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Song YH, Li WL, Yang Z, Gao Y, Feng ZP. Loss of heterozygosity for chromosomes 16q in Wilms tumors predicts outcomes: A meta-analysis. World J Gastrointest Oncol 2024; 16:2159-2167. [PMID: 38764827 PMCID: PMC11099455 DOI: 10.4251/wjgo.v16.i5.2159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/06/2024] [Accepted: 03/12/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND The research findings suggest that the prognosis of children with Wilms tumor (WT) is affected by various factors. Some scholars have indicated that loss of heterozygosity (LOH) on chromosome 16q is associated with a poor prognosis in patients with WT. AIM To further elucidate this relationship, we conducted a meta-analysis. METHODS This meta-analysis was registered in INPLASY (INPLASY2023100060). We systematically searched databases including Embase, PubMed, Web of Science, Cochrane, and Google Scholar up to May 31, 2020, for randomized trials reporting any intrapartum fetal surveillance approach. The meta-analysis was performed within a frequentist framework, and the quality and network inconsistency of trials were assessed. Odds ratios and 95%CIs were calculated to report the relationship between event-free survival and 16q LOH in patients with WT. RESULTS Eleven cohort studies were included in this meta-analysis to estimate the relationship between event-free survival and 16q LOH in patients with WT (I2 = 25%, P < 0.001). As expected, 16q LOH can serve as an effective predictor of event-free survival in patients with WT (risk ratio = 1.95, 95%CI: 1.52-2.49, P < 0.001). CONCLUSION In pediatric patients with WT, there exists a partial correlation between 16q LOH and an unfavorable treatment prognosis. Clinical detection of 16q chromosome LOH warrants increased attention to the patient's prognosis.
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Affiliation(s)
- Yuan-Hua Song
- Department of Oncology, Kunming Children's Hospital, Kunming 650103, Yunnan Province, China
| | - Wen-Ling Li
- Department of Oncology, Kunming Children's Hospital, Kunming 650103, Yunnan Province, China
| | - Zhen Yang
- Department of Oncology, Kunming Children's Hospital, Kunming 650103, Yunnan Province, China
| | - Yan Gao
- Department of Oncology, Kunming Children's Hospital, Kunming 650103, Yunnan Province, China
| | - Zhi-Ping Feng
- Department of Nuclear Medicine, The Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital), Kunming 650118, Yunnan Province, China
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2
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Benedetti DJ, Varela CR, Renfro LA, Tornwall B, Dix DB, Ehrlich PF, Glick RD, Kalapurakal J, Perlman E, Gratias E, Seibel NL, Geller JI, Khanna G, Malogolowkin M, Grundy P, Fernandez CV, Dome JS, Mullen EA. Treatment of children with favorable histology Wilms tumor with extrapulmonary metastases: A report from the COG studies AREN0533 and AREN03B2 and NWTSG study NWTS-5. Cancer 2024; 130:947-961. [PMID: 37933882 PMCID: PMC10922062 DOI: 10.1002/cncr.35099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/02/2023] [Accepted: 09/21/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Patients with stage IV favorable histology Wilms tumor (FHWT) with extrapulmonary metastases (EPM) constitute a small subset of patients with FHWT. Because of their rarity and heterogeneity, optimal FHWT treatment is not well understood. Children's Oncology Group protocol AREN0533 assigned patients with FHWT and EPM to intensified chemotherapy, regimen M, after initial DD-4A chemotherapy. To improve understanding of prognostic factors and best therapies, experiences of patients with EPM on AREN0533, as well as on protocols AREN03B2 and NWTS-5, were reviewed. METHODS Combined outcomes for patients with EPM from NWTS-5, AREN0533, and AREN03B2 were determined. Those treated on AREN0533 were compared with those treated on NWTS-5. Prognostic factors were explored in the pooled cohort. RESULTS Forty-seven patients with FHWT with EPM enrolled on AREN0533, 37 enrolled on NWTS-5, and 64 were followed only on AREN03B2. The pooled cohort of all 148 patients demonstrated a 4-year event-free survival (EFS) of 77.3% (95% CI, 70.8-84.4) and 4-year overall survival of 88.9% (95% CI, 83.9-94.2). Four-year EFS of patients with EPM treated on AREN0533 was 76.0% (95% CI, 64.6-89.4) vs 64.9% (95% CI, 51.7-82.2) on NWTS-5; hazard ratio, 0.64, p = .26; no difference in overall survival was observed. Increasing linear age and slow incomplete lung response were associated with worse EFS in a pooled cohort. CONCLUSIONS Outcomes for patients with EPM are among the lowest for children with FHWT. Further trials with standardized surgical and radiation treatment to metastatic sites, and prospectively collected biologic and treatment details are needed. CLINICAL TRIAL REGISTRATION Clinical Trials.gov identifiers: NCT00379340, NCT00898365, and NCT00002611.
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Affiliation(s)
- Daniel J Benedetti
- Division of Hematology/Oncology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Carly R Varela
- Division of Hematology and Oncology, Pediatric Specialists of Virginia, Inova Fairfax Hospital, Fairfax, Virginia, USA
- Janssen Research and Development, Spring House, Pennsylvania, USA
- Division of Oncology, Children's National Hospital and the George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Lindsay A Renfro
- Division of Biostatistics, University of Southern California, Los Angeles, California, USA
- Children's Oncology Group, Los Angeles, California, USA
| | | | - David B Dix
- Division of Oncology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Peter F Ehrlich
- Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Richard D Glick
- Division of Pediatric Surgery, Zucker School of Medicine at Hofstra/Northwell, Cohen Children's Medical Center, New Hyde Park, New York, USA
| | - John Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois, USA
| | - Elizabeth Perlman
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Eric Gratias
- eviCore Healthcare, Bluffton, South Carolina, USA
| | - Nita L Seibel
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Geetika Khanna
- Department of Radiology & Imaging Sciences, Emory University, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Marcio Malogolowkin
- Division of Pediatric Hematology-Oncology, UC Davis Comprehensive Cancer Center, Sacramento, California, USA
| | - Paul Grundy
- Division of Immunology, Hematology, Oncology, Palliative Care and Environmental Interactions, University of Alberta, Edmonton, Alberta, Canada
| | - Conrad V Fernandez
- Division of Pediatric Hematology/Oncology, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey S Dome
- Division of Oncology, Children's National Hospital and the George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Elizabeth A Mullen
- Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, Massachusetts, USA
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3
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Perotti D, Williams RD, Wegert J, Brzezinski J, Maschietto M, Ciceri S, Gisselsson D, Gadd S, Walz AL, Furtwaengler R, Drost J, Al-Saadi R, Evageliou N, Gooskens SL, Hong AL, Murphy AJ, Ortiz MV, O'Sullivan MJ, Mullen EA, van den Heuvel-Eibrink MM, Fernandez CV, Graf N, Grundy PE, Geller JI, Dome JS, Perlman EJ, Gessler M, Huff V, Pritchard-Jones K. Hallmark discoveries in the biology of Wilms tumour. Nat Rev Urol 2024; 21:158-180. [PMID: 37848532 DOI: 10.1038/s41585-023-00824-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/19/2023]
Abstract
The modern study of Wilms tumour was prompted nearly 50 years ago, when Alfred Knudson proposed the 'two-hit' model of tumour development. Since then, the efforts of researchers worldwide have substantially expanded our knowledge of Wilms tumour biology, including major advances in genetics - from cloning the first Wilms tumour gene to high-throughput studies that have revealed the genetic landscape of this tumour. These discoveries improve understanding of the embryonal origin of Wilms tumour, familial occurrences and associated syndromic conditions. Many efforts have been made to find and clinically apply prognostic biomarkers to Wilms tumour, for which outcomes are generally favourable, but treatment of some affected individuals remains challenging. Challenges are also posed by the intratumoural heterogeneity of biomarkers. Furthermore, preclinical models of Wilms tumour, from cell lines to organoid cultures, have evolved. Despite these many achievements, much still remains to be discovered: further molecular understanding of relapse in Wilms tumour and of the multiple origins of bilateral Wilms tumour are two examples of areas under active investigation. International collaboration, especially when large tumour series are required to obtain robust data, will help to answer some of the remaining unresolved questions.
