) both involve lack of resectability and gross residual post-operative disease; (b) stage 2B and one subtype of stage 3 (intermediate risk) both involve regional lymph node spread with laterality as the sole distinguishing factor; and (c) widespread disease in infants without osseous or extensive bone marrow involvement can be low-risk stage 4S or intermediate-risk stage 4 depending on the size and resectability of the primary tumor and the presence or absence of contralateral or distant nodal involvement.

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