Impact of Pulmonary Tumor Burden in Favorable Histology Wilms Tumor Outcomes: A Report From the Children's Oncology Group Study AREN053
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Key Takeaways
- Number and size of pulmonary nodules do NOT predict survival in favorable histology Wilms tumor with lung metastases.
- 1Q chromosomal gain is the strongest prognostic factor, associated with worse event-free and overall survival.
- Larger nodules showed worse event-free survival only if slow chemo response, but no impact on overall survival.
- Multivariable analysis confirms 1Q gain outperforms anatomic tumor burden measures for risk stratification.
- Clinical implication: Molecular profiling (1Q status) should guide treatment intensity over radiographic tumor burden alone.
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Your patient has a Wilms tumor with favorable histology, but workup shows that they also have lung metastases. How does this change outcomes for your patient? I'm Jill Knerath with Stay Current MD. This is an article you should know. In 2025, Dicketal published a report from a children's oncology group study. In the Journal of Clinical Oncology, they looked at factors in patients with favorable histology wilms and pulmonary metastases and how those may affect outcomes. Factors included the number of mets, the size of the mets, and different biological markers. When it came to the number of the metastases, there was no difference in survival. Patients who had a rapid response to chemo, larger nodules did show a worse event-free survival, but no changes in overall survival. In multi-variable models, neither the size nor the number of nodules had any effect on survival. However, a 1Q gain was associated with worse event-free survival and overall survival. So what is the takeaway? One cue gain is the superior prognostic factor when compared to size and number of nodules in patients with favorable histology Wilms and pulmonary metastases. Do these results surprise you?