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Abstract
Although differences exist in treatment and risk-stratification strategies for children with Wilms tumor (WT) between the European [International Society of Paediatric Oncology (SIOP)] and American [Children's Oncology Group (COG)] study groups, outcomes are very similar, with an overall survival of > 85%. Future strategies aim to de-intensify treatment and reduce toxicity for children with a low risk of relapse and intensify treatment for children with high-risk disease. For metastatic WT, response of lung nodules to chemotherapy is used as a marker to modify treatment intensity. For recurrent WT, a unified approach based on the use of agents that were not used for primary therapy is being introduced. Irinotecan is being explored as a new strategy in both metastatic and relapsed WT. Introduction of biology-driven approaches to risk stratification and new drug treatments has been slower in WT than in some other childhood cancers. While several new biological pathways have been identified recently in WT, their individual rarity has hampered their translation into clinical utility. Identification of robust prognostic factors requires extensive international collaborative studies because of the low proportion who relapse or die. Molecular profiling studies are in progress that should ultimately improve both risk classification and signposting to more targeted therapies for the small group for whom current therapies fail. Accrual of patients with WT to early-phase trials has been low, and the efficacy of these new agents has so far been very disappointing. Better in vitro model systems to test mechanistic dependence are needed so available new agents can be more rationally prioritized for recruitment of children with WT to early-phase trials.
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Affiliation(s)
- Radna Minou Oostveen
- UCL Great Ormond Street Hospital Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK.
| | - Kathy Pritchard-Jones
- UCL Great Ormond Street Hospital Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
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Loke BN, Wong MK, Tawng KD, Kuick CH, Jain S, Lian D, Wagner E, Zou Y, Ganesan V, Sim SW, Lee YT, Chin F, Chan MY, Tan AM, Teh BT, Soh SY, Chang KT, Loh AH. Clinical, pathological and loss of heterozygosity differences in Wilms tumors between Asian and non-Asian children. Int J Cancer 2018; 144:1234-1242. [DOI: 10.1002/ijc.31946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/27/2018] [Accepted: 10/10/2018] [Indexed: 01/02/2023]
Affiliation(s)
- Benjamin N. Loke
- Department of Biological Sciences; National University of Singapore; Singapore Singapore
| | - Meng Kang Wong
- VIVA-KKH Paediatric Solid Tumour Research Laboratory; KK Women's and Children's Hospital; Singapore Singapore
| | - Khawn D. Tawng
- Department of Paediatric Subspecialties Haematology/Oncology Service; KK Women's and Children's Hospital; Singapore Singapore
| | - Chick Hong Kuick
- Department of Pathology and Laboratory Medicine; KK Women's and Children's Hospital; Singapore Singapore
| | - Sudhanshi Jain
- Department of Pathology and Laboratory Medicine; KK Women's and Children's Hospital; Singapore Singapore
| | - Derrick Lian
- Department of Pathology and Laboratory Medicine; KK Women's and Children's Hospital; Singapore Singapore
| | - Elizabeth Wagner
- Institute for Genomic Medicine; Nationwide Children's Hospital; Columbus OH
| | - Yuhan Zou
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Visveswari Ganesan
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore Singapore
| | - Siam Wee Sim
- Department of Paediatric Surgery; KK Women's and Children's Hospital; Singapore Singapore
| | - York Tien Lee
- Department of Paediatric Surgery; KK Women's and Children's Hospital; Singapore Singapore
| | - Francis Chin
- Division of Radiation Oncology, National Cancer Centre Singapore; Singapore Singapore
| | - Mei Yoke Chan
- Department of Paediatric Subspecialties Haematology/Oncology Service; KK Women's and Children's Hospital; Singapore Singapore
| | - Ah Moy Tan
- Department of Paediatric Subspecialties Haematology/Oncology Service; KK Women's and Children's Hospital; Singapore Singapore
| | - Bin Tean Teh
- Laboratory of Cancer Epigenome, National Cancer Centre Singapore; Singapore Singapore
| | - Shui Yen Soh
- Department of Paediatric Subspecialties Haematology/Oncology Service; KK Women's and Children's Hospital; Singapore Singapore
| | - Kenneth T.E. Chang
- VIVA-KKH Paediatric Solid Tumour Research Laboratory; KK Women's and Children's Hospital; Singapore Singapore
- Department of Pathology and Laboratory Medicine; KK Women's and Children's Hospital; Singapore Singapore
| | - Amos H.P. Loh
- VIVA-KKH Paediatric Solid Tumour Research Laboratory; KK Women's and Children's Hospital; Singapore Singapore
- Department of Paediatric Surgery; KK Women's and Children's Hospital; Singapore Singapore
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Biological Drivers of Wilms Tumor Prognosis and Treatment. CHILDREN-BASEL 2018; 5:children5110145. [PMID: 30373137 PMCID: PMC6262554 DOI: 10.3390/children5110145] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 10/16/2018] [Accepted: 10/18/2018] [Indexed: 12/11/2022]
Abstract
Prior to the 1950s, survival from Wilms tumor (WT) was less than 10%. Today, a child diagnosed with WT has a greater than 90% chance of survival. These gains in survival rates from WT are attributed largely to improvements in multimodal therapy: Enhanced surgical techniques leading to decreased operative mortality, optimization of more effective chemotherapy regimens (specifically, dactinomycin and vincristine), and inclusion of radiation therapy in treatment protocols. More recent improvements in survival, however, can be attributed to a growing understanding of the molecular landscape of Wilms tumor. Particularly, identification of biologic markers portending poor prognosis has facilitated risk stratification to tailor therapy that achieves the best possible outcome with the least possible toxicity. The aim of this review is to (1) outline the specific biologic markers that have been associated with prognosis in WT and (2) provide an overview of the current use of biologic and other factors to stratify risk and assign treatment accordingly.
