Journal of Shanghai Jiao Tong University (Medical Science) >

2021 , Vol. 41 >Issue 10: 1330 - 1335

DOI: https://doi.org/10.3969/j.issn.1674-8115.2021.10.010

Clinical research

Surgical and oncological outcome of 79 consecutive patients with unilateral favorable histology Wilms tumor treated in one single institution following an upfront tumor surgical strategy

  • Chen-jie XIE ,
  • Yi-jin GAO ,
  • Min-zhi YIN ,
  • Jiao-yang CAI ,
  • An-an ZHANG ,
  • Yue-jia TANG ,
  • Song GU ,
  • Ci PAN ,
  • Jing-yan TANG ,
  • Min XU
Expand
  • 1.Department of General Surgery/Oncological Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
    2.Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
    3.Department of Pathology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
XU Min, E-mail: xumin@scmc.com.cn.

Online published: 2021-09-23

Fold

Abstract

Objective

·To improve the understanding of upfront surgical strategy in the treatment of Wilms tumor (WT) and standardize the upfront resection procedure and subsequent chemotherapy and/or radiotherapy approach, providing necessary data support for clinical study in childhood WT in China.

Method

·From January 1, 2010 to December 30, 2017, the clinical records of patients with unilateral favorable histology WT (FHWT) who were initially diagnosed at Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine were retrospectively collected. All cases were diagnosed, staged and treated according to the Chinese Children Cancer Group (CCCG)-WT-2009 or CCCG-WT-2015 Protocol. Surgical outcome, event-free survival (EFS) and overall survival (OS) were analyzed using SPSS software, version 25.0. Follow-up was updated to March 31, 2020.

Result

·A total of 79 consecutive cases with unilateral FHWT were enrolled, including 41 males and 38 females, with a median age of 27.1 months. Systemic staging showed that there were 7 cases with stage Ⅰ, 39 cases with stage Ⅱ, 23 cases with stage Ⅲ and 10 cases with stage Ⅳ. Sixty-nine patients (87.3%) underwent nephrectomy and 10 patients (12.7%) underwent biopsy of renal tumor tissue (2 with core needle biopsy and 8 with open biopsy) in the primary operation. Eleven cases experienced disease progression/recurrence and 1 abandoned treatment and returned to original treatment plan after 8 weeks. Local radiation therapy was applied to 27 of 32 patients with indication. Only 3 of 10 patients with lung metastasis at diagnosis received whole lung radiation therapy. A median follow-up of 69 cases without incident was 69.8 months. The 5-year EFS and OS of all cases were 84.8% and 92.4% respectively. The 5-year EFS of children with stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 100.0%, 84.6%, 95.7% and 50.0% (P=0.010), respectively. And the 5-year OS of children with stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 100.0%, 94.9%, 95.7 and 70.0% (P=0.070), respectively. The 5-year EFS of children with stage Ⅲ/Ⅳ receiving initial nephrectomy was higher than that of those undergoing biopsy (91.3% vs 60.0%, P= 0.032). The 5-year EFS of children with initial biopsy, who underwent nephrectomy at week 6 was significantly higher than that of those who did not (100% vs 0, P=0.005).

Conclusion

·The upfront tumor surgical strategy of unilateral WT is safe, feasible and effective in the treatment of FHWT. Initial nephrectomy and clearance of all local diseases with lymph nodal sampling is the key to staging and successful treatment.

Key words： Wilms tumor; favorable histology; treatment; prognosis; child

Cite this article

Chen-jie XIE , Yi-jin GAO , Min-zhi YIN , Jiao-yang CAI , An-an ZHANG , Yue-jia TANG , Song GU , Ci PAN , Jing-yan TANG , Min XU . Surgical and oncological outcome of 79 consecutive patients with unilateral favorable histology Wilms tumor treated in one single institution following an upfront tumor surgical strategy[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2021 , 41(10) : 1330 -1335 . DOI: 10.3969/j.issn.1674-8115.2021.10.010