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Affiliation(s)
- Daniela Perotti
- Predictive Medicine: Molecular Bases of Genetic Risk, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Richard D Williams
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Section of Genetics and Genomics, Faculty of Medicine, Imperial College London, London, UK
| | - Jenny Wegert
- Theodor-Boveri-Institute/Biocenter, Developmental Biochemistry, Wuerzburg University, Wuerzburg, Germany
| | - Jack Brzezinski
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Mariana Maschietto
- Research Center, Boldrini Children's Hospital, Campinas, São Paulo, Brazil
| | - Sara Ciceri
- Predictive Medicine: Molecular Bases of Genetic Risk, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - David Gisselsson
- Cancer Cell Evolution Unit, Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Genetics, Pathology and Molecular Diagnostics, Office of Medical Services, Skåne, Sweden
| | - Samantha Gadd
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Amy L Walz
- Division of Hematology,Oncology, Neuro-Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Rhoikos Furtwaengler
- Division of Pediatric Oncology and Hematology, Department of Pediatrics, Inselspital Bern University, Bern, Switzerland
| | - Jarno Drost
- Princess Máxima Center for Paediatric Oncology, Utrecht, Netherlands
- Oncode Institute, Utrecht, Netherlands
| | - Reem Al-Saadi
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - Nicholas Evageliou
- Divisions of Hematology and Oncology, Children's Hospital of Philadelphia, CHOP Specialty Care Center, Vorhees, NJ, USA
| | - Saskia L Gooskens
- Princess Máxima Center for Paediatric Oncology, Utrecht, Netherlands
| | - Andrew L Hong
- Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michael V Ortiz
- Department of Paediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maureen J O'Sullivan
- Histology Laboratory, Children's Health Ireland at Crumlin, Dublin, Ireland
- Trinity Translational Medicine Institute, Trinity College, Dublin, Ireland
| | - Elizabeth A Mullen
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | | | - Conrad V Fernandez
- Division of Paediatric Hematology Oncology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Norbert Graf
- Department of Paediatric Oncology and Hematology, Saarland University Hospital, Homburg, Germany
| | - Paul E Grundy
- Department of Paediatrics Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Jeffrey S Dome
- Division of Oncology, Center for Cancer and Blood Disorders, Children's National Hospital and the Department of Paediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Elizabeth J Perlman
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Manfred Gessler
- Theodor-Boveri-Institute/Biocenter, Developmental Biochemistry, Wuerzburg University, Wuerzburg, Germany
- Comprehensive Cancer Center Mainfranken, Wuerzburg, Germany
| | - Vicki Huff
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathy Pritchard-Jones
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
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Geller JI, Hong AL, Vallance KL, Evageliou N, Aldrink JH, Cost NG, Treece AL, Renfro LA, Mullen EA. Children's Oncology Group's 2023 blueprint for research: Renal tumors. Pediatr Blood Cancer 2023; 70 Suppl 6:e30586. [PMID: 37477907 PMCID: PMC10529605 DOI: 10.1002/pbc.30586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
Every year, approximately 600 infants, children, and adolescents are diagnosed with renal cancer in the United States. In addition to Wilms tumor (WT), which accounts for about 80% of all pediatric renal cancers, clear cell sarcoma of the kidney, renal cell carcinoma, malignant rhabdoid tumor, as well as more rare cancers (other sarcomas, rare carcinomas, lymphoma) and benign tumors can originate within the kidney. WT itself can be divided into favorable histology (FHWT), with a 5-year overall survival (OS) exceeding 90%, and anaplastic histology, with 4-year OS of 73.7%. Outcomes of the other pediatric renal cancers include clear cell sarcoma (5-year OS: 90%), malignant rhabdoid tumor (5-year OS: 10% for stages 3 and 4), and renal cell carcinoma (4-year OS: 84.8%). Recent clinical trials have identified novel biological prognostic markers for FHWT, and a series of Children's Oncology Group (COG) trials have demonstrated improving outcomes with therapy modification, and opportunities for further care refinement.
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Affiliation(s)
- James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Andrew L Hong
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kelly L Vallance
- Hematology and Oncology, Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Nick Evageliou
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Nicholas G Cost
- Department of Surgery, Division of Urology and the Surgical Oncology Program at Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amy L Treece
- Department of Pathology and Laboratory Medicine, Children's of Alabama, Birmingham, Alabama, USA
| | | | - Elizabeth A Mullen
- Dana-Farber/Boston Children's Blood Disorders and Cancer Center, Boston, Massachusetts, USA
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5
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Tanaka T, Goto Y, Horie M, Masuda K, Shinno Y, Matsumoto Y, Okuma Y, Yoshida T, Horinouchi H, Motoi N, Yatabe Y, Watanabe S, Yamamoto N, Ohe Y. Whole Exome Sequencing of Thymoma Patients Exhibiting Exceptional Responses to Pemetrexed Monotherapy. Cancers (Basel) 2023; 15:4018. [PMID: 37627046 PMCID: PMC10452868 DOI: 10.3390/cancers15164018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Pemetrexed is used for the chemotherapy of advanced thymoma. Exceptional responses of thymoma to pemetrexed treatment are not frequently observed. The underlying genetic mechanism of the exceptional responses remains unclear. We used whole-exome sequencing to explore the specific genomic aberrations that lead to an extreme and durable response. METHODS Whole-exome sequencing using NovaSeq6000 (150 bp paired-end sequencing) was performed on nine formalin-fixed paraffin-embedded tissues from patients with advanced thymomas treated with pemetrexed (two exceptional responders and seven typical responders). RESULTS We identified 284 somatic single-nucleotide variants (SNVs; 272 missense, 8 missense/splice-site, 3 stop-gain, and 1 stop-gain/splice-site), 34 insertions and deletions (Indels; 33 frameshift and one splice region), and 21 copy number variations (CNVs; 15 gains and six losses). No difference in the number of SNVs variants and distribution of deleterious Indels was observed between the exceptional and typical responders. Interestingly, arm-level chromosomal CNVs (15 gains and six losses) were detected in four patients, including an exceptional responder. The highest number of arm-level CNVs was observed in an exceptional responder. CONCLUSION Exceptional responders to pemetrexed for metastatic thymomas may be characterized by arm-level CNVs. Further, whole-genome and RNA sequencing studies should be performed.
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Affiliation(s)
- Tomohiro Tanaka
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Medical & Dental Hospital, Niigata 951-8510, Japan
| | - Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Masafumi Horie
- Department of Molecular and Cellular Pathology, Kanazawa University, Kanazawa 920-8640, Japan
| | - Ken Masuda
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Yuki Shinno
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Yuji Matsumoto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Yusuke Okuma
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Tatsuya Yoshida
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Hidehito Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Noriko Motoi
- Department of Pathology, Saitama Cancer Center, Saitama 362-0806, Japan
| | - Yasushi Yatabe
- Department of Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Shunichi Watanabe
- Department of Thoracic Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Noboru Yamamoto
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, Tokyo 104-0045, Japan
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6
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Zheng H, Liu J, Pan X, Cui X. Biomarkers for patients with Wilms tumor: a review. Front Oncol 2023; 13:1137346. [PMID: 37554168 PMCID: PMC10405734 DOI: 10.3389/fonc.2023.1137346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/27/2023] [Indexed: 08/10/2023] Open
Abstract
Wilms tumor, originating from aberrant fetal nephrogenesis, is the most common renal malignancy in childhood. The overall survival of children is approximately 90%. Although existing risk-stratification systems are helpful in identifying patients with poor prognosis, the recurrence rate of Wilms tumors remains as high as 15%. To resolve this clinical problem, diverse studies on the occurrence and progression of the disease have been conducted, and the results are encouraging. A series of molecular biomarkers have been identified with further studies on the mechanism of tumorigenesis. Some of these show prognostic value and have been introduced into clinical practice. Identification of these biomarkers can supplement the existing risk-stratification systems. In the future, more biomarkers will be discovered, and more studies are required to validate their roles in improving the detection rate of occurrence or recurrence of Wilms tumor and to enhance clinical outcomes.