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Mullen EA, Chi YY, Hibbitts E, Anderson JR, Steacy KJ, Geller JI, Green DM, Khanna G, Malogolowkin MH, Grundy PE, Fernandez CV, Dome JS. Impact of Surveillance Imaging Modality on Survival After Recurrence in Patients With Favorable-Histology Wilms Tumor: A Report From the Children's Oncology Group. J Clin Oncol 2018; 36:JCO1800076. [PMID: 30335557 PMCID: PMC6269130 DOI: 10.1200/jco.18.00076] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
PURPOSE The use of computed tomography (CT) for routine surveillance to detect recurrence in patients with Wilms tumor (WT) has increased in recent years. The utility of CT, despite increased risk and cost, to improve outcome for these patients is unknown. We conducted a retrospective analysis with patients enrolled in the fifth National Wilms Tumor Study (NWTS-5) to determine if surveillance with CT correlates with improved overall survival (OS) after recurrence compared with chest x-ray (CXR) and abdominal ultrasound (US). PATIENTS AND METHODS Overall, 281 patients with recurrent unilateral favorable-histology WT were reviewed to assess how WT recurrence was detected: sign/symptoms (SS), surveillance imaging (SI) with CT scan, or SI with CXR/US. RESULTS The estimated 5-year OS rate after relapse was 67% (95% CI, 61% to 72%). Twenty-five percent of recurrences were detected with SS; 48.5%, with CXR/US; and 26.5%, with CT. Patients with SS had a 5-year OS rate of 59% (95% CI, 46% to 72%) compared with 70% (95% CI, 63% to 77%; P = .23) for those detected by SI. Recurrences detected by CT had a shorter median time from diagnosis to recurrence (0.60 years) compared with SS (0.91 years) or CXR/US (0.86 years; P = .003). For recurrences detected by SI, more tumor foci at relapse ( P < .001) and size of the largest focus greater than 2 cm ( P = .02) were associated with inferior OS. However, there was no difference in OS after relapse when recurrence was detected by CT versus CXR/US (5-year OS rate, 65% v 73%; P = .20). CONCLUSION In patients with favorable-histology WT, elimination of CT scans from surveillance programs is unlikely to compromise survival but would result in substantial reduction in radiation exposure and health care costs.