References

1 汤静燕, 徐敏, 王常林, 等. 小儿肿瘤协会儿童肾母细胞瘤WT-2003协作方案初步报告[J]. 中华小儿外科杂志, 2006, 27(6): 281-284.
2 中国抗癌协会儿科专业委员会, 中华医学会儿科学分会血液学组. 儿童肾肿瘤多中心协作方案诊治随访报告[J]. 中华儿科杂志, 2016, 54(11): 808-813.
3 中国抗癌协会小儿肿瘤专业委员会. 儿童肾母细胞瘤诊断治疗建议(CCCG-WT-2016)[J]. 中华儿科杂志, 2017, 55(2): 90-94.
4 鲍萍萍, 李凯, 吴春晓, 等. 2002—2010年上海市户籍儿童恶性实体肿瘤发病特征和变化趋势分析[J]. 中华儿科杂志, 2013, 51(4): 288-294.
5 Chan CC, To KF, Yuen HL, et al. A 20-year prospective study of Wilms tumor and other kidney tumors: a report from Hong Kong pediatric hematology and oncology study group[J]. J Pediatr Hematol Oncol, 2014, 36(6): 445-450.
6 Mostert S, Arora RS, Arreola M, et al. Abandonment of treatment for childhood cancer: position statement of a SIOP PODC Working Group[J]. Lancet Oncol, 2011, 12(8): 719-720.
7 National Cancer Institute. SEER Cancer Statistics Review(CSR)1975-2018[R/OL]. (2021-04-55)[2021-08-10]. .
8 Smith MA, Altekruse SF, Adamson PC, et al. Declining childhood and adolescent cancer mortality[J]. Cancer, 2014, 120(16): 2497-2506.
9 Dome JS, Graf N, Geller JI, et al. Advances in Wilms tumor treatment and biology: progress through international collaboration[J]. J Clin Oncol, 2015, 33(27): 2999-3007.
10 Yao W, Li K, Xiao X, et al. Outcomes of Wilms' tumor in Eastern China: 10 years of experience at a single center[J]. J Invest Surg, 2012, 25(3): 181-185.
11 Pan C, Cai JY, Xu M, et al. Renal tumor in developing countries: 142 cases from a single institution at Shanghai, China[J]. World J Pediatr, 2015, 11(4): 326-330.
12 黄俊廷, 谭玉婷, 甄子俊, 等. 87例儿童青少年Ⅲ~Ⅳ期预后良好型肾母细胞瘤综合治疗结果分析[J]. 广东医学, 2017, 38(20): 3116-3119.
13 Shamberger RC, Guthrie KA, Richey ML, et al. Surgery-related factors and local recurrence of Wilms tumor in National Wilms Study 4[J]. Ann Surg, 1999, 229(2): 292-297.
14 Aldrink JH, Heaton TE, Dasgupta R, et al. Update on Wilms tumor[J]. J Pediatr Surg, 2019, 54(3): 390-397.
15 Ehrlich PF, Anderson JR, Ritchey ML, et al. Clinicopathologic findings predictive of relapse in children with stage Ⅲ favorable-histology Wilms tumor[J]. J Clin Oncol, 2013, 31(9): 1196-1201.
16 Fernandez CV, Mullen EA, Chi YY, et al. Outcome and prognostic factors in stage Ⅲ favorable-histology Wilms tumor: a report from the children's oncology group study AREN0532[J]. J Clin Oncol, 2018, 36(3): 254-261.
17 Saltzman AF, Smith DE, Gao D, et al. How many lymph nodes are enough? Assessing the adequacy of lymph node yield for staging in favorable histology wilms tumor[J]. J Pediatr Surg, 2019, 54(11): 2331-2335.
18 Nanda RH, Shehata BM, Khoshnam N, et al. Impact of lymph node evaluation in adjuvant and neoadjuvant chemotherapy settings on survival outcomes in Wilms tumour: a review of 185 cases from a single institution[J]. Pathology, 2017, 49(1): 19-23.
19 Ehrlich PF, Ritchey ML, Hamilton TE, et al. Quality assessment for Wilms' tumor: a report from the National Wilms' Tumor Study-5[J]. J Pediatr Surg, 2005, 40(1): 208-212; discussion212-213.
20 Dix DB, Seibel NL, Chi YY, et al. Treatment of stage Ⅳ favorable histology Wilms tumor with lung metastases: a report from the children's oncology group AREN0533 study[J]. J Clin Oncol, 2018, 36(16): 1564-1570.
21 Verschuur A, van Tinteren H, Graf N, et al. Treatment of pulmonary metastases in children with stage Ⅳ nephroblastoma with risk-based use of pulmonary radiotherapy[J]. J Clin Oncol, 2012, 30(28): 3533-3539.
22 Ehrlich PF, Hamilton TE, Grundy P, et al. The value of surgery in directing therapy for patients with Wilms' tumor with pulmonary disease. A report from the National Wilms' Tumor Study Group (National Wilms' Tumor Study 5)[J]. J Pediatr Surg, 2006, 41(1): 162-167.
23 Meisel JA, Guthrie KA, Breslow NE, et al. Significance and management of computed tomography detected pulmonary nodules: a report from the National Wilms Tumor Study Group[J]. Int J Radiat Oncol Biol Phys, 1999, 44 (3): 579-585.
24 常晓峰, 秦红, 杨维, 等. 95例肾母细胞瘤临床病理特点及预后因素分析[J]. 中国肿瘤临床, 2012, 39(15): 1040-1042.
25 Dix DB, Fernandez CV, Chi YY, et al. Augmentation of therapy for combined loss of heterozygosity 1p and 16q in favorable histology Wilms tumor: a children's oncology group AREN0532 and AREN0533 study report[J]. J Clin Oncol, 2019, 37(30): 2769-2777.
26 Dome JS, Graf N, Geller JI, et al. Advances in Wilms tumor treatment and biology: progress through international collaboration[J]. J Clin Oncol, 2015, 33(27): 2999-3007.
Options
Outlines

/

〈 〉