A higher tumor volume and undernutrition at diagnosis adversely affect the survival of children with Wilms tumor : A study of 200 patients
© 2022 Wiley Periodicals LLC..
BACKGROUND: Distinct prognostic factors for Wilms tumor (WT) in low- and middle-income countries need identification.
METHODS: Retrospective study of patients with WT managed by the International Society of Pediatric Oncology (SIOP) approach for over 11 years (2005-2016) at a single center in Chandigarh, India.
RESULTS: The study included 200 patients (median age: 33.5 months). The tumor stage (SIOP) distribution included stage I (30%), II (36%), III (14%), IV (17%), and V (3%). The histology-risk groups were low (8%), intermediate (84%), and high risk (9%). At diagnosis, 68 out of 190 (36%) patients were underweight. The median tumor volume at diagnosis was 481 ml (interquartile ratio [IQR]: 306.9, 686.8, n = 146). Following neoadjuvant chemotherapy, it reduced to 110 ml (IQR: 151.2, 222, n = 77). Treatment was abandoned in 20.5% of the patients. Treatment-related mortality occurred in 13 of 179 (7.2%) patients. Relapse occurred in 26 of 158 (16.5%) patients. The 3-year overall survival (OS) and event-free survival (EFS) of patients who completed therapy were 78.3 and 72%, respectively. The stage (p = .013) and histology (p = .023) influenced OS. A lower OS in stage II (75.4%) versus stage III disease (83.7%) suggested understaging. Patients with a higher tumor volume at diagnosis (p = .005; odds ratio [OR]: 0.99; 95% confidence interval [CI]: 0.99-1.00) or a lower weight-for-age z-score (p = .002; OR: 1.68; 95% CI: 1.21-2.33) had an increased risk of death or relapse.
CONCLUSIONS: The 3-year OS and EFS of children who completed therapy were 78.3 and 72%, respectively. A higher tumor volume and lower weight-for-age z-score at diagnosis were identified as distinct adverse prognostic factors. A likely suboptimal lymph node assessment (intraoperative and histopathology) contributed to the understaging of stage III to II disease and reduced survival.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:69 |
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| Enthalten in: |
Pediatric blood & cancer - 69(2022), 11 vom: 12. Nov., Seite e29880 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Rahiman, Emine A [VerfasserIn] |
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| Links: |
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| Themen: |
Developing country |
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| Anmerkungen: |
Date Completed 30.09.2022 Date Revised 08.11.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1002/pbc.29880 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM343615509 |
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| 100 | 1 | |a Rahiman, Emine A |e verfasserin |4 aut | |
| 245 | 1 | 2 | |a A higher tumor volume and undernutrition at diagnosis adversely affect the survival of children with Wilms tumor |b A study of 200 patients |
| 264 | 1 | |c 2022 | |
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| 500 | |a Date Completed 30.09.2022 | ||
| 500 | |a Date Revised 08.11.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 Wiley Periodicals LLC. | ||
| 520 | |a BACKGROUND: Distinct prognostic factors for Wilms tumor (WT) in low- and middle-income countries need identification | ||
| 520 | |a METHODS: Retrospective study of patients with WT managed by the International Society of Pediatric Oncology (SIOP) approach for over 11 years (2005-2016) at a single center in Chandigarh, India | ||
| 520 | |a RESULTS: The study included 200 patients (median age: 33.5 months). The tumor stage (SIOP) distribution included stage I (30%), II (36%), III (14%), IV (17%), and V (3%). The histology-risk groups were low (8%), intermediate (84%), and high risk (9%). At diagnosis, 68 out of 190 (36%) patients were underweight. The median tumor volume at diagnosis was 481 ml (interquartile ratio [IQR]: 306.9, 686.8, n = 146). Following neoadjuvant chemotherapy, it reduced to 110 ml (IQR: 151.2, 222, n = 77). Treatment was abandoned in 20.5% of the patients. Treatment-related mortality occurred in 13 of 179 (7.2%) patients. Relapse occurred in 26 of 158 (16.5%) patients. The 3-year overall survival (OS) and event-free survival (EFS) of patients who completed therapy were 78.3 and 72%, respectively. The stage (p = .013) and histology (p = .023) influenced OS. A lower OS in stage II (75.4%) versus stage III disease (83.7%) suggested understaging. Patients with a higher tumor volume at diagnosis (p = .005; odds ratio [OR]: 0.99; 95% confidence interval [CI]: 0.99-1.00) or a lower weight-for-age z-score (p = .002; OR: 1.68; 95% CI: 1.21-2.33) had an increased risk of death or relapse | ||
| 520 | |a CONCLUSIONS: The 3-year OS and EFS of children who completed therapy were 78.3 and 72%, respectively. A higher tumor volume and lower weight-for-age z-score at diagnosis were identified as distinct adverse prognostic factors. A likely suboptimal lymph node assessment (intraoperative and histopathology) contributed to the understaging of stage III to II disease and reduced survival | ||
| 650 | 4 | |a Journal Article | |
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| 650 | 4 | |a low- and middle-income countries (LMIC) | |
| 650 | 4 | |a malnutrition | |
| 650 | 4 | |a prognosis | |
| 650 | 4 | |a survival | |
| 650 | 4 | |a treatment | |
| 700 | 1 | |a Trehan, Amita |e verfasserin |4 aut | |
| 700 | 1 | |a Jain, Richa |e verfasserin |4 aut | |
| 700 | 1 | |a Menon, Prema |e verfasserin |4 aut | |
| 700 | 1 | |a Kakkar, Nandita |e verfasserin |4 aut | |
| 700 | 1 | |a Srinivasan, Radhika |e verfasserin |4 aut | |
| 700 | 1 | |a Sodhi, Kushaljit Singh |e verfasserin |4 aut | |
| 700 | 1 | |a Saxena, Akshay Kumar |e verfasserin |4 aut | |
| 700 | 1 | |a Kapoor, Rakesh |e verfasserin |4 aut | |
| 700 | 1 | |a Bansal, Deepak |e verfasserin |4 aut | |
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