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Affiliation(s)
- Elizabeth A. Mullen
- Elizabeth A. Mullen, Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; Yueh-Yun Chi and Emily Hibbitts, University of Florida, Gainesville, FL; James R. Anderson, Merck Research Laboratories, North Wales, PA; Katarina J. Steacy, University of Maryland Medical Center, Baltimore, MD; James I. Geller, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Daniel M. Green, St Jude Children’s Research Hospital, Memphis, TN; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Paul E. Grundy, Stollery Children’s Hospital, University of Alberta, Alberta; Conrad V. Fernandez, IWK Health Center, Dalhousie University Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, Children’s National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Yueh-Yun Chi
- Elizabeth A. Mullen, Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; Yueh-Yun Chi and Emily Hibbitts, University of Florida, Gainesville, FL; James R. Anderson, Merck Research Laboratories, North Wales, PA; Katarina J. Steacy, University of Maryland Medical Center, Baltimore, MD; James I. Geller, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Daniel M. Green, St Jude Children’s Research Hospital, Memphis, TN; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Paul E. Grundy, Stollery Children’s Hospital, University of Alberta, Alberta; Conrad V. Fernandez, IWK Health Center, Dalhousie University Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, Children’s National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Emily Hibbitts
- Elizabeth A. Mullen, Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; Yueh-Yun Chi and Emily Hibbitts, University of Florida, Gainesville, FL; James R. Anderson, Merck Research Laboratories, North Wales, PA; Katarina J. Steacy, University of Maryland Medical Center, Baltimore, MD; James I. Geller, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Daniel M. Green, St Jude Children’s Research Hospital, Memphis, TN; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Paul E. Grundy, Stollery Children’s Hospital, University of Alberta, Alberta; Conrad V. Fernandez, IWK Health Center, Dalhousie University Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, Children’s National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - James R. Anderson
- Elizabeth A. Mullen, Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; Yueh-Yun Chi and Emily Hibbitts, University of Florida, Gainesville, FL; James R. Anderson, Merck Research Laboratories, North Wales, PA; Katarina J. Steacy, University of Maryland Medical Center, Baltimore, MD; James I. Geller, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Daniel M. Green, St Jude Children’s Research Hospital, Memphis, TN; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Paul E. Grundy, Stollery Children’s Hospital, University of Alberta, Alberta; Conrad V. Fernandez, IWK Health Center, Dalhousie University Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, Children’s National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Katarina J. Steacy
- Elizabeth A. Mullen, Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; Yueh-Yun Chi and Emily Hibbitts, University of Florida, Gainesville, FL; James R. Anderson, Merck Research Laboratories, North Wales, PA; Katarina J. Steacy, University of Maryland Medical Center, Baltimore, MD; James I. Geller, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Daniel M. Green, St Jude Children’s Research Hospital, Memphis, TN; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Paul E. Grundy, Stollery Children’s Hospital, University of Alberta, Alberta; Conrad V. Fernandez, IWK Health Center, Dalhousie University Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, Children’s National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - James I. Geller
- Elizabeth A. Mullen, Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; Yueh-Yun Chi and Emily Hibbitts, University of Florida, Gainesville, FL; James R. Anderson, Merck Research Laboratories, North Wales, PA; Katarina J. Steacy, University of Maryland Medical Center, Baltimore, MD; James I. Geller, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Daniel M. Green, St Jude Children’s Research Hospital, Memphis, TN; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Paul E. Grundy, Stollery Children’s Hospital, University of Alberta, Alberta; Conrad V. Fernandez, IWK Health Center, Dalhousie University Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, Children’s National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Daniel M. Green
- Elizabeth A. Mullen, Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; Yueh-Yun Chi and Emily Hibbitts, University of Florida, Gainesville, FL; James R. Anderson, Merck Research Laboratories, North Wales, PA; Katarina J. Steacy, University of Maryland Medical Center, Baltimore, MD; James I. Geller, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Daniel M. Green, St Jude Children’s Research Hospital, Memphis, TN; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Paul E. Grundy, Stollery Children’s Hospital, University of Alberta, Alberta; Conrad V. Fernandez, IWK Health Center, Dalhousie University Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, Children’s National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Geetika Khanna
- Elizabeth A. Mullen, Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; Yueh-Yun Chi and Emily Hibbitts, University of Florida, Gainesville, FL; James R. Anderson, Merck Research Laboratories, North Wales, PA; Katarina J. Steacy, University of Maryland Medical Center, Baltimore, MD; James I. Geller, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Daniel M. Green, St Jude Children’s Research Hospital, Memphis, TN; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Paul E. Grundy, Stollery Children’s Hospital, University of Alberta, Alberta; Conrad V. Fernandez, IWK Health Center, Dalhousie University Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, Children’s National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Marcio H. Malogolowkin
