Impact of post‐chemotherapy classification on outcomes in stage III and IV unilateral favorable histology Wilms tumor: Pooled data from Children’s Oncology Group AREN0532, AREN0533, and AREN03B2 studies

BACKGROUND: Improvements in therapy for patients with favorable histology Wilms tumor (FHWT) have relied on refinement of risk stratification for therapeutic assignment through identification of favorable and unfavorable prognostic factors. Although well established in International Society of Pediatric Oncology-Renal Tumor Study Group protocols, the Children's Oncology Group (COG) has not historically used post-chemotherapy histology (PCH) to guide therapy. This study examines whether outcomes are associated with PCH classification in the COG treatment context. METHODS: The authors identified 2386 patients with stage III or IV FHWT enrolled on AREN0532, AREN0533, or AREN03B2-only from 2006 to 2019. Inclusion criteria included delayed nephrectomy more than 5 and fewer than 16 weeks after initial biopsy, treatment on or as per protocol with DD4A or Regimen M, and known PCH classification and outcome. RESULTS: Of 352 included patients, 45 (12.7%) were classified as low risk (LR), 287 (81.5%) as intermediate risk (IR), and 20 (5.6%) as high risk (HR). PCH classification was significantly prognostic for event-free survival (EFS) (p < .0001) and overall survival (OS) (p < .0001). Four-year EFS for LR, IR, and HR groups was 93% (95% CI, 86%-100%), 85% (95% CI, 81%-89%), and 53% (95% CI, 35%-81%); 4-year OS was 96% (95% CI, 90%-100%), 93% (95% CI, 89%-96%), and 62% (95% CI, 44%-89%). Compared with LR or IR, EFS and OS were significantly lower for HR, regardless of stage or treatment. CONCLUSION: PCH is a significant prognostic factor in unilateral FHWT treated on COG regimens, strongly supporting its incorporation into therapeutic stratification in prospective COG trials.

Authors

Institutions

Publication Details

Journal
Cancer
Published
2026-09-17
DOI
https://doi.org/10.1002/cncr.70610
Primary Topic
Renal and related cancers
Type
article
Field-Weighted Citation Impact
0.00
Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
article

Impact of post‐chemotherapy classification on outcomes in stage III and IV unilateral favorable histology Wilms tumor: Pooled data from Children’s Oncology Group AREN0532, AREN0533, and AREN03B2 studies

Arnold C. Paulino, David Dix, Geetika Khanna, Maddy Artunduaga et al.
Cancer
Renal and related cancers
article

Impact of post‐chemotherapy classification on outcomes in stage III and IV unilateral favorable histology Wilms tumor: Pooled data from Children’s Oncology Group AREN0532, AREN0533, and AREN03B2 studies

Arnold C. Paulino, David Dix, Geetika Khanna, Maddy Artunduaga, Ethan A. Smith, Carly R. Varela, Peter F. Ehrlich, Richard D. Glick, Jeffrey S. Dome, Daniel J. Benedetti, Kelly Vallance, Jennifer H. Aldrink, Nicholas F. Evageliou, J KALAPURAKAL, Conrad V. Fernandez, Lauren Parsons, Lindsay A. Renfro, Michael V. Ortiz, James I. Geller, Elizabeth A. Mullen, Nicholas G. Cost
article en

Abstract

BACKGROUND: Improvements in therapy for patients with favorable histology Wilms tumor (FHWT) have relied on refinement of risk stratification for therapeutic assignment through identification of favorable and unfavorable prognostic factors. Although well established in International Society of Pediatric Oncology-Renal Tumor Study Group protocols, the Children's Oncology Group (COG) has not historically used post-chemotherapy histology (PCH) to guide therapy. This study examines whether outcomes are associated with PCH classification in the COG treatment context. METHODS: The authors identified 2386 patients with stage III or IV FHWT enrolled on AREN0532, AREN0533, or AREN03B2-only from 2006 to 2019. Inclusion criteria included delayed nephrectomy more than 5 and fewer than 16 weeks after initial biopsy, treatment on or as per protocol with DD4A or Regimen M, and known PCH classification and outcome. RESULTS: Of 352 included patients, 45 (12.7%) were classified as low risk (LR), 287 (81.5%) as intermediate risk (IR), and 20 (5.6%) as high risk (HR). PCH classification was significantly prognostic for event-free survival (EFS) (p < .0001) and overall survival (OS) (p < .0001). Four-year EFS for LR, IR, and HR groups was 93% (95% CI, 86%-100%), 85% (95% CI, 81%-89%), and 53% (95% CI, 35%-81%); 4-year OS was 96% (95% CI, 90%-100%), 93% (95% CI, 89%-96%), and 62% (95% CI, 44%-89%). Compared with LR or IR, EFS and OS were significantly lower for HR, regardless of stage or treatment. CONCLUSION: PCH is a significant prognostic factor in unilateral FHWT treated on COG regimens, strongly supporting its incorporation into therapeutic stratification in prospective COG trials.

CancerVol. 132(19)
Northwestern University (US), University of Southern California (US), Children's Hospital of Wisconsin (US), Cincinnati Children's Hospital Medical Center (US), George Washington University Hospital (US), Dalhousie University (CA), Nationwide Children's Hospital (US), Johnson & Johnson (United States) (US), Memorial Sloan Kettering Cancer Center (US), Children's Hospital of Philadelphia (US), Children's National (US), The University of Texas MD Anderson Cancer Center (US), George Washington University (US), University of Michigan (US), University of California San Diego (US), Cook Children's Medical Center (US), Children's Hospital Colorado (US), Southwestern Medical Center (US), Center for Cancer and Blood Disorders (US), Cohen Children's Medical Center (US), Children's Oncology Group (US), Children's Healthcare of Atlanta (US), BC Children's Hospital (CA), Dana-Farber/Boston Children's Cancer and Blood Disorders Center (US), The University of Texas Southwestern Medical Center (US), Vanderbilt University Medical Center (US), University of Colorado Denver (US)
Openalex Percentile: Top 18%
Renal and related cancers
DOISourceOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.