Relapsed Wilms Tumor Management and Outcomes in Canada: A Report From CYP-C
Bibliographic record
Abstract
BACKGROUND: Wilms tumor (WT) is the most common pediatric renal tumor. While relapse of WT occurs in up to 15%, its management is not well characterized. We aimed to describe the Canadian experience in relapsed WT and the potential effect of surgical intervention as part of multimodal therapy on survival. METHODS: We identified a cohort of patients with relapsed WT between 2001 and 2020 from the Cancer in Young People in Canada program (CYP-C), a population-based surveillance program. Four-year event-free survival (EFS) and overall survival (OS) were estimated using the Kaplan-Meier method. The effect of surgical intervention on 4-year EFS/OS was evaluated through a Cox proportional hazards model (which included the number of upfront chemotherapy drugs). RESULTS: Ninety-seven patients were identified. Median age at relapse was 5.2 years (range: 0.4 to 16.0) and median time to relapse from initial diagnosis was 13.0 months (range: 3.0 to 73.0). 28.9% of relapses occurred after initial upfront treatment with 2 chemotherapy drugs versus 62.9% with ≥3 drugs. Four-year EFS and OS from time of first relapse were 54.0% (95% CI: 44.6-65.4) and 61.6% (95% CI: 52.4-72.6), respectively. Seventy-one percent of patients with relapsed WT had surgery as part of multimodal therapy. The hazard ratio associated with surgical intervention in multiple regression was 0.54 for EFS (95% CI: 0.29-1.02; P =.06) and 0.36 for OS (95% CI: 0.19-0.71; P =.003). CONCLUSIONS: Outcomes compare favorably to those reported by international cooperative groups. More favorable survival was observed in patients amenable to surgical intervention at relapse. This association may reflect a true therapeutic benefit of resection or may be confounded by the extent of disease at presentation, response to chemotherapy, the patient's performance status, or other variables. The impact of these on outcomes should be further investigated.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".