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Affiliation(s)
| | | | - Xiuwu Pan
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xingang Cui
- Department of Urology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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7
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Ruas JS, Silva FLT, Euzébio MF, Biazon TO, Daiggi CMM, Nava D, Franco MT, Cardinalli IA, Cassone AE, Pereira LH, Seidinger AL, Maschietto M, Jotta PY. Somatic Copy Number Alteration in Circulating Tumor DNA for Monitoring of Pediatric Patients with Cancer. Biomedicines 2023; 11:biomedicines11041082. [PMID: 37189699 DOI: 10.3390/biomedicines11041082] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 04/07/2023] Open
Abstract
Pediatric tumors share few recurrent mutations and are instead characterized by copy number alterations (CNAs). The cell-free DNA (cfDNA) is a prominent source for the detection of cancer-specific biomarkers in plasma. We profiled CNAs in the tumor tissues for further evaluation of alterations in 1q, MYCN and 17p in the circulating tumor DNA (ctDNA) in the peripheral blood at diagnosis and follow-up using digital PCR. We report that among the different kinds of tumors (neuroblastoma, Wilms tumor, Ewing sarcoma, rhabdomyosarcoma, leiomyosarcoma, osteosarcoma and benign teratoma), neuroblastoma presented the greatest amount of cfDNA, in correlation with tumor volume. Considering all tumors, cfDNA levels correlated with tumor stage, metastasis at diagnosis and metastasis developed during therapy. In the tumor tissue, at least one CNA (at CRABP2, TP53, surrogate markers for 1q and 17p, respectively, and MYCN) was observed in 89% of patients. At diagnosis, CNAs levels were concordant between tumor and ctDNA in 56% of the cases, and for the remaining 44%, 91.4% of the CNAs were present only in cfDNA and 8.6% only in the tumor. Within the cfDNA, we observed that 46% and 23% of the patients had MYCN and 1q gain, respectively. The use of specific CNAs as targets for liquid biopsy in pediatric patients with cancer can improve diagnosis and should be considered for monitoring of the disease response.
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Affiliation(s)
| | - Felipe Luz Torres Silva
- Research Center, Boldrini Children’s Hospital, Campinas 13083-884, SP, Brazil
- Genetics and Molecular Biology, Institute of Biology, State University of Campinas, Campinas 13083-862, SP, Brazil
| | - Mayara Ferreira Euzébio
- Research Center, Boldrini Children’s Hospital, Campinas 13083-884, SP, Brazil
- Genetics and Molecular Biology, Institute of Biology, State University of Campinas, Campinas 13083-862, SP, Brazil
| | - Tássia Oliveira Biazon
- Research Center, Boldrini Children’s Hospital, Campinas 13083-884, SP, Brazil
- Genetics and Molecular Biology, Institute of Biology, State University of Campinas, Campinas 13083-862, SP, Brazil
| | | | - Daniel Nava
- Boldrini Children’s Hospital, Campinas 13083-210, SP, Brazil
| | | | | | | | | | - Ana Luiza Seidinger
- Research Center, Boldrini Children’s Hospital, Campinas 13083-884, SP, Brazil
| | - Mariana Maschietto
- Research Center, Boldrini Children’s Hospital, Campinas 13083-884, SP, Brazil
- Genetics and Molecular Biology, Institute of Biology, State University of Campinas, Campinas 13083-862, SP, Brazil
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8
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Walz AL, Maschietto M, Crompton B, Evageliou N, Dix D, Tytgat G, Gessler M, Gisselsson D, Daw NC, Wegert J. Tumor biology, biomarkers, and liquid biopsy in pediatric renal tumors. Pediatr Blood Cancer 2023; 70 Suppl 2:e30130. [PMID: 36592003 DOI: 10.1002/pbc.30130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/10/2022] [Accepted: 11/12/2022] [Indexed: 01/03/2023]
Abstract
The expansion of knowledge regarding driver mutations for Wilms tumor (WT) and malignant rhabdoid tumor of the kidney (MRT) and various translocations for other pediatric renal tumors opens up new possibilities for diagnosis and treatment. In addition, there are growing data surrounding prognostic factors that can be used to stratify WT treatment to improve outcomes. Here, we review the molecular landscape of WT and other pediatric renal tumors as well as WT prognostic factors. We also review incorporation of circulating tumor DNA/liquid biopsies to leverage this molecular landscape, with potential use in the future for distinguishing renal tumors at the time of diagnosis and elucidating intratumor heterogeneity, which is not well evaluated with standard biopsies. Incorporation of liquid biopsies will require longitudinal collection of multiple biospecimens. Further preclinical research, identification and validation of biomarkers, molecular studies, and data sharing among investigators are crucial to inform therapeutic strategies that improve patient outcomes.
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Affiliation(s)
- Amy L Walz
- Division of Hematology, Oncology, Neuro-Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Mariana Maschietto
- Research Center, Boldrini Children's Hospital, Campinas, São Paulo, Brazil
| | - Brian Crompton
- Department of Pediatric Oncology, Dana-Farber/Harvard Cancer Center, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nicholas Evageliou
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - David Dix
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Godelieve Tytgat
- Princess Máxima Center for Pediatric Oncology, CS Utrecht, The Netherlands
| | - Manfred Gessler
- Comprehensive Cancer Center Mainfranken, Wuerzburg, Germany.,Theodor-Boveri-Institute/Biocenter, Developmental Biochemistry, University of Wuerzburg, Wuerzburg, Germany
| | - David Gisselsson
- Cancer Cell Evolution Unit, Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Najat C Daw
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Jenny Wegert
- Theodor-Boveri-Institute/Biocenter, Developmental Biochemistry, University of Wuerzburg, Wuerzburg, Germany
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9
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van Belzen IAEM, van Tuil M, Badloe S, Strengman E, Janse A, Verwiel ETP, van der Leest DFM, de Vos S, Baker-Hernandez J, Groenendijk A, de Krijger R, Kerstens HHD, Drost J, van den Heuvel-Eibrink MM, Tops BBJ, Holstege FCP, Kemmeren P, Hehir-Kwa JY. Molecular Characterization Reveals Subclasses of 1q Gain in Intermediate Risk Wilms Tumors. Cancers (Basel) 2022; 14:cancers14194872. [PMID: 36230794 PMCID: PMC9564324 DOI: 10.3390/cancers14194872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Chromosomal alterations and other structural variants have been recurrently identified in Wilms tumors (WT) and are promising biomarkers for risk stratification. Chromosome 1q gain occurs in one in three WTs and is associated with poor prognosis, but its impact on tumor biology remains unknown. Here, we investigated the mutational mechanisms and functional effects of chromosomal alterations in WTs, and in particular 1q gain. We identified subgroups of tumors with typical activated biological processes: muscle differentiation, immune system, kidney development and proliferation. Combining these subgroups with genomic data showed that tumors with 1q gain occur in all subgroups and can be associated with different functional effects. Also, 1q gain tumors differ in mutational mechanisms and co-occurring tumor-specific mutations. In conclusion, we identified subgroups of tumors with 1q gain and therefore propose that incorporating expression data in risk stratification could improve the clinical utility of 1q gain. Abstract Chromosomal alterations have recurrently been identified in Wilms tumors (WTs) and some are associated with poor prognosis. Gain of 1q (1q+) is of special interest given its high prevalence and is currently actively studied for its prognostic value. However, the underlying mutational mechanisms and functional effects remain unknown. In a national unbiased cohort of 30 primary WTs, we integrated somatic SNVs, CNs and SVs with expression data and distinguished four clusters characterized by affected biological processes: muscle differentiation, immune system, kidney development and proliferation. Combined genome-wide CN and SV profiles showed that tumors profoundly differ in both their types of 1q+ and genomic stability and can be grouped into WTs with co-occurring 1p−/1q+, multiple chromosomal gains or CN neutral tumors. We identified 1q+ in eight tumors that differ in mutational mechanisms, subsequent rearrangements and genomic contexts. Moreover, 1q+ tumors were present in all four expression clusters reflecting activation of various biological processes, and individual tumors overexpress different genes on 1q. In conclusion, by integrating CNs, SVs and gene expression, we identified subgroups of 1q+ tumors reflecting differences in the functional effect of 1q gain, indicating that expression data is likely needed for further risk stratification of 1q+ WTs.
