Updated Favorable histology Wilms tumor risk stratification: Rationale for future Children’s Oncology Group clinical trials
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- New risk model adds loss of heterozygosity at 11p15, 1q gain, and lymph node involvement as stratification factors.
- Tumor nephrectomy weight is no longer used in the updated Children's Oncology Group risk stratification.
- Histology and age criteria have been modified for certain patient subgroups in favorable histology Wilms tumor.
- Biological markers now complement clinical features in second-generation Wilms tumor risk assessment.
- Future COG trial results will likely drive additional refinements to risk stratification protocols.
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Risk stratification for Wilm's tumor has evolved many times over the years, so let's catch up. I'm Jill Knera, the Stay Current MD, and this is an article you should know. The Children's Oncology Group published updated risk stratification for patients with favorable histology Wilms tumor in Nature in June 2025. So what has changed? This new risk stratification model. Includes biological and clinical features that were not in the first generation risk stratification. It also changes some of the older features or gets rid of them altogether. Factors that are being added are loss of heterozygosity of 11P15C, 1Q gain. And lymph node involvement. Tumor nephrectomy weight is no longer included. They also modified how histology and age are used to stratify certain patients. Keep an eye out for more changes in the future as ongoing cog trials produce more results.