Outcome and prognostic factors in stage III favorable histology Wilms tumor (FHWT): A report from the Children’s Oncology Group (COG) study AREN0532.
Bibliographic record
Abstract
10010 Background: National Wilms Tumor Study 5 showed an inferior outcome for stage III FHWT patients with combined Loss of Heterozygosity (LOH) at chromosomes 1p and 16q when treated with Regimen DD4A (vincristine/dactinomycin/doxorubicin/radiation therapy (RT)). Patients with combined LOH were thus treated with increased therapy on COG study AREN0533. We evaluated the outcomes and prognostic utility of clinical and biological variables for the remaining stage III FHWT patients. Methods: From October 2006 to August 2013, 583 eligible patients met COG stage III criteria on central review of pathology, diagnostic imaging and surgical reports. Forty patients found to have combined LOH 1p and 16q were excluded from the survival analysis. All patients received DD4A; those with anaplasia at delayed nephrectomy were removed from protocol therapy. Tumor 1p and 16q LOH status was determined by microsatellite analysis. Results: Median follow up was 42 months (1.5-90). Median age at diagnosis was 45 months (range 1.4-220); 381 (70%) were white. Median tumor weight was 550 grams (22-3140). The 4-year event-free survival (EFS) and OS estimates were 88% (95%CI: 85-91%) and 96% (95%CI 93-98%), respectively. Fifty-eight out of 62 events occurred in the first 2 years. Site of relapse: lung +/- other (n = 35), abdomen or pelvis (n = 5), liver (n = 5), other (n = 15). Causes of death: relapse (n = 12), toxicity (n = 2), second malignancy (n = 1), non-cancer death (n = 1), other (n = 1). 123/543 (23%) had delayed nephrectomy. Submitted delayed nephrectomy histology showed: Anaplasia (n = 8); Low Risk/completely necrotic (n = 5; 0 relapses), Intermediate risk (n = 54; 6 relapses), High-Risk/Blastemal Type (n = 4; 4 relapses) and Indeterminate (n = 2; 2 relapses). Other prognostic variables examined in the table below. Conclusions: Most stage III FHWT patients had very good EFS and OS with DD4A and RT. Lymph node status, post-chemotherapy histology, and LOH were predictive of EFS. Future trials should consider modifying therapy based on identified prognostic markers. Clinical trial information: NCT00352534. n EFS P value OS P value Lymph Nodes Negative 237 95% < 0.01 98% 0.18 Positive 152 83% 95% Gross residual disease Negative 394 89% 0.14 97% 0.39 Positive 134 85% 93% LOH Neither 382 92% < 0.01 97% 0.55 16q only 99 83% 97% 1p only 56 74% 93%
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".