There was a significant difference in the distribution of International Neuroblastoma Staging System (INSS) stage (P = .0017) with 21.7% of patients having INSS stage III (n = 13/60) and 76.7% (n = 46/60) with stage IV in patients with ALK-aberrant disease, versus 6.6% (n = 12/182) with stage III and 91.2% (n = 166/182) with stage IV disease in patients with ALK-wild-type (WT) tumors (Table 1). This evidence concerns the gene ALK and neuroblastoma.