Updated favourable-histology Wilms tumour risk stratification: rationale for future Children's Oncology Group clinical trials

Daniel J. Benedetti, Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA. Daniel.Benedetti@vumc.org.
Nicholas G. Cost, Department of Surgery, Division of Urology and Surgical Oncology Program at Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
Peter F. Ehrlich, Section of Pediatric Surgery, University of Michigan, Ann Arbor, MI, USA.
Nicholas Evageliou, Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Elizabeth Fialkowski, Department of Surgery, Division of Pediatric Surgery, Oregon Health and Science University, Portland, OR, USA.
Lauren N. Parsons, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA.
Kelly L. Vallance, Hematology and Oncology, Cook Children's Medical Center, Fort Worth, TX, USA.
Lindsay A. Renfro, Division of Biostatistics, University of Southern California, Los Angeles, California, and Children's Oncology Group, Los Angeles, CA, USA.
Andrew L. Hong, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.
Jennifer H. Aldrink, Department of Surgery, Division of Pediatric Surgery, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA.
Luke Pater, Department of Radiation Oncology, University of Cincinnati, Cincinnati, OH, USA.
Arnold C. Paulino, Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Jesse K. Sandberg, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, USA.
Ethan A. Smith, Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
Amy L. Treece, Department of Pathology and Laboratory Medicine, Children's of Alabama, Birmingham, AL, USA.
Jeffrey S. Dome, Division of Oncology, Children's National Hospital, Washington, DC, USA.
James I. Geller, Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
Elizabeth A. Mullen, Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, MA, USA.

Document Type

Journal Article

Publication Date

6-20-2025

Journal

Nature reviews. Urology

DOI

10.1038/s41585-025-01055-1

Abstract

Patients with Wilms tumour have benefited from the results of decades of large collaborative clinical trials, leading to improved care. In the National Wilms Tumor Study Group and now Children's Oncology Group (COG) trials, risk stratification evolved and expanded with each generation of studies and, therefore, ensuring that each patient receives the appropriate therapy has become increasingly complex. A new risk stratification system has been developed that forms the basis of the upcoming COG favourable-histology Wilms tumour (FHWT) study. Topics of diagnostic and prognostic uncertainty, such as the findings of tumour pulmonary emboli or extra-abdominal lymphadenopathy at diagnosis, will be integrated into the central review determination of staging of FHWT by committee consensus to facilitate clinical classification for therapeutic studies. Clear documentation of the elements of current risk stratification are of particular importance as refinement of the classification of patients with FHWT continues in an effort to optimize research, personalize treatment and provide an educational resource.

Department

Pediatrics

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