Associations of Patient Age, Tumor Nephrectomy Weight, and Tumor Diameter with Event-Free and Overall Survival in Stage I or II Favorable Histology Wilms Tumor: A Pooled Analysis of Children's Oncology Group Studies AREN0532 and AREN03B2

Lindsay A. Renfro, Division of Biostatistics, University of Southern California and Children's Oncology Group, Los Angeles, CA.
Kelly L. Vallance, Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX.
Ian C. Tfirn, Children's Oncology Group Statistics and Data Center, Monrovia, CA.
Nicholas Evageliou, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA.
Daniel J. Benedetti, Division of Pediatric Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN.
Robert C. Shamberger, Department of Surgery, Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, MA.
Peter F. Ehrlich, Department of Surgery, University of Michigan School of Medicine, Ann Arbor, MI.
Nicholas G. Cost, Department of Surgery, Division of Urology at the University of Colorado School of Medicine and the Surgical Oncology Program at Children's Hospital Colorado, Aurora, CO.
Jennifer H. Aldrink, Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH.
Ann Schechter, Department of Pediatric Radiology, Morgan Stanley Children's Hospital, Columbia University, New York, NY.
Amy Treece, Department of Pathology and Laboratory Medicine, Children's of Alabama, Birmingham, AL.
Lauren N. Parsons, Department of Pathology/Division of Pediatric Pathology, Medical College of Wisconsin/Children's Wisconsin, Milwaukee, WI.
Amy L. Walz, Division of Hematology, Oncology, Neuro-Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Kathryn S. Sutton, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
Amy E. Armstrong, Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis, MO.
Conrad V. Fernandez, Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
Jeffrey S. Dome, Division of Oncology and the Department of Pediatrics, Children's National Hospital and the 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, Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, MA.

Document Type

Journal Article

Publication Date

4-11-2025

Journal

Annals of surgery

DOI

10.1097/SLA.0000000000006726

Keywords

age, tumor nephrectomy weight; favorable histology Wilms tumor; prognostic factors; tumor diameter

Abstract

OBJECTIVE: To evaluate age, TNW, or tumor diameter (TD) as continuous prognostic variables for outcomes in early stage FHWT after accounting for biology and treatment. SUMMARY OF BACKGROUND DATA: Patient age (< 2 vs. ≥ 2 years) and tumor nephrectomy weight (TNW; < 550g vs. ≥ 550 grams) have been used to risk stratify children with stage I favorable histology Wilms tumor (FHWT) on Children's Oncology Group (COG) studies and select patients for omission of chemotherapy. METHODS: Included patients had stage I or II FHWT per central review and were treated with nephrectomy only, EE4A, or DD4A on COG trials. Restricted cubic splines models were used to estimate the stage-specific effects of age, TNW, and TD on event-free survival (EFS) and overall survival (OS), accounting for treatment and biology. RESULTS: In pooled analyses of 775 stage I and 936 stage II patients, age was not significantly associated with EFS or OS for stage I or II patients after accounting for adverse biology that is more prevalent with older age. Greater TNW and larger TD were associated with increased risk of relapse in stage I and increased risk of death in stage II, but not when restricted to patients less than 4 years old. CONCLUSIONS: Age, TNW, and TD are each prognostic for EFS or OS in some cohorts of patients with stage I or II FHWT. However, after accounting for adverse biology that becomes more prevalent at older ages, these factors are no longer independently prognostic. The next COG FHWT study will implement and validate these findings.

Department

Pediatrics

Link to Full Text

Share

COinS