# Updated Favorable histology Wilms tumor risk stratification: Rationale for future Children’s Oncology Group clinical trials — GCMD Library Daniel J Benedetti, Nicholas G Cost, Peter F Ehrlich, Nicholas Evageliou, Elizabeth Fialkowski, Lauren N Parsons, Kelly L Vallance, Lindsay A Renfro, Andrew L Hong, Jennifer H Aldrink, Luke Pater, Arnold C Paulino, Jesse K Sandberg, Ethan A Smith, Amy L Treece, Jeffrey S Dome, James I Geller, Elizabeth A Mullen

Abstract:
Patients with Wilms tumor (WT) have benefitted from 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 as a result, ensuring that each patient receives the appropriate therapy has become increasingly complex. This review describes the evolution of risk-based treatment and outlines the rationale for a new risk stratification system that forms the basis for the upcoming COG favorable histology WT (FHWT) study. Additionally, topics of diagnostic and prognostic uncertainty are highlighted, with explanations of their integration 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 classification of patients with FHWT continues in effort to optimize research, personalize treatment, and provide an educational resource.
Type: video · 0 min · posted 2026-04-17 Canonical: https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856 ## Chapters - [0:00](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=0) Updated Wilms Tumor Risk Stratification ## Statements - "Risk stratification for Wilms tumor has evolved many times over the years." — Jill Knera (clinical) [0:00](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=0) - "The Children's Oncology Group published updated risk stratification for patients with favorable histology Wilms tumor in Nature in June 2025." — Jill Knera (guideline) [0:09](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=9) - "The new risk stratification model includes biological and clinical features that were not in the first generation risk stratification." — Jill Knera (guideline) [0:19](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=19) - "The new model changes some of the older features or gets rid of them altogether." — Jill Knera (guideline) [0:27](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=27) - "Factors being added are loss of heterozygosity of 11P15, 1Q gain, and lymph node involvement." — Jill Knera (guideline) [0:32](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=32) - "Tumor nephrectomy weight is no longer included in the risk stratification." — Jill Knera (guideline) [0:41](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=41) - "The model modified how histology and age are used to stratify certain patients." — Jill Knera (guideline) [0:43](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=43) - "More changes are expected in the future as ongoing COG trials produce more results." — Jill Knera (opinion) [0:48](https://library.globalcastmd.com/watch/updated-favorable-histology-wilms-tumor-risk-stratification-rationale-for-future-children-s-oncology-group-clinical-trials-11856?t=48) ## Transcript 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. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai