{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T13:51:25Z","timestamp":1791467485563,"version":"4.3.4"},"reference-count":32,"publisher":"Harborside Press, LLC","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,8]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    Although Wilms tumor (WT) is the most common kidney cancer of childhood, it also presents infrequently in adolescents and even adults. Older patients with WT have inferior survival, but the reasons for this are unclear, and age is not currently used for therapeutic risk stratification. This study evaluates age as a prognostic variable and examines the influence of clinical and biological features on outcomes in a cohort of older patients with WT.\n                    <jats:bold>Patients and Methods:<\/jats:bold>\n                    We evaluated 4,100 patients with unilateral WT on Children\u2019s Oncology Group protocol AREN03B2. \u201cStandard-age\u201d patients (age 0\u20139 years) were compared with those presenting at \u201colder-age\u201d (age 10\u201330 years). The impact of age on survival was evaluated across the entire cohort and stratified by stage and histology.\n                    <jats:bold>Results:<\/jats:bold>\n                    There were 3,936 standard-age and 164 older-age patients. Older-age patients were more likely to have higher local (\n                    <jats:italic>P<\/jats:italic>\n                    =.009) and overall disease stage (\n                    <jats:italic>P<\/jats:italic>\n                    &lt;.001), larger tumor diameter (\n                    <jats:italic>P<\/jats:italic>\n                    &lt;.001), longer intervals between diagnostic imaging and renal surgery (\n                    <jats:italic>P<\/jats:italic>\n                    &lt;.001), no lymph nodes sampled (\n                    <jats:italic>P<\/jats:italic>\n                    &lt;.001), and treatment that included radiation (\n                    <jats:italic>P<\/jats:italic>\n                    =.010). No older-age patients had WT predisposition syndromes. The effect of age as a continuous variable was significantly associated with worse prognosis for event-free and overall survival after accounting for differences in disease stage and histology. There was neither higher rates of anaplasia nor high-risk tumor cytogenetics in older-age patients to account for this survival disadvantage.\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    Advancing age is an inferior continuous prognostic risk factor in patients with unilateral WT, independent of conventional risk stratification parameters of stage and histology. Future studies should prospectively interrogate the biology of older-age patients and incorporate advanced age into therapeutic risk stratification.\n                  <\/jats:p>","DOI":"10.6004\/jnccn.2026.7052","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:56:35Z","timestamp":1791464195000},"page":"1-8","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Older Age at Diagnosis on Wilms Tumor Characteristics and Patient Outcomes: A Children\u2019s Oncology Group Study"],"prefix":"10.6004","author":[{"given":"Michael V.","family":"Ortiz","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsay A.","family":"Renfro","sequence":"additional","affiliation":[{"name":"Division of Biostatistics, University of Southern California and Children\u2019s Oncology Group, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian C.","family":"Tfirn","sequence":"additional","affiliation":[{"name":"Children\u2019s Oncology Group, Monrovia, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas G.","family":"Cost","sequence":"additional","affiliation":[{"name":"Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO"},{"name":"Surgical Oncology Program, Children\u2019s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisabeth T.","family":"Tracy","sequence":"additional","affiliation":[{"name":"UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter F.","family":"Ehrlich","sequence":"additional","affiliation":[{"name":"Section of Pediatric Surgery, University of Michigan, Ann Arbor, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jesse","family":"Sandberg","sequence":"additional","affiliation":[{"name":"Division of Pediatric Radiology, Lucille Packard Children\u2019s Hospital, Stanford University, Palo Alto, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geetika","family":"Khanna","sequence":"additional","affiliation":[{"name":"Department of Radiology & Imaging Sciences, Emory University, Children\u2019s Healthcare of Atlanta, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Najat C.","family":"Daw","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew L.","family":"Hong","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Emory University School of Medicine, Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnold C.","family":"Paulino","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Gulliver","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, Madison, WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey S.","family":"Dome","sequence":"additional","affiliation":[{"name":"Division of Oncology, Department of Pediatrics, Children\u2019s National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James I.","family":"Geller","sequence":"additional","affiliation":[{"name":"Peckham Center for Cancer and Blood Disorders, Rady Children\u2019s Hospital, San Diego, CA"},{"name":"Division of Pediatric Hematology\/Oncology, Department of Pediatrics, University of California San Diego, La Jolla, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Mullen","sequence":"additional","affiliation":[{"name":"Dana-Farber\/Boston Children\u2019s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4047","reference":[{"key":"B1","series-title":"Nat Rev Dis Primers","first-page":"75","article-title":"Wilms tumour","volume":"7","author":"Spreafico F","year":"2021","unstructured":"Spreafico F, Fernandez CV, Brok J,  Wilms tumour. Nat Rev Dis Primers 2021;7:75."},{"key":"B2","series-title":"Wilms Tumor.","article-title":"The clinical relevance of age at presentation in nephroblastoma","author":"Gooskens SL","year":"2016","unstructured":"Gooskens SL, Segers H, Pritchard-Jones K,  The clinical relevance of age at presentation in nephroblastoma. van den Heuvel-Eibrink MM, ed. Wilms Tumor. Brisbane, Australia: Codon Publications; 2016."},{"key":"B3","series-title":"J Clin Oncol","first-page":"4500","article-title":"Wilms\u2019 tumor in adults: results of the Society of Pediatric Oncology (SIOP) 93-01\/Society for Pediatric Oncology and Hematology (GPOH) study","volume":"22","author":"Reinhard H","year":"2004","unstructured":"Reinhard H, Aliani S, Ruebe C,  Wilms\u2019 tumor in adults: results of the Society of Pediatric Oncology (SIOP) 93-01\/Society for Pediatric Oncology and Hematology (GPOH) study. J Clin Oncol 2004;22:4500\u20134506."},{"key":"B4","series-title":"Eur J Cancer","first-page":"2363","article-title":"Incidence of and survival from Wilms\u2019 tumour in adults in Europe: data from the EUROCARE study","volume":"42","author":"Mitry E","year":"2006","unstructured":"Mitry E, Ciccolallo L, Coleman MP,  Incidence of and survival from Wilms\u2019 tumour in adults in Europe: data from the EUROCARE study. Eur J Cancer 2006;42:2363\u20132368."},{"key":"B5","series-title":"Expert Rev Anticancer Ther","first-page":"1105","article-title":"Management of adults with Wilms\u2019 tumor: recommendations based on international consensus","volume":"11","author":"Segers H","year":"2011","unstructured":"Segers H, van den Heuvel-Eibrink MM, Pritchard-Jones K,  Management of adults with Wilms\u2019 tumor: recommendations based on international consensus. Expert Rev Anticancer Ther 2011;11:1105\u20131113."},{"key":"B6","series-title":"Am J Clin Oncol","first-page":"471","article-title":"Disparity in outcomes for adolescent and young adult patients diagnosed with pediatric solid tumors across 4 decades","volume":"41","author":"Chen I","year":"2018","unstructured":"Chen I, Pasalic D, Fischer-Valuck B,  Disparity in outcomes for adolescent and young adult patients diagnosed with pediatric solid tumors across 4 decades. Am J Clin Oncol 2018;41:471\u2013475."},{"key":"B7","series-title":"Urology","first-page":"50","article-title":"Patterns of care and survival comparison of adult and pediatric Wilms tumor in the United States: a study of the National Cancer Database","volume":"135","author":"Saltzman AF","year":"2020","unstructured":"Saltzman AF, Carrasco A, Amini A, Cost NG. Patterns of care and survival comparison of adult and pediatric Wilms tumor in the United States: a study of the National Cancer Database. Urology 2020;135:50\u201356."},{"key":"B8","series-title":"Cancer","first-page":"2541","article-title":"A Surveillance, Epidemiology and End Results (SEER) program comparison of adult and pediatric Wilms\u2019 tumor","volume":"118","author":"Ali AN","year":"2012","unstructured":"Ali AN, Diaz R, Shu HK,  A Surveillance, Epidemiology and End Results (SEER) program comparison of adult and pediatric Wilms\u2019 tumor. Cancer 2012;118:2541\u20132551."},{"key":"B9","series-title":"Cancer","first-page":"827","article-title":"Better survival after combined modality care for adults with Wilms\u2019 tumor. A report from the National Wilms\u2019 Tumor Study","volume":"66","author":"Arrigo S","year":"1990","unstructured":"Arrigo S, Beckwith JB, Sharples K,  Better survival after combined modality care for adults with Wilms\u2019 tumor. A report from the National Wilms\u2019 Tumor Study. Cancer 1990;66:827\u2013830."},{"key":"B10","series-title":"Int J Radiat Oncol Biol Phys","first-page":"1379","article-title":"Treatment outcomes in adults with favorable histologic type Wilms tumor-an update from the National Wilms Tumor Study Group","volume":"60","author":"Kalapurakal JA","year":"2004","unstructured":"Kalapurakal JA, Nan B, Norkool P,  Treatment outcomes in adults with favorable histologic type Wilms tumor-an update from the National Wilms Tumor Study Group. Int J Radiat Oncol Biol Phys 2004;60:1379\u20131384."},{"key":"B11","series-title":"Nat Rev Urol","first-page":"775","article-title":"Updated favourable-histology Wilms tumour risk stratification: rationale for future Children\u2019s Oncology Group clinical trials","volume":"22","author":"Benedetti DJ","year":"2025","unstructured":"Benedetti DJ, Cost NG, Ehrlich PF,  Updated favourable-histology Wilms tumour risk stratification: rationale for future Children\u2019s Oncology Group clinical trials. Nat Rev Urol 2025;22:775\u2013788."},{"key":"B12","series-title":"Pediatr Dev Pathol","first-page":"189","article-title":"Renal tumors in children aged 10-16 years: a report from the United Kingdom Children\u2019s Cancer and Leukaemia Group","volume":"14","author":"Popov SD","year":"2011","unstructured":"Popov SD, Sebire NJ, Pritchard-Jones K, Vujani\u0107 GM. Renal tumors in children aged 10-16 years: a report from the United Kingdom Children\u2019s Cancer and Leukaemia Group. Pediatr Dev Pathol 2011;14:189\u2013193."},{"key":"B13","series-title":"PLoS One","first-page":"e0221373","article-title":"Prognostic significance of age in 5631 patients with Wilms tumour prospectively registered in International Society of Paediatric Oncology (SIOP) 93-01 and 2001","volume":"14","author":"Hol JA","year":"2019","unstructured":"Hol JA, Lopez-Yurda MI, Van Tinteren H,  Prognostic significance of age in 5631 patients with Wilms tumour prospectively registered in International Society of Paediatric Oncology (SIOP) 93-01 and 2001. PLoS One 2019;14:e0221373."},{"key":"B14","series-title":"Pediatr Blood Cancer","first-page":"e30586","article-title":"Children\u2019s Oncology Group\u2019s 2023 blueprint for research: renal tumors","volume":"70(Suppl 6)","author":"Geller JI","year":"2023","unstructured":"Geller JI, Hong AL, Vallance KL,  Children\u2019s Oncology Group\u2019s 2023 blueprint for research: renal tumors. Pediatr Blood Cancer 2023;70(Suppl 6):e30586."},{"key":"B15","series-title":"J Clin Oncol","first-page":"1564","article-title":"Treatment of stage IV favorable histology Wilms tumor with lung metastases: a report from the Children\u2019s Oncology Group AREN0533 Study","volume":"36","author":"Dix DB","year":"2018","unstructured":"Dix DB, Seibel NL, Chi YY,  Treatment of stage IV favorable histology Wilms tumor with lung metastases: a report from the Children\u2019s Oncology Group AREN0533 Study. J Clin Oncol 2018;36:1564\u20131570."},{"key":"B16","series-title":"Cancer","first-page":"3887","article-title":"Gain of 1q is associated with inferior event-free and overall survival in patients with favorable histology Wilms tumor: a report from the Children\u2019s Oncology Group","volume":"119","author":"Gratias EJ","year":"2013","unstructured":"Gratias EJ, Jennings LJ, Anderson JR,  Gain of 1q is associated with inferior event-free and overall survival in patients with favorable histology Wilms tumor: a report from the Children\u2019s Oncology Group. Cancer 2013;119:3887\u20133894."},{"key":"B17","series-title":"J Clin Oncol","first-page":"7312","article-title":"Loss of heterozygosity for chromosomes 1p and 16q is an adverse prognostic factor in favorable-histology Wilms tumor: a report from the National Wilms Tumor Study Group","volume":"23","author":"Grundy PE","year":"2005","unstructured":"Grundy PE, Breslow NE, Li S,  Loss of heterozygosity for chromosomes 1p and 16q is an adverse prognostic factor in favorable-histology Wilms tumor: a report from the National Wilms Tumor Study Group. J Clin Oncol 2005;23:7312\u20137321."},{"key":"B18","series-title":"J Clin Oncol","first-page":"1558","article-title":"Activity of vincristine and irinotecan in diffuse anaplastic Wilms tumor and therapy outcomes of stage II to IV disease: results of the Children\u2019s Oncology Group AREN0321 study","volume":"38","author":"Daw NC","year":"2020","unstructured":"Daw NC, Chi YY, Kalapurakal JA,  Activity of vincristine and irinotecan in diffuse anaplastic Wilms tumor and therapy outcomes of stage II to IV disease: results of the Children\u2019s Oncology Group AREN0321 study. J Clin Oncol 2020;38:1558\u20131568."},{"key":"B19","series-title":"J Clin Oncol","first-page":"2769","article-title":"Augmentation of therapy for combined loss of heterozygosity 1p and 16q in favorable histology Wilms tumor: a Children\u2019s Oncology Group AREN0532 and AREN0533 study report","volume":"37","author":"Dix DB","year":"2019","unstructured":"Dix DB, Fernandez CV, Chi YY,  Augmentation of therapy for combined loss of heterozygosity 1p and 16q in favorable histology Wilms tumor: a Children\u2019s Oncology Group AREN0532 and AREN0533 study report. J Clin Oncol 2019;37:2769\u20132777."},{"key":"B20","series-title":"J Clin Oncol","first-page":"254","article-title":"Outcome and prognostic factors in stage III favorable-histology Wilms tumor: a report from the Children\u2019s Oncology Group study AREN0532","volume":"36","author":"Fernandez CV","year":"2018","unstructured":"Fernandez CV, Mullen EA, Chi YY,  Outcome and prognostic factors in stage III favorable-histology Wilms tumor: a report from the Children\u2019s Oncology Group study AREN0532. J Clin Oncol 2018;36:254\u2013261."},{"key":"B21","series-title":"Cancer","first-page":"e35713","article-title":"Treatment of focal anaplastic Wilms tumor: a report from the Children\u2019s Oncology Group AREN0321 and AREN03B2 studies","volume":"131","author":"Armstrong AE","year":"2025","unstructured":"Armstrong AE, Daw NC, Renfro LA,  Treatment of focal anaplastic Wilms tumor: a report from the Children\u2019s Oncology Group AREN0321 and AREN03B2 studies. Cancer 2025;131:e35713."},{"key":"B22","series-title":"Eur J Cancer","first-page":"58","article-title":"Treatment of stage I anaplastic Wilms\u2019 tumour: a report from the Children\u2019s Oncology Group AREN0321 study","volume":"118","author":"Daw NC","year":"2019","unstructured":"Daw NC, Chi YY, Kim Y,  Treatment of stage I anaplastic Wilms\u2019 tumour: a report from the Children\u2019s Oncology Group AREN0321 study. Eur J Cancer 2019;118:58\u201366."},{"key":"B23","series-title":"J Natl Compr Canc Netw","first-page":"978","article-title":"Impact of the first generation of Children\u2019s Oncology Group clinical trials on clinical practice for Wilms tumor","volume":"19","author":"Dome JS","year":"2021","unstructured":"Dome JS, Mullen EA, Dix DB,  Impact of the first generation of Children\u2019s Oncology Group clinical trials on clinical practice for Wilms tumor. J Natl Compr Canc Netw 2021;19:978\u2013985."},{"key":"B24","series-title":"J Clin Oncol","first-page":"1196","article-title":"Clinicopathologic findings predictive of relapse in children with stage III favorable-histology Wilms tumor","volume":"31","author":"Ehrlich PF","year":"2013","unstructured":"Ehrlich PF, Anderson JR, Ritchey ML,  Clinicopathologic findings predictive of relapse in children with stage III favorable-histology Wilms tumor. J Clin Oncol 2013;31:1196\u20131201."},{"key":"B25","series-title":"Eur J Pediatr Surg","first-page":"109","article-title":"Maximizing lymph node retrieval during surgical resection of Wilms tumor","volume":"25","author":"Stewart CL","year":"2015","unstructured":"Stewart CL, Bruny JL. Maximizing lymph node retrieval during surgical resection of Wilms tumor. Eur J Pediatr Surg 2015;25:109\u2013112."},{"key":"B26","series-title":"J Pediatr Surg","first-page":"1228","article-title":"Factors associated with relapse and survival in Wilms tumor: a multivariate analysis","volume":"47","author":"Honeyman JN","year":"2012","unstructured":"Honeyman JN, Rich BS, McEvoy MP,  Factors associated with relapse and survival in Wilms tumor: a multivariate analysis. J Pediatr Surg 2012;47:1228\u20131233."},{"key":"B27","series-title":"Cancer","first-page":"1577","article-title":"Wilms\u2019 tumor: prognostic factors for patients without metastases at diagnosis: results of the National Wilms\u2019 Tumor Study","volume":"41","author":"Breslow NE","year":"1978","unstructured":"Breslow NE, Palmer NF, Hill LR,  Wilms\u2019 tumor: prognostic factors for patients without metastases at diagnosis: results of the National Wilms\u2019 Tumor Study. Cancer 1978;41:1577\u20131589."},{"key":"B28","series-title":"J Clin Oncol","first-page":"521","article-title":"Prognosis for Wilms\u2019 tumor patients with nonmetastatic disease at diagnosis\u2013results of the second National Wilms\u2019 Tumor Study","volume":"3","author":"Breslow N","year":"1985","unstructured":"Breslow N, Churchill G, Beckwith JB,  Prognosis for Wilms\u2019 tumor patients with nonmetastatic disease at diagnosis\u2013results of the second National Wilms\u2019 Tumor Study. J Clin Oncol 1985;3:521\u2013531."},{"key":"B29","series-title":"Cancer","first-page":"2345","article-title":"Prognostic factors in nonmetastatic, favorable histology Wilms\u2019 tumor. Results of the Third National Wilms\u2019 Tumor Study","volume":"68","author":"Breslow N","year":"1991","unstructured":"Breslow N, Sharples K, Beckwith JB,  Prognostic factors in nonmetastatic, favorable histology Wilms\u2019 tumor. Results of the Third National Wilms\u2019 Tumor Study. Cancer 1991;68:2345\u20132353."},{"key":"B30","series-title":"Ann Surg","first-page":"292","article-title":"Surgery-related factors and local recurrence of Wilms tumor in National Wilms Tumor Study 4","volume":"229","author":"Shamberger RC","year":"1999","unstructured":"Shamberger RC, Guthrie KA, Ritchey ML,  Surgery-related factors and local recurrence of Wilms tumor in National Wilms Tumor Study 4. Ann Surg 1999;229:292\u2013297."},{"key":"B31","series-title":"J Pediatr Surg","first-page":"700","article-title":"Lymph node involvement in Wilms tumor: results from National Wilms Tumor Studies 4 and 5","volume":"47","author":"Kieran K","year":"2012","unstructured":"Kieran K, Anderson JR, Dome JS,  Lymph node involvement in Wilms tumor: results from National Wilms Tumor Studies 4 and 5. J Pediatr Surg 2012;47:700\u2013706."},{"key":"B32","series-title":"Bull Cancer","first-page":"177","article-title":"Standard of care for adult Wilms tumor? From adult urologist to pediatric oncologist. 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