- Elizabeth A. Mullen, Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; Yueh-Yun Chi and Emily Hibbitts, University of Florida, Gainesville, FL; James R. Anderson, Merck Research Laboratories, North Wales, PA; Katarina J. Steacy, University of Maryland Medical Center, Baltimore, MD; James I. Geller, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Daniel M. Green, St Jude Children’s Research Hospital, Memphis, TN; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Paul E. Grundy, Stollery Children’s Hospital, University of Alberta, Alberta; Conrad V. Fernandez, IWK Health Center, Dalhousie University Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, Children’s National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Paul E. Grundy
- Elizabeth A. Mullen, Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; Yueh-Yun Chi and Emily Hibbitts, University of Florida, Gainesville, FL; James R. Anderson, Merck Research Laboratories, North Wales, PA; Katarina J. Steacy, University of Maryland Medical Center, Baltimore, MD; James I. Geller, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Daniel M. Green, St Jude Children’s Research Hospital, Memphis, TN; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Paul E. Grundy, Stollery Children’s Hospital, University of Alberta, Alberta; Conrad V. Fernandez, IWK Health Center, Dalhousie University Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, Children’s National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Conrad V. Fernandez
- Elizabeth A. Mullen, Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; Yueh-Yun Chi and Emily Hibbitts, University of Florida, Gainesville, FL; James R. Anderson, Merck Research Laboratories, North Wales, PA; Katarina J. Steacy, University of Maryland Medical Center, Baltimore, MD; James I. Geller, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Daniel M. Green, St Jude Children’s Research Hospital, Memphis, TN; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Paul E. Grundy, Stollery Children’s Hospital, University of Alberta, Alberta; Conrad V. Fernandez, IWK Health Center, Dalhousie University Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, Children’s National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jeffrey S. Dome
- Elizabeth A. Mullen, Dana-Farber Cancer Institute/Boston Children’s Cancer and Blood Disorders Center, Boston, MA; Yueh-Yun Chi and Emily Hibbitts, University of Florida, Gainesville, FL; James R. Anderson, Merck Research Laboratories, North Wales, PA; Katarina J. Steacy, University of Maryland Medical Center, Baltimore, MD; James I. Geller, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH; Daniel M. Green, St Jude Children’s Research Hospital, Memphis, TN; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Marcio H. Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Paul E. Grundy, Stollery Children’s Hospital, University of Alberta, Alberta; Conrad V. Fernandez, IWK Health Center, Dalhousie University Halifax, Nova Scotia, Canada; and Jeffrey S. Dome, Children’s National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
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Klega K, Imamovic-Tuco A, Ha G, Clapp AN, Meyer S, Ward A, Clinton C, Nag A, Van Allen E, Mullen E, DuBois SG, Janeway K, Meyerson M, Thorner AR, Crompton BD. Detection of Somatic Structural Variants Enables Quantification and Characterization of Circulating Tumor DNA in Children With Solid Tumors. JCO Precis Oncol 2018; 2018. [PMID: 30027144 DOI: 10.1200/po.17.00285] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Objective Liquid biopsies are being rapidly used in adult cancers as new biomarkers of disease. Circulating tumor DNA (ctDNA) levels have been reported to be proportional to disease burden, correlate with treatment response, and predict relapse. However, little is known about how frequently ctDNA is detectable in pediatric patients with solid tumors. Therefore, we developed a next-generation sequencing approach to detect and quantify ctDNA in the blood of patients with the most common pediatric solid tumors. Methods Detection of ctDNA requires assays sensitive to somatic events typically observed in the cancer type being studied. In pediatric solid tumors, structural variants are more common than recurrent point mutations. We adapted an ultralow passage whole-genome sequencing approach to capture copy number variants and a hybrid capture sequencing assay to detect translocations in liquid biopsy samples from pediatric patients. Results Copy number changes seen by ultralow passage whole-genome sequencing enabled detection of ctDNA in patients with osteosarcoma, neuroblastoma, alveolar rhabdomyosarcoma, and Wilms tumor. In Ewing sarcoma, detection of the EWSR1 translocation was a more sensitive approach. For patients with samples collected at multiple time points, changes in ctDNA levels corresponded to treatment response. We also found that disease-specific genomic biomarkers of prognosis were detectable in ctDNA. Conclusion This study demonstrates that liquid biopsy approaches that detect somatic structural variants are well suited to pediatric solid tumors. We show that children with the most common solid tumor malignancies have detectable levels of ctDNA, which may be used to track disease response and identify genomic subclassifiers of disease. Efforts to profile larger collections of clinically annotated specimens are under way to validate the clinical use of these assays.
