Race and Ethnic Group Enrollment and Outcomes for Wilms Tumor: Analysis of the Current Era Children's Oncology Group Study AREN03B2


Harold N. Lovvorn Iii, Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN.
Lindsay A. Renfro, Division of Biostatistics, University of Southern California, and Children's Oncology Group, Los Angeles, CA.
Daniel J. Benedetti, Department of Pediatrics, Division of Pediatric Hematology/Oncology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN.
Meera Kotagal, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Surgery, University of Cincinnati College of Medicine.
Hannah M. Phelps, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO.
Peter F. Ehrlich, Section of Pediatric Surgery, C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.
Andrea C. Lo, Department of Radiation on Oncology, BC Cancer, Vancouver, British Columbia, Canada.
Jesse K. Sandberg, Division of Pediatric Radiology, Lucille Packard Children's Hospital, Stanford University, Palo Alto, CA.
Amanda L. Treece, Department of Pathology and Laboratory Medicine, Children's Hospital of Alabama, Birmingham, AL.
Kenneth W. Gow, Division of General & Thoracic Surgery, Seattle Children's Hospital, Seattle, WA.
Richard D. Glick, Division of Pediatric Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY.
Andrew M. Davidoff, Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN.
Nicholas G. Cost, Department of Surgery, Division of Urology, University of Colorado School of Medicine, Surgical Oncology Program, Children's Hospital Colorado, Aurora, CO.
David B. Dix, Division of Hematology and Oncology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.
Conrad V. Fernandez, Department of Pediatrics, Division of Paediatric Haematology Oncology, Dalhousie University, Halifax, Nova Scotia.
Jeffrey S. Dome, Center for Cancer and Blood Disorders, Children's National Hospital, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC.
James I. Geller, Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH.
Elizabeth A. Mullen, Division of Pediatric Hematology and Oncology, Dana-Farber Cancer Institute, Boston, MA.

Document Type

Journal Article

Publication Date



Journal of the American College of Surgeons




INTRODUCTION: To review race and ethnic group enrollment and outcomes for Wilms tumor (WT) across all four risk-assigned therapeutic trials from the current era Children's Oncology Group Renal Tumor Biology and Risk Stratification Protocol, AREN03B2. METHODS: For WT patients enrolled on AREN03B2 (2006-2019), disease and biologic features, therapeutic study-specific enrollment, and event-free (EFS) and overall (OS) 4-year survival were compared between institutionally reported race and ethnic groups. RESULTS: Among 5,146 WT patients, no statistically significant differences were detected between race and ethnic groups regarding subsequent risk-assigned therapeutic study enrollment, disease stage, histology, biologic factors, or overall EFS or OS, except the following variables: Black children were older and had larger tumors at enrollment, while Hispanic children had lower rates of diffuse anaplasia (DAWT) and LOH at 1p. The only significant difference in EFS or OS between race and ethnic groups was observed among the few children treated for DAWT with Regimen UH-1/2 on high-risk protocol, AREN0321. On this therapeutic arm only, Black children showed worse EFS (HR=3.18) and OS (HR=3.42). However, this finding was not replicated for patients treated with Regimen UH-1/2 under AREN03B2 but not on AREN0321. CONCLUSION: Race and ethnic group enrollment appeared constant across AREN03B2 risk-assigned therapeutic trials. EFS and OS on these therapeutic trials when analyzed together were comparable regarding race and ethnicity. Black children may have experienced worse stage-specific survival when treated with Regimen UH-1/2 on AREN0321, but this survival gap was not confirmed when analyzing additional high-risk AREN03B2 patients.