Version May 2024
| Stage | Children's Oncology Group (before chemotherapy) | International Society of Paediatric Oncology (after chemotherapy) |
| I | Tumor is limited to the kidney and completely excised | Tumor is limited to the kidney or surrounded with fibrous pseudocapsule if outside of the normal contours of the kidney; the kidney capsule or pseudocapsule may be infiltrated with the tumor, but it does not reach the outer surface and is completely resected (resection margins "clear") |
| Tumor was not ruptured before or during removal | Tumor may be protruding into the pelvic system and "dipping" into the ureter (but not infiltrating their walls) | |
| Vessels of the renal sinus are not involved beyond 2 mm | Vessels of the renal sinus are not involved | |
| No residual tumor apparent beyond the margins of excision | Intrarenal vessel involvement may be present | |
| II | Tumor extends beyond the kidney but is completely excised | Tumor extends beyond the kidney or penetrates through the kidney capsule and/or fibrous pseudocapsule into perirenal fat but is completely resected (resection margins "clear") |
| No residual tumor is apparent at or beyond the margins of excision | Tumor infiltrates the renal sinus and/or invades blood and lymphatic vessels outside of the kidney parenchyma but is completely resected | |
| Tumor thrombus in vessels outside of the kidney is stage II if the thrombus is removed en bloc with the tumor | Tumor infiltrates adjacent organs or vena cava but is completely resected | |
| Although tumor biopsy or local spillage confined to the flank were considered stage II in the past, such events are now considered stage III | ||
| III Residual tumor confined to the abdomen | Lymph nodes in the renal hilum, in the periaortic chains, or beyond are found to contain tumor | Incomplete excision of the tumor, which extends beyond resection margins (gross or microscopical tumor remains postoperatively) |
| Diffuse peritoneal contamination by the tumor | Any abdominal lymph nodes are involved | |
| Implants are found on the peritoneal surfaces | Tumor rupture before or intraoperatively (irrespective of other criteria for staging) | |
| Tumor extends beyond the surgical margins either microscopically or grossly | Tumor has penetrated through the peritoneal surface | |
| Tumor is not completely resectable, because of local infiltration into vital structures | Tumor thrombi present at resection margins of vessels or ureter; transected or removed piecemeal by surgeon | |
| Tumor has been surgically biopsied (wedge biopsy) prior to preoperative chemotherapy or surgery | ||
| Regional lymph node involvement was considered stage II in the previous International Society of Paediatric Oncology staging system | ||
| IV | Presence of hematogenous metastases or metastases to distant lymph nodes | Hematogenous metastases (lung, liver, bone, brain, etc) or lymph node metastases outside of the abdominopelvic region |
| V | Bilateral kidney involvement at the time of initial diagnosis | Bilateral kidney tumors at diagnosis |
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