Algorithm for the COG Neuroblastoma Risk Classifier (version 2)

Risk classifier v2 algorithm for patients with (A) locoregional and (B) metastatic tumors. (A) Patients with locoregional tumors with neuroblastoma and ganglioneuroblastoma (nodular) are classified based on INRG stage (L1 and L2), age, resection, biomarkers (MYCN, ploidy, and SCAs), and INPC. Select patients with all favorable features are eligible for surveillance on the current non-high-risk COG ANBL1232 protocol. L1 or L2 tumors with histopathology diagnostic category of ganglioneuroma or ganglioneuroblastoma-intermixed will be classified as low risk regardless of biomarkers (and thus are not included in the figure). Ages are broken down by <18 months, 18 months to <5 years, and ≥5 years based on age categories used by INPC. (B) Patients with metastatic tumors are classified by stage (M and MS), age, INPC, and biomarkers. For MS patients, presence or absence of symptoms may influence therapy independent of biomarker status. In previous risk classifiers, missing data were considered as unfavorable. In COG v2, missing data for SCA will not be considered as unfavorable based on the low incidence of SCA in otherwise favorable subsets.