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Affiliation(s)
| | - Marc van Tuil
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Shashi Badloe
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Eric Strengman
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Alex Janse
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | | | | | - Sam de Vos
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | | | - Alissa Groenendijk
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | - Ronald de Krijger
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | | | - Jarno Drost
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Oncode Institute, 3521 AL Utrecht, The Netherlands
| | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- UMCU-Wilhelmina Children’s Hospital—Child Health, 3584 EA Utrecht, The Netherlands
| | - Bastiaan B. J. Tops
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
| | | | - Patrick Kemmeren
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Center for Molecular Medicine, UMC Utrecht and Utrecht University, 3584 CX Utrecht, The Netherlands
- Correspondence: (P.K.); (J.Y.H.-K.)
| | - Jayne Y. Hehir-Kwa
- Princess Máxima Center for Pediatric Oncology, 3584 CS Utrecht, The Netherlands
- Correspondence: (P.K.); (J.Y.H.-K.)
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10
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Tian XM, Xiang B, Jin LM, Mi T, Wang JK, Zhanghuang C, Zhang ZX, Chen ML, Shi QL, Liu F, Lin T, Wei GH. Immune-related gene signature associates with immune landscape and predicts prognosis accurately in patients with Wilms tumour. Front Immunol 2022; 13:920666. [PMID: 36172369 PMCID: PMC9510599 DOI: 10.3389/fimmu.2022.920666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Wilms tumour (WT) is the most common kidney malignancy in children. Chemoresistance is the leading cause of tumour recurrence and poses a substantial therapeutic challenge. Increasing evidence has underscored the role of the tumour immune microenvironment (TIM) in cancers and the potential for immunotherapy to improve prognosis. There remain no reliable molecular markers for reflecting the immune landscape and predicting patient survival in WT. Here, we examine differences in gene expression by high-throughput RNA sequencing, focused on differentially expressed immune-related genes (IRGs) based on the ImmPort database. Via univariate Cox regression analysis and Lasso-penalized Cox regression analysis, IRGs were screened out to establish an immune signature. Kaplan-Meier curves, time-related ROC analysis, univariate and multivariate Cox regression studies, and nomograms were used to evaluate the accuracy and prognostic significance of this signature. Furthermore, we found that the immune signature could reflect the immune status and the immune cell infiltration character played in the tumour microenvironment (TME) and showed significant association with immune checkpoint molecules, suggesting that the poor outcome may be partially explained by its immunosuppressive TME. Remarkably, TIDE, a computational method to model tumour immune evasion mechanisms, showed that this signature holds great potential for predicting immunotherapy responses in the TARGET-wt cohort. To decipher the underlying mechanism, GSEA was applied to explore enriched pathways and biological processes associated with immunophenotyping and Connectivity map (CMap) along with DeSigN analysis for drug exploration. Finally, four candidate immune genes were selected, and their expression levels in WT cell lines were monitored via qRT-PCR. Meanwhile, we validated the function of a critical gene, NRP2. Taken together, we established a novel immune signature that may serve as an effective prognostic signature and predictive biomarker for immunotherapy response in WT patients. This study may give light on therapeutic strategies for WT patients from an immunological viewpoint.
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Affiliation(s)
- Xiao-Mao Tian
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Bin Xiang
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Li-Ming Jin
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Tao Mi
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Jin-Kui Wang
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Chenghao Zhanghuang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Zhao-Xia Zhang
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Mei-Ling Chen
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Qin-Lin Shi
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
| | - Feng Liu
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
- *Correspondence: Feng Liu,
| | - Tao Lin
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Guang-Hui Wei
- Department of Urology, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Chongqing, China
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11
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Gadd S, Huff V, Skol AD, Renfro LA, Fernandez CV, Mullen EA, Jones CD, Hoadley KA, Yap KL, Ramirez NC, Aris S, Phung QH, Perlman EJ. Genetic changes associated with relapse in favorable histology Wilms tumor: A Children's Oncology Group AREN03B2 study. Cell Rep Med 2022; 3:100644. [PMID: 35617957 PMCID: PMC9244995 DOI: 10.1016/j.xcrm.2022.100644] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 12/15/2022]
Abstract
Over the last decade, sequencing of primary tumors has clarified the genetic underpinnings of Wilms tumor but has not affected therapy, outcome, or toxicity. We now sharpen our focus on relapse samples from the umbrella AREN03B2 study. We show that over 40% of relapse samples contain mutations in SIX1 or genes of the MYCN network, drivers of progenitor proliferation. Not previously seen in large studies of primary Wilms tumors, DIS3 and TERT are now identified as recurrently mutated. The analysis of primary-relapse tumor pairs suggests that 11p15 loss of heterozygosity (and other copy number changes) and mutations in WT1 and MLLT1 typically occur early, but mutations in SIX1, MYCN, and WTX are late developments in some individuals. Most strikingly, 75% of relapse samples had gain of 1q, providing strong conceptual support for studying circulating tumor DNA in clinical trials to better detect 1q gain earlier and monitor response.
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Affiliation(s)
- Samantha Gadd
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Robert H. Lurie Cancer Center, Northwestern University, 225 East Chicago Avenue, Box 17, Chicago, IL 60611, USA
| | - Vicki Huff
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Andrew D Skol
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Robert H. Lurie Cancer Center, Northwestern University, 225 East Chicago Avenue, Box 17, Chicago, IL 60611, USA
| | - Lindsay A Renfro
- Division of Biostatistics, University of Southern California, Los Angeles, CA 90007, USA
| | - Conrad V Fernandez
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NS B3K 6R8, Canada
| | - Elizabeth A Mullen
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA 02215, USA
| | - Corbin D Jones
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Katherine A Hoadley
- Department of Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kai Lee Yap
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Robert H. Lurie Cancer Center, Northwestern University, 225 East Chicago Avenue, Box 17, Chicago, IL 60611, USA
| | - Nilsa C Ramirez
- Institute for Genomic Medicine and Biopathology Center, Nationwide Children's Hospital, Departments of Pathology and Pediatrics, Ohio State University, Columbus, OH 43205, USA
| | - Sheena Aris
- Biospecimen Research Group, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA
| | - Quy H Phung
- Biospecimen Research Group, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA
| | - Elizabeth J Perlman
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Robert H. Lurie Cancer Center, Northwestern University, 225 East Chicago Avenue, Box 17, Chicago, IL 60611, USA.
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12
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Balis F, Green DM, Anderson C, Cook S, Dhillon J, Gow K, Hiniker S, Jasty-Rao R, Lin C, Lovvorn H, MacEwan I, Martinez-Agosto J, Mullen E, Murphy ES, Ranalli M, Rhee D, Rokitka D, Tracy EL, Vern-Gross T, Walsh MF, Walz A, Wickiser J, Zapala M, Berardi RA, Hughes M. Wilms Tumor (Nephroblastoma), Version 2.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2021; 19:945-977. [PMID: 34416707 DOI: 10.6004/jnccn.2021.0037] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The NCCN Guidelines for Wilms Tumor focus on the screening, diagnosis, staging, treatment, and management of Wilms tumor (WT, also known as nephroblastoma). WT is the most common primary renal tumor in children. Five-year survival is more than 90% for children with all stages of favorable histology WT who receive appropriate treatment. All patients with WT should be managed by a multidisciplinary team with experience in managing renal tumors; consulting a pediatric oncologist is strongly encouraged. Treatment of WT includes surgery, neoadjuvant or adjuvant chemotherapy, and radiation therapy (RT) if needed. Careful use of available therapies is necessary to maximize cure and minimize long-term toxicities. This article discusses the NCCN Guidelines recommendations for favorable histology WT.
