Calculators & Tools

Neuroblastoma — INRGSS Stage

International Neuroblastoma Risk Group Staging System - pre-treatment, imaging-based.

1 What is the Neuroblastoma — INRGSS Stage?

The Neuroblastoma — INRGSS Stage is a oncology scoring tool used in paediatric practice. International Neuroblastoma Risk Group Staging System - pre-treatment, imaging-based. It scores 1 criteria and interprets the total across 4 bands, so the number always arrives with the severity it implies rather than on its own. In PediAid each criterion is shown as a labelled option with the weight it carries, so the total can be checked rather than taken on trust.

2 When to use it

  • Grading severity at the bedside in oncology
  • Recording an objective severity band in the case notes
  • Deciding when a total crosses the threshold for escalation
  • Re-scoring to track whether a child is improving or deteriorating
  • Checking the exact criteria of a score used infrequently

3 Formula & method

The score sums 1 criteria: Extent of disease on imaging. Totals are then banded: 1 stage or more - Stage L1: l1 - localised without IDRFs. Surgery alone is often curative in low-risk biology; 2 stage or more - Stage L2: l2 - locoregional with IDRFs; upfront complete resection is hazardous. Neoadjuvant chemotherapy usually precedes surgery; 3 stage or more - Stage M: m - metastatic disease. High-risk therapy: induction chemotherapy, surgery, high-dose therapy with stem-cell rescue, radiotherapy, immunotherapy and retinoic acid; 4 stage or more - Stage MS: mS - special metastatic pattern in infants; frequently has an excellent outcome and can spontaneously regress, but assess MYCN and symptomatic hepatomegaly.
  • Risk group also depends on age, MYCN amplification, histology, ploidy and 11q aberration.
  • Source: Monclair T et al. The International Neuroblastoma Risk Group (INRG) staging system. J Clin Oncol 2009;27:298-303.
  • Source: Gupta S, Aitken JF, Bartels U et al. Paediatric cancer stage in population-based cancer registries: the Toronto consensus principles and guidelines. Lancet Oncol 2016;17:e163-72.

4 Frequently asked questions

How many criteria does the Neuroblastoma — INRGSS Stage use?

1. They are Extent of disease on imaging.

What do the bands of the Neuroblastoma — INRGSS Stage mean?

The total is interpreted as: 1 stage or more - Stage L1: l1 - localised without IDRFs. Surgery alone is often curative in low-risk biology; 2 stage or more - Stage L2: l2 - locoregional with IDRFs; upfront complete resection is hazardous. Neoadjuvant chemotherapy usually precedes surgery; 3 stage or more - Stage M: m - metastatic disease. High-risk therapy: induction chemotherapy, surgery, high-dose therapy with stem-cell rescue, radiotherapy, immunotherapy and retinoic acid; 4 stage or more - Stage MS: mS - special metastatic pattern in infants; frequently has an excellent outcome and can spontaneously regress, but assess MYCN and symptomatic hepatomegaly.

Does the score replace clinical judgement?

No. It is a structured way to record and communicate severity. A clinician concerned about a child should act on that concern regardless of the total.

Where does this score come from?

Risk group also depends on age, MYCN amplification, histology, ploidy and 11q aberration.

Does it work offline?

Yes. Score definitions are bundled with the PediAid app, so the score computes without a connection.

For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.