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Affiliation(s)
| | | | - Gavin Ha
- Dana-Farber Cancer Institute, Boston
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Fernandez CV, Perlman EJ, Gastier-Foster J, Geller JI, Mullen EA, Ehrlich PF, Dome JS. Reply to B. Zhang et al. J Clin Oncol 2018; 36:1454-1455. [PMID: 29613833 DOI: 10.1200/jco.2018.78.0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Conrad V Fernandez
- Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Julie Gastier-Foster, Nationwide Children's Hospital, Columbus, OH; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC
| | - Elizabeth J Perlman
- Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Julie Gastier-Foster, Nationwide Children's Hospital, Columbus, OH; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC
| | - Julie Gastier-Foster
- Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Julie Gastier-Foster, Nationwide Children's Hospital, Columbus, OH; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC
| | - James I Geller
- Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Julie Gastier-Foster, Nationwide Children's Hospital, Columbus, OH; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC
| | - Elizabeth A Mullen
- Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Julie Gastier-Foster, Nationwide Children's Hospital, Columbus, OH; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC
| | - Peter F Ehrlich
- Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Julie Gastier-Foster, Nationwide Children's Hospital, Columbus, OH; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC
| | - Jeffrey S Dome
- Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Julie Gastier-Foster, Nationwide Children's Hospital, Columbus, OH; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC
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Saltzman AF, Carrasco A, Amini A, Aldrink JH, Dasgupta R, Gow KW, Glick RD, Ehrlich PF, Cost NG. Patterns of lymph node sampling and the impact of lymph node density in favorable histology Wilms tumor: An analysis of the national cancer database. J Pediatr Urol 2018; 14:161.e1-161.e8. [PMID: 29133167 DOI: 10.1016/j.jpurol.2017.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/28/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION There is controversy about the role of lymph node (LN) sampling or dissection in the management of favorable histology (FH) Wilms tumor (WT), specifically how it performed and how it may impact survival. OBJECTIVE The objective of this study was to analyze factors affecting LN sampling patterns and the impact of LN yield and density (number of positive LNs/LNs examined) on overall survival (OS) in patients with advanced-stage favorable histology Wilms tumor (FHWT). METHODS The National Cancer Database (NCDB) was queried for patients with FHWT during 2004-2013. Demographic, clinical and OS data were abstracted for those who underwent surgical resection. Poisson regression was performed to analyze how factors influenced LN yield. Patients with positive LNs had LN density calculated and were further analyzed. RESULTS A total of 2340 patients met criteria, with a median age at diagnosis of 3 years (range 0-78 years). The median number of LNs examined was three (range 0-87). Lymph node yield was affected by age, race, insurance, tumor size, laterality, advanced stage, LN positivity, and institutional volume. A total of 390 (16.6%) patients had LN-positive disease. Median LN density for these LN-positive patients was 0.38 (range 0.02-1) (Summary Figure). Estimated 5-year OS was significantly improved for those with LN density ≤0.38 vs. >0.38 (94% vs. 84.6%, P = 0.012). In this population, on multivariate analysis, age and LN density were significant predictors of OS. DISCUSSION It is difficult to compile large numbers of cases in rare diseases like WT, and fortunately a large administrative database such as the NCDB can serve as a great resource. However, administrative data come with inherent limitations such as missing data and inability to account for a variety of factors that may influence LN yield and/or OS (specimen designation, pathologist experience, surgeon experience/volume, institutional Children's Oncology Group (COG) association, etc.). In this specific disease, the American Joint Committee on Cancer staging (captured by the NCDB) is different than the COG WT staging system that is used clinically, and the NCDB does not capture oncologic outcomes beyond OS. CONCLUSIONS In a review of the NCDB, various factors associated with LN yield and observed LN density were identified to be significantly associated with OS in patients with LN-positive FHWT. This reinforces the need for adequate LN sampling at the time of WT surgery, to maximize surgical disease control. It was proposed that LN density as a metric may allow for improved risk-stratification, and possibly allow for therapeutic reduction in a sub-set of patients with low LN density.
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Affiliation(s)
- A F Saltzman
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO, USA
| | - A Carrasco
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO, USA
| | - A Amini
- Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - J H Aldrink
- Division of Pediatric Surgery, Department of Surgery, The Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - R Dasgupta
- Division of Pediatric Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - K W Gow
- Division of Pediatric Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - R D Glick
- Division of Pediatric Surgery, Steven and Alexandra Cohen Medical Center of New York, New York, NY, USA
| | - P F Ehrlich
- Department of Surgery, C.S. Mott Children's Hospital, University of Michigan Medical School, Ann Arbor, MI, USA
| | - N G Cost
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, CO, USA.
