Table 5 Levels of evidence for favourable-histology Wilms tumour risk-stratification features

Level of evidence¹¹⁷	Feature	Part of updated COG risk stratification?
I	Stage	Yes
	Histology	Yes
	LOH of 1p and 16q	Yes
	Lung metastatic response to chemotherapy	Yes
II	Lymph node sampling	Yes
	Age	Yes
	Tumour nephrectomy weight	No
	Extra pulmonary metastasis^a	Yes
	11p15 status in patients with very-low-risk disease	Yes
	Epithelial-predominant histology	Yes
	1q gain	Yes
	Lymph node involvement with isolated LOH 1p/16q	Yes
	Post-chemotherapy blastemal-predominant histology	Yes
	Peritoneal metastases	Yes^b
	Partial nephrectomy for unilateral Wilms tumour	No
	Unilateral multifocal tumours	No
III	Tumour involving adrenal gland	No^b
III	Inferior vena cava thrombus	No^b
IV	Extrarenal Wilms tumour	No
V	Malignant pleural effusions	Yes^b
	Tumour pulmonary emboli	Yes^b
	Extra-abdominal lymph nodes not pathologically sampled	No^b
	Malignant ascites (peritoneal fluid)	No
	Contralateral nephrogenic rests	No
	Tumour in renal collecting system	No^b
	Genetic predisposition to Wilms tumour	Yes^c

Data collated from refs. ^{5,7,8,9,11,12,14,17,22,23,24,27,28,34,41,53,54,60,61,66,67,69,71,79,80,81,83,84,85,86,88,100,101,102,105,106,108,109}. Level I is a high-quality prospective cohort study with adequate power or a systematic review of these studies. Level II is a reduced-quality prospective cohort study, retrospective cohort study, untreated healthy participants from a randomized control trial or a systematic review of these studies. Level III is a case–control study or a systematic review of these studies. Level IV is case series. Level V is an expert opinion, a case report or clinical example, or evidence based on physiology, bench research or ‘first principles’. LOH, loss of heterozygosity. ^aSome features considered extrapulmonary metastasis have reduced-quality evidence. ^bFeature is incorporated into stage, but not independently factored into risk stratification. ^cPatients with genetic predisposition to Wilms tumour are excluded from treatment with nephrectomy only.

Quick links

Search