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Affiliation(s)
- Frank Balis
- Abramson Cancer Center at the University of Pennsylvania
| | - Daniel M Green
- St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Shelly Cook
- University of Wisconsin Carbone Cancer Center
| | | | - Kenneth Gow
- Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | | | | | - Chi Lin
- Fred & Pamela Buffett Cancer Center
| | | | | | | | | | - Erin S Murphy
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Mark Ranalli
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Daniel Rhee
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Amy Walz
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | - Matthew Zapala
- UCSF Helen Diller Family Comprehensive Cancer Center; and
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13
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Dome JS, Mullen EA, Dix DB, Gratias EJ, Ehrlich PF, Daw NC, Geller JI, Chintagumpala M, Khanna G, Kalapurakal JA, Renfro LA, Perlman EJ, Grundy PE, Fernandez CV. Impact of the First Generation of Children's Oncology Group Clinical Trials on Clinical Practice for Wilms Tumor. J Natl Compr Canc Netw 2021; 19:978-985. [PMID: 34416705 DOI: 10.6004/jnccn.2021.7070] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022]
Abstract
Refinements in surgery, radiation therapy, and chemotherapy since the mid-20th century have resulted in a survival rate exceeding 90% for patients with Wilms tumor (WT). Although this figure is remarkable, a significant proportion of patients continue to have event-free survival (EFS) estimates of <75%, and nearly 25% of survivors experience severe chronic medical conditions. The first-generation Children's Oncology Group (COG) renal tumor trials (AREN '0'), which opened to enrollment in 2006, focused on augmenting treatment regimens for WT subgroups with predicted EFS <75% to 80%, including those with the adverse prognostic marker of combined loss of heterozygosity (LOH) at chromosomes 1p/16q, pulmonary metastasis with incomplete lung nodule response after 6 weeks of chemotherapy, bilateral disease, and anaplastic histology. Conversely, therapy was reduced for patient subgroups with good outcomes and potential for long-term toxicity, such as those with lung metastasis with complete lung nodule response after 6 weeks of chemotherapy. This article summarizes the key findings of the first-generation COG renal tumor studies and their implications for clinical practice.
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Affiliation(s)
- Jeffrey S Dome
- Division of Oncology, Center for Cancer and Blood Disorders, Children's National Hospital and the Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Elizabeth A Mullen
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - David B Dix
- Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Peter F Ehrlich
- Department of Pediatric Surgery, University of Michigan, CS Mott Children's Hospital, Ann Arbor, Michigan
| | - Najat C Daw
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James I Geller
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Geetika Khanna
- Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern University School of Medicine, Chicago, Illinois
| | - Lindsay A Renfro
- Children's Oncology Group and Division of Biostatistics, University of Southern California, Los Angeles, California
| | - Elizabeth J Perlman
- Department of Pathology, Northwestern University Feinberg School of Medicine, and the Robert H. Lurie Cancer Center, Chicago, Illinois
| | - Paul E Grundy
- Department of Pediatrics, University of Alberta Hospital, Edmonton, Alberta, Canada; and
| | - Conrad V Fernandez
- Division of Pediatric Hematology/Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
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14
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Apple AN, Neuzil KE, Phelps HM, Li B, Lovvorn Iii HN. Race disparities in genetic alterations within Wilms tumor specimens. J Pediatr Surg 2021; 56:1135-1141. [PMID: 33745745 DOI: 10.1016/j.jpedsurg.2021.02.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 02/05/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Wilms tumor (WT) affects Black children disproportionately. Genetic aberrations within WT specimens that contribute to this disparity have not been reported. METHODS The Therapeutically Applied Research to Generate Effective Treatments (TARGET) database was queried for WT patient and genomic features. Clinical and genetic variables were compared by race. RESULTS Within the discovery set (enriched for adverse events; N = 94 White, 19 Black, 14 Other/unreported patients), Black children were more likely to present with advanced stage disease (p = 0.019). Within the validation set (primarily a random sampling of NWTS-5; N = 360 White, 92 Black, 72 Other/Unreported), Black children appeared older at diagnosis (p = 0.050), had decreased median follow-up time (p<0.0005) and were over-represented (17.4%) relative to the concurrent U.S. Census (12.8%). Among the 37 target genes sequenced, ACTB (p = 0.030) and DICER1 (p = 0.026) mutations were more common in Black patient specimens, whereas DGCR8 (p = 0.041) mutations were more common in White patient specimens. White patient specimens were more likely to contain one or multiple targeted mutations (p = 0.026). CONCLUSION Within the TARGET database, Black children were over-represented and harbored WT specimens containing more frequent ACTB and DICER1 mutations. In contrast, WT from White children contained overall more mutations in targeted genes and specifically in DGCR8. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Annie N Apple
- Vanderbilt University School of Medicine, Nashville, TN, United States; Surgical Outcomes Center for Kids, Monroe Carrell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, United States.
| | - Kevin E Neuzil
- Vanderbilt University School of Medicine, Nashville, TN, United States; Surgical Outcomes Center for Kids, Monroe Carrell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Hannah M Phelps
- Department of Surgery, Washington University at St. Louis School of Medicine, St. Louis, MO, United States
| | - Bingshan Li
- Department of Molecular Physiology and Biophysics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Harold N Lovvorn Iii
- Department of Pediatric Surgery, Monroe Carrell Jr. Children's Hospital, Vanderbilt University Medical Center, Nashville, TN, United States
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15
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Abstract
PURPOSE OF REVIEW Pediatric renal tumors account for 7% of new cancer diagnoses in children. Here, we will review results from recently completed clinical trials informing the current standard of care and discuss targeted and immune therapies being explored for the treatment of high risk or relapsed/refractory pediatric renal malignancies. RECENT FINDINGS Cooperative group trials have continued to make improvements in the care of children with pediatric tumors. In particular, trials that standardize treatment of rare cancers (e.g., bilateral Wilms tumor) have improved outcomes significantly. We have seen improvements in event free and overall survival in recently completed clinical trials for many pediatric renal tumors. Still, there are subsets of rarer cancers where outcomes remain poor and new therapeutic strategies are needed. Future trials aim to balance treatment toxicity with treatment efficacy for those with excellent outcomes while identifying novel therapeutics for those with poor outcomes.
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Affiliation(s)
- Juhi Jain
- Aflac Cancer and Blood Disorders Center, Children Healthcare of Atlanta, Atlanta, GA, USA.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA.,Emory Children's Center, 2015 Uppergate Drive NE , 400, Atlanta, GA, 30322, USA
| | - Kathryn S Sutton
- Aflac Cancer and Blood Disorders Center, Children Healthcare of Atlanta, Atlanta, GA, USA.,Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA.,Emory Children's Center, 2015 Uppergate Drive NE, 434B, Atlanta, GA, 30322, USA
| | - Andrew L Hong
- Aflac Cancer and Blood Disorders Center, Children Healthcare of Atlanta, Atlanta, GA, USA. .,Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA. .,Winship Cancer Institute, Atlanta, GA, USA. .,Health Sciences Research Building, 1760 Haygood Drive NE, E-370, Atlanta, GA, 30322, USA.
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16
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Abstract
PURPOSE OF REVIEW The treatment of Wilms tumor is one of the great achievements in the field of oncology. One of the key success factors has been improved risk stratification, enabling augmentation or reduction of therapy depending on a patient's risk of relapse. This article highlights the evolution of clinical and biological prognostic markers that have been applied in the treatment of Wilms tumor. RECENT FINDINGS Historically, tumor stage and histology were the sole determinants of Wilms tumor treatment. Recent clinical trials conducted by the Children's Oncology Group (COG) and the International Society of Pediatric Oncology (SIOP) Renal Tumor Study Group have expanded the menu of prognostic factors to include histologic and volumetric response to therapy and tumor-specific loss of heterozygosity (LOH) at chromosomes 1p and 16q. Augmentation of therapy has been able to overcome the adverse risk factors. An emerging prognostic marker is chromosome 1q gain, will be incorporated into future clinical trials. SUMMARY The application of new clinical and biological prognostic factors has created unprecedented ability to tailor therapy for Wilms tumor, accompanied with improved outcomes. Current and future trials will continue to enhance precision medicine for Wilms tumor.
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Affiliation(s)
- Marie V. Nelson
- Division of Oncology, Children's National Hospital and the George Washington University School of Medicine and Health Sciences, Washington DC, United States
| | | | - Norbert Graf
- Department of Pediatric Oncology, University Hospital of Saarland, Homburg, Germany
| | - Jeffrey S. Dome
- Division of Oncology, Children's National Hospital and the George Washington University School of Medicine and Health Sciences, Washington DC, United States
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17
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Lopyan NM, Ehrlich PF. Surgical Management of Wilms Tumor (Nephroblastoma) and Renal Cell Carcinoma in Children and Young Adults. Surg Oncol Clin N Am 2021; 30:305-323. [PMID: 33706902 DOI: 10.1016/j.soc.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This article reviews the epidemiology, pathophysiology, clinical presentation, and multimodality management of Wilms tumors and renal cell carcinoma in pediatric and young adults. Key renal Société Internationale d'Oncologie Pédiatrique and Children Oncology Group studies are presented. The article reviews the common staging systems and risk-adapted treatment strategies with particular attention to the surgical management.
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Affiliation(s)
- Natalie M Lopyan
- C.S. Mott Children's Hospital Section of Pediatric Surgery, 1540 East Hospital Drive, Ann Arbor, MI 48109, USA
| | - Peter F Ehrlich
- University of Michigan, C.S. Mott Children's Hospital Section of Pediatric Surgery, 1540 East Hospital Drive, SPC 4811, Ann Arbor, MI 48109, USA.
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18
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Abstract
Wilms tumor is the most common renal tumor of childhood. It is a biologically and morphologically diverse entity, with ongoing studies contributing to our understanding of the pathobiology of various subgroups of patients with Wilms tumor. The interplay of histologic examination and molecular interrogation is integral in prognostication and direction of therapy. This review provides an overview of some of the challenging aspects and pitfalls in pathologic assessment of Wilms tumor, along with discussion of current and up-and-coming markers of biological behavior with prognostic significance.
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Affiliation(s)
- Lauren N Parsons
- Medical College of Wisconsin, Milwaukee, WI, USA; Children's Hospital of Wisconsin, Milwaukee, WI, USA.
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Gjerstorff MF. Novel Insights Into Epigenetic Reprogramming and Destabilization of Pericentromeric Heterochromatin in Cancer. Front Oncol 2020; 10:594163. [PMID: 33251148 PMCID: PMC7674669 DOI: 10.3389/fonc.2020.594163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/15/2020] [Indexed: 12/17/2022] Open
Abstract
Pericentromeric heterochromatin is maintained in a condensed structure by repressive epigenetic control mechanisms and perturbation of these may cause diseases. The chromosome 1q12 region harbors the largest pericentromeric heterochromatin domain in the genome and is among the most common breakpoints in both solid and hematopoietic cancers. Furthermore, the 1q arm is frequently amplified in cancer and this may support tumorigenesis by increasing the dosage of the many oncogenes of this genomic region. Recent studies have provided insight into the mechanisms leading to loss of 1q12 stability and 1q amplification and DNA hypomethylation seems to play a prominent role. This may be the result of decreased activity of DNA methyltransferases and instrumental for 1q12 destabilization or arise secondary to perturbation of other important epigenetic mechanisms that control repression of pericentromeric heterochromatin. Polycomb proteins were recently demonstrated to epigenetically reprogram demethylated 1q12 pericentromeric heterochromatin in premalignant and malignant cells to form large subnuclear structures known as polycomb bodies. This may influence the regulation and stability of 1q12 pericentromeric heterochromatin and/or the distribution of polycomb factors to support tumorigenesis. This review will discuss recent insight into the epigenetic perturbations causing the destabilization of 1q12 pericentromeric heterochromatin and its possible implications for tumor biology.
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Affiliation(s)
- Morten Frier Gjerstorff
- Department of Cancer and Inflammation Research, Institute for Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Department of Oncology, Odense University Hospital, Odense, Denmark.,Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
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20
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Sudour-Bonnange H, Coulomb-Lherminé A, Fantoni JC, Escande A, Brisse HJ, Thebaud E, Verschuur A. Standard of care for adult Wilms tumor? From adult urologist to pediatric oncologist. A retrospective review. Bull Cancer 2020; 108:177-186. [PMID: 33129487 DOI: 10.1016/j.bulcan.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
Nephroblastoma or Wilms tumor, a common embryonal tumor in children, can occasionally occur in adults. The survival of patients older than 18 years is reported to be significantly inferior to that of pediatric patients. Establishing a diagnosis for these rare tumors can be challenging for both clinicians and pathologists, who are not accustomed to considering Wilms tumor as a potential differential in adults. This leads to misdiagnosis and a subsequent delay in the initiation of appropriate therapy. The standard of care is not well established for Wilms tumors in adults. We provide here a comprehensive review of the international literature on the subject with the current management protocols in France. We also propose the need of strong inter-disciplinary collaboration between surgeons, pathologists, and medical and pediatric oncologists for increasing knowledge and formulating treatment strategies for these rare tumors. Homogenous guidelines for treating adults with Wilms tumors have been proposed for all patients in France.
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Affiliation(s)
| | | | | | | | | | - Estelle Thebaud
- CHRU Nantes, department of pediatric hemato-oncology, Nantes, France
| | - Arnaud Verschuur
- AP-HM, La Timone Children's hospital, department of pediatric oncology and hematology, Marseille, France
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21
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Abstract
BACKGROUND The prognostic role of copy number variation is upcoming in Wilms tumor, and its identification will help in tailored therapy for improved cure. STUDY DESIGN This was a retrospective, nested case-control, pilot study. MATERIALS AND METHODS Formalin-fixed paraffin-embedded blocks of nephrectomy specimens were retrieved for the study and control groups (children with relapse and survivors for ≥2 y). Multiplex ligand probe amplification (MRC-Holland probe-mix P 380 A1) was performed, with 3 reference samples of normal kidney DNA run for every 7 cases. RESULTS At least 1 variation was detected in 41 (97.8%) specimens. Loss of heterozygosity 1p was not observed. Loss of 16q, 1q gain, and MYCN gain were observed in 5 (11.9%), 29 (69%), and 39 (92.9%) specimens, respectively. The occurrence of copy number variations was similar in both groups: 1q gain: 15 versus 14 (P=1.0), 16q loss: 4 versus 1 (P=0.34), MYCN gain: 19 versus 20 (P=1.0). The gain of 1q, 16p loss, and MYCN gain did not differ across stage or age. CONCLUSIONS The gain of 1q, MYCN gain, and 16p loss were identified. A higher occurrence of 1q gain and MYCN gain and a lack of difference in the distribution of variations among survivors and those with a relapse suggest a different molecular profile of Wilms tumor in Indian children.
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22
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Zhang X, Liu C, Li H, Guo L. Effects of miR-21 on proliferation and apoptosis of WT cells via PTEN/Akt pathway. Exp Ther Med 2020; 19:2155-2160. [PMID: 32104279 PMCID: PMC7027200 DOI: 10.3892/etm.2019.8376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/13/2019] [Indexed: 12/29/2022] Open
Abstract
Micro ribonucleic acid (miR)-21 in the proliferation and apoptosis of Wilms' tumor (WT) cells was explored. SK-NEP-1 cells were transfected with miR-21 inhibitor to silence the expression of miR-21. Then, the effects of miR-21 silencing on the proliferation and apoptosis of WT SK-NEP-1 cells were detected through cell counting kit-8 (CCK-8), colony formation assay and flow cytometry. The targets of miR-21 were analyzed via TargetScan database. Fluorescence real-time quantitative polymerase chain reaction (RT-qPCR) assay and western blot analysis were conducted to detect the changes in messenger RNA (mRNA) and protein expression levels of gene of phosphate and tension homology deleted on chromosome ten (PTEN) after silencing miR-21. Whether miR-21 directly binds to PTEN was examined by activity detection via dual luciferase reporter gene assay. Western blotting was employed to detect the correlation of miR-21 with PTEN and protein kinase B (Akt). Compared with normal control (NC) group, miR-21 inhibitor group had significantly inhibited proliferation of SK-NEP-1 cells (P<0.05), notably reduced number of clones (P<0.05) and overtly raised proportion of apoptotic cells (P<0.05). The suppression of miR-21 expression upregulated the mRNA and protein expression levels of PTEN, and the results of activity detection via dual luciferase reporter gene assay indicated that miR-21 bound to PTEN 3'-untranslated region (UTR) to repress its expression (P<0.05). PTEN silencing increased phosphorylated Akt (p-Akt) level in SK-NEP-1 cells, but there was no changes in Akt protein level. After silencing both PTEN and miR-21, the decrease in p-Akt was reversed, thereby reversing the inhibitory effect of miR-21 on the proliferation of SK-NEP-1 cells (P<0.05). miR-21 affects the proliferation and apoptosis of WT SK-NEP-1 cells via the PTEN/Akt pathway.