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Fernandez CV, Mullen EA, Chi YY, Ehrlich PF, Perlman EJ, Kalapurakal JA, Khanna G, Paulino AC, Hamilton TE, Gow KW, Tochner Z, Hoffer FA, Withycombe JS, Shamberger RC, Kim Y, Geller JI, Anderson JR, Grundy PE, Dome JS. Outcome and Prognostic Factors in Stage III Favorable-Histology Wilms Tumor: A Report From the Children's Oncology Group Study AREN0532. J Clin Oncol 2017; 36:254-261. [PMID: 29211618 DOI: 10.1200/jco.2017.73.7999] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background The National Wilms Tumor Study (NWTS) approach to treating stage III favorable-histology Wilms tumor (FHWT) is Regimen DD4A (vincristine, dactinomycin, and doxorubicin) and radiation therapy. Further risk stratification is required to improve outcomes and reduce late effects. We evaluated clinical and biologic variables for patients with stage III FHWT without combined loss of heterozygosity (LOH) at chromosomes 1p and 16q treated in the Children's Oncology Group protocol AREN0532. Methods From October 2006 to August 2013, 588 prospectively treated, centrally reviewed patients with stage III FHWT were treated with Regimen DD4A and radiation therapy. Tumor LOH at 1p and 16q was determined by microsatellite analysis. Ineligible patients (n = 5) and those with combined LOH 1p/16q (n = 40) were excluded. Results A total of 535 patients with stage III disease were studied. Median follow-up was 5.2 years (range, 0.2 to 9.5). Four-year event-free survival (EFS) and overall survival estimates were 88% (95% CI, 85% to 91%) and 97% (95% CI, 95% to 99%), respectively. A total of 58 of 66 relapses occurred in the first 2 years, predominantly pulmonary (n = 36). Eighteen patients died, 14 secondary to disease. A better EFS was associated with negative lymph node status ( P < .01) and absence of LOH 1p or 16q ( P < .01), but not with gross residual disease or peritoneal implants. In contrast, the 4-year EFS was only 74% in patients with combined positive lymph node status and LOH 1p or 16q. A total of 123 patients (23%) had delayed nephrectomy. Submitted delayed nephrectomy histology showed anaplasia (n = 8; excluded from survival analysis); low risk/completely necrotic (n = 7; zero relapses), intermediate risk (n = 63; six relapses), and high-risk/blastemal type (n=7; five relapses). Conclusion Most patients with stage III FHWT had good EFS/overall survival with DD4A and radiation therapy. Combined lymph node and LOH status was highly predictive of EFS and should be considered as a potential prognostic marker for future trials.
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Affiliation(s)
- Conrad V Fernandez
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Elizabeth A Mullen
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Yueh-Yun Chi
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Peter F Ehrlich
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Elizabeth J Perlman
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - John A Kalapurakal
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Geetika Khanna
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Arnold C Paulino
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Thomas E Hamilton
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Kenneth W Gow
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Zelig Tochner
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Fredric A Hoffer
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Janice S Withycombe
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Robert C Shamberger
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Yeonil Kim
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - James I Geller
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - James R Anderson
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Paul E Grundy
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Jeffrey S Dome
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
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Pan Z, He H, Tang L, Bu Q, Cheng H, Wang A, Lyu J, You H. Loss of heterozygosity on chromosome 16q increases relapse risk in Wilms' tumor: a meta-analysis. Oncotarget 2017; 8:66467-66475. [PMID: 29029528 PMCID: PMC5630428 DOI: 10.18632/oncotarget.20191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/06/2017] [Indexed: 02/05/2023] Open
Abstract
Wilms’ tumor (WT) is the most frequent malignant renal tumor in children. The survival rate is lower in patients with recurrence, and the factors that influence relapse in WT are not fully understood. Loss of heterozygosity on chromosome 16q (LOH 16q) has been reported to be associated with the relapse in WT, but this remains controversial. We performed a meta-analysis to clarify this. PUBMED, EMBASE, and the Cochrane Library were searched up to March 17, 2017. Ten studies involving 3385 patients were ultimately included in the meta-analysis. The meta-analysis showed that LOH 16q was significantly associated with the relapse in WT (relative risk [RR] = 1.74, 95% confidence interval [CI] = 1.43–2.13, P < 0.00001; hazard ratio [HR] = 1.76, 95% CI = 1.38–2.24, P < 0.00001). No significant heterogeneity among studies or publication bias was found. Sensitivity analysis showed omitting one study in each turn could not change the results. Subgroup analysis based on two studies indicated LOH 16q was more effective on elevated replase risk in patients with favorable-histology WT (RR = 2.52, 95% CI = 1.68–3.78, P < 0.00001; HR = 2.99, 95% CI = 1.84–4.88, P < 0.0001) but further work are needed to confirm this. These findings confirm that LOH 16q increased the relapse risk in WT, but more studies are required to further assess the association between LOH 16q and WT relapse among different subgroups.
