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?