Wilms' tumor (nephroblastoma) staging according to the Children's Oncology Group (COG) defines Stage III disease based on which criterion?

• A Residual non-hematogenous tumor confined to the abdomen (positive lymph nodes, peritoneal spillage, or positive margins) ✓
• B Tumor confined to the kidney with complete resection
• C Extension beyond the kidney but complete resection without lymph node involvement
• D Hematogenous metastases to the lungs or liver

Explanation

COG staging of Wilms' tumor: Stage I is tumor confined to kidney with complete resection; Stage II is tumor beyond kidney (into perinephric fat or vessels) with complete resection and negative lymph nodes; Stage III is residual non-hematogenous tumor confined to the abdomen — this includes positive regional lymph nodes, peritoneal contamination/spillage, positive surgical margins, or biopsy before nephrectomy; Stage IV is hematogenous metastases (lungs, liver, bone, brain); Stage V is bilateral Wilms' tumor. Stage III drives the decision for whole-abdomen radiation and intensified chemotherapy.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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