Wilms tumor is the most common renal malignancy in children . Five-year overall survival rates have dramatically improved with multimodal therapy and now approach 90 percent.
The treatment and outcome of Wilms tumor will be reviewed here. The epidemiology, presentation, diagnosis, and staging of Wilms tumor are discussed separately. (See "Presentation, diagnosis, and staging of Wilms tumor".)
Several prognostic factors at the time of initial diagnosis are associated with an increased risk of tumor recurrence or death, and include:
- Tumor histology (anaplasia)
- Tumor stage
- Molecular and genetic markers
- Age greater than two years of age
The presence of poor prognostic factor(s) leads to more aggressive initial therapeutic regimens, which are targeted to reduce the rates of tumor recurrence and death. In contrast, patients less than two years of age with a small tumor that is less than 550 g have a favorable prognosis and may not require adjuvant chemotherapy. (See 'National Wilms Tumor Study' below.)