Staging systems for pediatric solid tumors have traditionally placed great weight on surgical removal of the primary tumor and regional nodal involvement (Evans et al. 1976a) The present INSS was devised as a synthesis of the previous systems (Kiely 1993; Evans et al. 1990). This staging system has been adopted by the Children's Oncology Group USA (COG), as well as cooperative groups in Europe and Japan. It is worthwhile to review each staging system to illustrate the impact of surgery on stage and consequently risk status and treatment.

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