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Affiliation(s)
- Zhenyu Pan
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China.,Department of Pharmacy, Xi'an Jiaotong University Affiliated Children's Hospital, Xi'an, Shaanxi, 710003, China
| | - Hairong He
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Lina Tang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Qingting Bu
- Department of Genetics, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, 710061, China
| | - Hua Cheng
- Department of Pharmacy, Xi'an Jiaotong University Affiliated Children's Hospital, Xi'an, Shaanxi, 710003, China
| | - Anmin Wang
- Department of Pharmacy, Xi'an Jiaotong University Affiliated Children's Hospital, Xi'an, Shaanxi, 710003, China
| | - Jun Lyu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Haisheng You
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
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Carrasco A, Caldwell BT, Cost CR, Greffe BS, Garrington TP, Bruny JL, Black JO, Cost NG. Reliability of intraoperative frozen section for the diagnosis of renal tumors suspicious for malignancy in children and adolescents. Pediatr Blood Cancer 2017; 64:10.1002/pbc.26458. [PMID: 28097784 PMCID: PMC5509572 DOI: 10.1002/pbc.26458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 12/14/2016] [Accepted: 12/25/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND The ability of intraoperative frozen section (IFS) to reliably diagnose renal tumors in children and adolescents is largely unknown. The objective of our study is to evaluate the ability of IFS to establish a histologic diagnosis for renal tumors in this population. METHODS We reviewed our experience with patients who underwent IFS at the time of surgery for a renal tumor suspicious for malignancy from 2005 to 2015. The IFS was compared to the final pathology (FP). Data on concordance and reliability were analyzed. RESULTS One hundred thirty patients underwent surgical interventions for a renal tumor suspicious for malignancy, and 32 (25%) patients underwent IFS. Median turnaround time for IFS was 20 min (range 13-44). The histologic IFS diagnosis correlated with FP in 26 (81.2%) cases was discrepant in three (9.4%) cases, and IFS was deferred to FP in three (9.4%) cases (kappa 0.71, 95% confidence interval [CI]: 0.52-0.899, P < 0.001). The IFS correctly distinguished between Wilms tumor and non-Wilms tumor in 30 (94%) cases (kappa 0.874, 95% CI: 0.705-1, P < 0.001). A total of 17 of 19 (89.5%) Wilms tumors were correctly diagnosed by IFS, yielding a sensitivity of 0.89 (95% CI: 0.67-0.99) and a specificity of 1 (95% CI: 0.75-1). CONCLUSION IFS is a reliable tool to establish a histologic diagnosis and to differentiate between Wilms and non-Wilms tumors in children and adolescents with renal tumors. The use of IFS should be encouraged in cases in which obtaining a diagnosis will provide guidance for important "real-time" medical decision making, specifically additional adjunctive surgical procedures.
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Affiliation(s)
- Alonso Carrasco
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian T. Caldwell
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, Colorado
| | - Carrye R. Cost
- Department of Pediatrics, Division of Hematology and Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian S. Greffe
- Department of Pediatrics, Division of Hematology and Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Timothy P. Garrington
- Department of Pediatrics, Division of Hematology and Oncology, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer L. Bruny
- Department of Surgery, Division of Pediatric Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Jennifer O. Black
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado
| | - Nicholas G. Cost
- Department of Surgery, Division of Urology, University of Colorado School of Medicine, Aurora, Colorado
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Affiliation(s)
- Brian T Caldwell
- Department of Pediatric Urology, Children's Hospital Colorado, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA; Division of Urology, Department of Surgery, University of Colorado School of Medicine, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA.
| | - Duncan T Wilcox
- Department of Pediatric Urology, Children's Hospital Colorado, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA; Division of Urology, Department of Surgery, University of Colorado School of Medicine, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA
| | - Nicholas G Cost
- Department of Pediatric Urology, Children's Hospital Colorado, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA; Division of Urology, Department of Surgery, University of Colorado School of Medicine, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA
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Results of the Third AIEOP Cooperative Protocol on Wilms Tumor (TW2003) and Related Considerations. J Urol 2017; 198:1138-1145. [PMID: 28655531 DOI: 10.1016/j.juro.2017.06.081] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE TW2003, the third Italian prospective study on Wilms tumor, aimed to improve survival in patients with stage III-IV tumors, de-escalate therapy for stage I-II nonanaplastic tumors, refine the risk stratification of therapy, and develop a national infrastructure for biobanking and central pathology review. MATERIALS AND METHODS TW2003 recruited children 18 years old or younger with primary intrarenal tumors. Local physicians chose nephrectomy with or without preoperative chemotherapy as the initial treatment based on the risk of unsafe and/or incomplete immediate surgery. The main drivers for adjuvant therapy were tumor stage and diffuse anaplasia. A new risk stratification schema was investigated, incorporating patient age, reason for stage III designation and completeness of lung nodule response in stage IV disease. RESULTS We report on 453 patients with unilateral Wilms tumor. Preoperative chemotherapy was administered to 42% of patients. The 5-year event-free survival and overall survival rates were 89.1% (95% CI 83.6-94.9) and 97.0% (93.7-100) for stage I; 85.1% (79.6-91.1) and 94.0% (90.1-98.1) for stage II (160); 82.7% (75.3-90.8) and 90.9% (85.0-97.1) for stage III (101); and 72.1% (61.9-84.0) and 82.5% (73.1-93.1) for stage IV (69), respectively. On multivariable analysis only anaplasia was significant for event-free survival (HR 2.68, 95% CI 1.48-4.86, p=0.001; bias corrected c-index 0.580) and overall survival (HR 5.29, 95% CI 2.52-11.12, p <0.001; bias corrected c-index 0.697). CONCLUSIONS The survival rates achieved and the proposed risk stratification schema provide a basis for future comparisons of Wilms tumor treatment burden and patient outcome.