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Affiliation(s)
- Xiuli Zhang
- Pediatrics Intensive Care Unit, Shanxian Central Hospital, Heze, Shandong 274300, P.R. China
| | - Chunyan Liu
- Pediatrics Intensive Care Unit, Shanxian Central Hospital, Heze, Shandong 274300, P.R. China
| | - Haiyan Li
- Pediatrics Intensive Care Unit, Shanxian Central Hospital, Heze, Shandong 274300, P.R. China
| | - Li Guo
- Pediatrics Intensive Care Unit, Shanxian Central Hospital, Heze, Shandong 274300, P.R. China
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23
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Ehrlich PF. The impact of cooperative group studies on childhood cancer: Improving outcomes and quality and international collaboration. Semin Pediatr Surg 2019; 28:150857. [PMID: 31931967 DOI: 10.1016/j.sempedsurg.2019.150857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The advances in pediatric cancer far exceed those achieved in adults. The success in improving survival and minimizing late effects has been due to several reasons but work of the pediatric cancer cooperative groups is a primary. These cooperative groups are multidisciplinary with medical oncologists, pathologists, radiologists, surgeons, radiation oncologists, scientists and most importantly the patients and families. Studies have expanded from regional to national and now international studies which continue to target problems pertinent to improving the outcome for children with cancer. In this article we review the history of the cooperative groups, a selection of seminal studies pertaining to solid tumors, future challenges and collaborations.
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Affiliation(s)
- Peter F Ehrlich
- Section of Pediatric Surgery, CS Mott Children's Hospital, University of Michigan, Ann Arbor, MI, United States.
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24
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Dix DB, Fernandez CV, Chi YY, Mullen EA, Geller JI, Gratias EJ, Khanna G, Kalapurakal JA, Perlman EJ, Seibel NL, Ehrlich PF, Malogolowkin M, Anderson J, Gastier-Foster J, Shamberger RC, Kim Y, Grundy PE, Dome JS. 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 Clin Oncol 2019; 37:2769-2777. [PMID: 31449468 DOI: 10.1200/jco.18.01972] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE In National Wilms Tumor Study 5 (NWTS-5), tumor-specific combined loss of heterozygosity of chromosomes 1p and 16q (LOH1p/16q) was associated with adverse outcomes in patients with favorable histology Wilms tumor. The AREN0533/AREN0532 studies assessed whether augmenting therapy improved event-free survival (EFS) for these patients. Patients with stage I/II disease received regimen DD4A (vincristine, dactinomycin and doxorubicin) but no radiation therapy. Patients with stage III/IV disease received regimen M (vincristine, dactinomycin, and doxorubicin alternating with cyclophosphamide and etoposide) and radiation therapy. METHODS Patients were enrolled through the AREN03B2 Biology study between October 2006 and October 2013; all underwent central review of pathology, surgical reports, and imaging. Tumors were evaluated for LOH1p/16q by microsatellite testing. EFS and overall survival were compared using the log-rank test between NWTS-5 and current studies. RESULTS LOH1p/16q was detected in 49 of 1,147 evaluable patients with stage I/II disease (4.27%) enrolled in AREN03B2; 32 enrolled in AREN0532. LOH1p/16q was detected in 82 of 1,364 evaluable patients with stage III/IV disease (6.01%) in AREN03B2; 51 enrolled in AREN0533. Median follow-up for 83 eligible patients enrolled in AREN0532/0533 was 5.73 years (range, 2.84 to 9.63 years). The 4-year EFS for patients with stage I/II and stage III/IV disease with LOH1p/16 was 87.3% (95% CI, 75.1% to 99.5%) and 90.2% (95% CI, 81.8% to 98.6%), respectively. These results are improved compared with the NWTS-5 updated 4-year EFS of 68.8% for patients with stage I/II disease (P = .042), and 61.3% for patients with stage III/IV disease (P = .001), with trends toward improved 4-year overall survival. The most common grade 3 or higher nonhematologic toxicities with regimen M were febrile neutropenia (39.2%) and infections (21.6%). CONCLUSION Augmentation of therapy improved EFS for patients with favorable histology Wilms tumor and LOH1p/16q compared with the historical NWTS-5 comparison group, with an expected toxicity profile.
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Affiliation(s)
- David B Dix
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Elizabeth A Mullen
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | - James I Geller
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Eric J Gratias
- University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
| | | | - John A Kalapurakal
- Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | | | | | - Marcio Malogolowkin
- University of California at Davis Comprehensive Cancer Center, Sacramento, CA
| | | | - Julie Gastier-Foster
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH
| | | | | | - Paul E Grundy
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey S Dome
- Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
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25
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Qu X, Li H, Braziel RM, Passerini V, Rimsza LM, Hsi ED, Leonard JP, Smith SM, Kridel R, Press O, Weigert O, LeBlanc M, Friedberg JW, Fang M. Genomic alterations important for the prognosis in patients with follicular lymphoma treated in SWOG study S0016. Blood 2019; 133:81-93. [PMID: 30446494 PMCID: PMC6318431 DOI: 10.1182/blood-2018-07-865428] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/06/2018] [Indexed: 02/08/2023] Open
Abstract
Although recent advances in molecular genetics have enabled improved risk classification of follicular lymphoma (FL) using, for example, the m7-FLIPI score, the impact on treatment has been limited. We aimed to assess the prognostic significance of copy-number aberrations (CNAs) and copy-neutral loss of heterozygosity (cnLOH) identified by chromosome genomic-array testing (CGAT) at FL diagnosis using prospectively collected clinical trial specimens from 255 patients enrolled in the SWOG study S0016. The impact of genomic aberrations was assessed for early progression (progressed or died within 2 years after registration), progression-free survival (PFS), and overall survival (OS). We showed that increased genomic complexity (ie, the total number of aberration calls) was associated with poor outcome in FL. Certain chromosome arms were critical for clinical outcome. Prognostic CNAs/cnLOH were identified: whereas early progression was correlated with 2p gain (P = .007; odds ratio [OR] = 2.55 [1.29, 5.03]) and 2p cnLOH (P = .005; OR = 10.9 [2.08, 57.2]), 2p gain specifically encompassing VRK2 and FANCL predicted PFS (P = .01; hazard ratio = 1.80 [1.14, 2.68]) as well as OS (P = .005; 2.40 [1.30, 4.40]); CDKN2A/B (9p) deletion correlated with worse PFS (P = .004, 3.50 [1.51, 8.28]); whereas CREBBP (16p) (P < .001; 6.70 [2.52, 17.58]) and TP53 (17p) (P < .001; 3.90 [1.85, 8.31]) deletion predicted worse OS. An independent cohort from the m7-FLIPI study was explored, and the prognostic significance of aberration count, and TP53 and CDKN2A/B deletion were further validated. In conclusion, assessing genomic aberrations at FL diagnosis with CGAT improves risk stratification independent of known clinical parameters, and provides a framework for development of future rational targeted therapies.
