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Table 8. Children’s Oncology Group (COG) Neuroblastoma High-Risk Group Assignment Schema

INSS Stage  Age  MYCN Status  INPC Classification  DNA Ploidya 
2A/2Bb≥365 d–21 yAmplifiedUnfavorable-
3c<365 dAmplifiedAnyAny
≥365 d–21 yNonamplifiedUnfavorable-
≥365 d–21 yAmplifiedAny-
4c<365 dAmplifiedAnyAny
≥548 d–21 yAnyAny-
4S<365 dAmplifiedAnyAny

INPC = International Neuroblastoma Pathologic Classification; INSS = International Neuroblastoma Staging System.
aDNA Ploidy: DNA Index (DI) > 1 is favorable, DI = 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).
bINSS stage 2A/2B symptomatic patients with spinal cord compression, neurologic deficits, or other symptoms are treated with immediate chemotherapy for four cycles.
cINSS stage 3 or stage 4 patients with clinical symptoms as listed above receive immediate chemotherapy.