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Abstract
Despite an impressive increase in survival rate over the past decades, there is still a need to improve the survival of specific subgroups of Wilms tumor (anaplastic, metastatic, and bilateral) and to decrease the late effects of treatment in terms of renal function and heart toxicity. We aim to explore new areas of improvement, from diagnosis to treatment: in the field of radiology the increased use of MRI and exploration of its diffusion-weighted imaging capabilities to predict WT histology at diagnosis and for preoperative assessment; in biology the emergence of new biomarkers that could be integrated into the decision-making process; and surgical techniques with more accurate indication of nephron-sparing surgery that is no longer reserved for bilateral WT and the minimally invasive approach. The long-term outcome of patients with WT should thus be a strong indicator of the improvement in adapting and personalizing the treatment to each individual.
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Affiliation(s)
- Sabine Irtan
- Department of Pediatric Surgery, APHP Hôpital Armand Trousseau, Research Unit St Antoine Inserm UMRS.938, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Peter F Ehrlich
- Pediatric Surgery Department, C.S. Mott Children׳s Hospital, University of Michigan, Ann Arbor, Michigan
| | - Kathy Pritchard-Jones
- Cancer Section, Developmental Biology & Cancer Programme, Institute of Child Health, University College London, 30 Guilford St, London WC1N 1EH, UK.
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Gratias EJ, Dome JS, Jennings LJ, Chi YY, Tian J, Anderson J, Grundy P, Mullen EA, Geller JI, Fernandez CV, Perlman EJ. Association of Chromosome 1q Gain With Inferior Survival in Favorable-Histology Wilms Tumor: A Report From the Children's Oncology Group. J Clin Oncol 2016; 34:3189-94. [PMID: 27400937 PMCID: PMC5012705 DOI: 10.1200/jco.2015.66.1140] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The goal of this study was to analyze the association of copy number gain of 1q in favorable-histology Wilms tumors (FHWTs) with event-free survival (EFS) and overall survival (OS) within each tumor stage and with 1p and 16q copy number loss and/or loss of heterozygosity. METHODS Unilateral FHWTs from 1,114 patients enrolled in National Wilms Tumor Study-5 that were informative for 1p and 16q microsatellite markers (previously determined) and informative for 1q gain, 1p loss, and 16q loss using multiplex ligation-dependent probe amplification were analyzed. RESULTS Eight-year EFS was 86% (95% CI, 84% to 88%) for the entire cohort. Of 1,114 patients, 317 tumors (28%) displayed 1q gain. Eight-year EFS was 77% for those with 1q gain and 90% for those lacking 1q gain (P < .001). Eight-year OS was 88% for those with 1q gain and 96% for those lacking 1q gain (P < .001). Within each disease stage, 1q gain was associated with inferior EFS (stage I, 85% v 95%; P = .0052; stage II, 81% v 87%; P = .0775; stage III, 79% v 89%; P = .01; stage IV, 64% v 91%; P = .001). OS was significantly inferior in patients with stage I (P < .0015) and stage IV disease (P = .011). With multivariable analysis, 1q gain was associated with an increased relative risk of relapse of 2.4 (P < .001), whereas 1p loss was not, despite significance on univariable analysis. CONCLUSION Gain of 1q is associated with inferior survival in unilateral FHWTs and may be used to guide risk stratification in future studies.
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Affiliation(s)
- Eric J Gratias
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Jeffrey S Dome
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Lawrence J Jennings
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Yueh-Yun Chi
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Jing Tian
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - James Anderson
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Paul Grundy
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Elizabeth A Mullen
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - James I Geller
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Conrad V Fernandez
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Elizabeth J Perlman
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH.
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