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Affiliation(s)
- Xiaoyu Qu
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Hongli Li
- SWOG Statistical Center, Seattle, WA
| | - Rita M Braziel
- Department of Pathology, Oregon Health & Science University, Portland, OR
| | - Verena Passerini
- Department of Medicine III, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
- German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | | | | | - John P Leonard
- Weill Cornell Medicine/New York Presbyterian Hospital, New York, NY
| | - Sonali M Smith
- Department of Medicine, University of Chicago, Chicago, IL
| | - Robert Kridel
- Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, ON, Canada; and
| | - Oliver Press
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Oliver Weigert
- Department of Medicine III, University Hospital, Ludwig Maximilians University Munich, Munich, Germany
- German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | | | | | - Min Fang
- Fred Hutchinson Cancer Research Center, Seattle, WA
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26
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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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27
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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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28
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Dix DB, Seibel NL, Chi YY, Khanna G, Gratias E, Anderson JR, Mullen EA, Geller JI, Kalapurakal JA, Paulino AC, Perlman EJ, Ehrlich PF, Malogolowkin M, Gastier-Foster JM, Wagner E, Grundy PE, Fernandez CV, Dome JS. Treatment of Stage IV Favorable Histology Wilms Tumor With Lung Metastases: A Report From the Children's Oncology Group AREN0533 Study. J Clin Oncol 2018; 36:1564-1570. [PMID: 29659330 DOI: 10.1200/jco.2017.77.1931] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose The National Wilms Tumor Study (NWTS) treatment of favorable histology Wilms tumor with lung metastases was vincristine/dactinomycin/doxorubicin (DD4A) and lung radiation therapy (RT). The AREN0533 study applied a new risk stratification and treatment strategy to improve event-free survival (EFS) while reducing exposure to lung RT. Methods Patients with favorable histology Wilms tumor and isolated lung metastases showing complete lung nodule response (CR) after 6 weeks of DD4A continued receiving chemotherapy without lung RT. Patients with incomplete response (IR) or loss of heterozygosity at chromosomes 1p/16q received lung RT and four cycles of cyclophosphamide/etoposide in addition to DD4A drugs (Regimen M). AREN0533 was designed to preserve a 4-year EFS of 85% for lung nodule CR and improve 4-year EFS from 75% to 85% for lung nodule IR. Results Among 292 assessable patients, 133 had CR and 159 had IR. For patients with CR, 4-year EFS and overall survival (OS) estimates were 79.5% (95% CI, 71.2% to 87.8%) and 96.1% (95% CI, 92.1% to 100%), respectively. Expected versus observed event rates were 15% and 20.2% ( P = .052), respectively. For patients with IR, 4-year EFS and OS estimates were 88.5% (95% CI, 81.8% to 95.3%) and 95.4% (95% CI, 90.9% to 99.8%), respectively. Expected versus observed event rates were 25% and 12.2% ( P < .001), respectively. Overall, 4-year EFS and OS were 85.4% (95% CI, 80.5% to 90.2%) and 95.6% (95% CI, 92.8% to 98.4%) compared with 72.5% (95% CI, 66.9% to 78.1%; P < .001) and 84.0% (95% CI, 79.4% to 88.6%; P < .001), respectively, in the predecessor NWTS-5 study. Conclusion Excellent OS was achieved after omission of primary lung RT in patients with lung nodule CR, although there were more events than expected. EFS was significantly improved, with excellent OS, in patients with lung nodule IR using four cycles of cyclophosphamide/etoposide in addition to DD4A drugs. The overall AREN0533 treatment strategy yielded EFS and OS estimates that were superior to previous studies.
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Affiliation(s)
- David B Dix
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Nita L Seibel
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Yueh-Yun Chi
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Geetika Khanna
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Eric Gratias
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - James R Anderson
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Elizabeth A Mullen
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - James I Geller
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - John A Kalapurakal
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Arnold C Paulino
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Elizabeth J Perlman
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Peter F Ehrlich
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Marcio Malogolowkin
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Julie M Gastier-Foster
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Elizabeth Wagner
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Paul E Grundy
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Conrad V Fernandez
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Jeffrey S Dome
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
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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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D'Angelo P, Di Cataldo A, Terenziani M, Bisogno G, Collini P, Di Martino M, Melchionda F, Mosa C, Nantron M, Perotti D, Puccio G, Serra A, Catania S, Spreafico F. Factors possibly affecting prognosis in children with Wilms' tumor diagnosed before 24 months of age: A report from the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) Wilms Tumor Working Group. Pediatr Blood Cancer 2017; 64. [PMID: 28598537 DOI: 10.1002/pbc.26644] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 04/22/2017] [Accepted: 04/24/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Children with Wilms' tumor (WT) aged under 24 months (infants) have a better prognosis than older patients. Our aim was to study the epidemiology of this age group, with focus on the modality of diagnosis, tumor size, and association with malformations/syndromes, seeking to understand if any of these factors might be related to prognosis. PATIENTS AND METHODS Infants diagnosed with WT between 2003 and February 2010 were evaluated. A query form was used to collect data on the modality of WT diagnosis (symptomatic or incidental), tumor volume, maximum diameter, site, and stage. RESULTS Data were collected for 117 of 124 WT infants registered. Twenty-four cases had an incidental diagnosis (ID) of renal mass, usually arising from an abdominal ultrasound performed for other reasons, and 93 had been diagnosed based on clinical signs/symptoms. The incidental cohort displayed unifocal disease, mean tumor diameter 5.52 cm, mean tumor volume 84.30 ml, and 14 patients showed associated malformations. Symptomatic patients had mean maximum tumor diameter of 10.18 cm, mean tumor volume of 451.18 ml, and six had associated malformations. CONCLUSIONS Our study showed that 20% of the infants had an ID of WT; they had a relatively smaller nonmetastatic tumor and a higher rate of malformations than infants of the symptomatically diagnosed group, but we did not detect any difference in age at diagnosis between the two groups. Conversely, we found a significant difference in the 5-year event-free survival rate (P = 0.018) between infants under 1 year (96%), more frequently associated with congenital malformations, and infants 1-2 years (80%).
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Affiliation(s)
- Paolo D'Angelo
- Pediatric Oncology Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - Andrea Di Cataldo
- Pediatric Hematology and Oncology Unit, Catania University, Catania, Italy
| | - Monica Terenziani
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Gianni Bisogno
- Pediatric Hematology and Oncology Unit, Pediatric Department, University of Padua, Padua, Italy
| | - Paola Collini
- Soft Tissue and Bone Pathology, Histopathology, and Pediatric Pathology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Martina Di Martino
- Pediatric Oncology Unit, Pediatric Department, II University, Naples, Italy
| | - Fraia Melchionda
- Pediatric Hematology and Oncology Unit "Lalla Seràgnoli", Bologna University, Bologna, Italy
| | - Clara Mosa
- Pediatric Oncology Unit, A.R.N.A.S. Ospedali Civico, Di Cristina e Benfratelli, Palermo, Italy
| | - Marilina Nantron
- Department of Hematology and Oncology, Istituto G. Gaslini, Genoa, Italy
| | - Daniela Perotti
- Molecular Bases of Genetic Risk and Genetic Testing Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Annalisa Serra
- Pediatric Hematology and Oncology Department, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Serena Catania
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
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Karpelowsky JS, Davidoff AM. Risk Stratification and Surgical Advances in Pediatric Solid Tumors. CURRENT PEDIATRICS REPORTS 2017. [DOI: 10.1007/s40124-017-0141-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Clinicopathological parameters and prognostic relevance of miR-21 and PTEN expression in Wilms' tumor. J Pediatr Surg 2017; 52:1348-1354. [PMID: 28040201 DOI: 10.1016/j.jpedsurg.2016.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/13/2016] [Accepted: 12/05/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND MiR-21 is one of the most often found miRNAs overexpressed in solid tumors, while PTEN is the most highly mutated tumor suppressor gene. Our purpose was to examine the expression levels of miR-21 and PTEN protein in Wilms' tumor (WT) and in para-tumoral tissues and to investigate the relationships among miR-21, PTEN expression, clinicopathological parameters and the prognosis of patients with WT. METHODS The expression levels of miR-21 and PTEN protein in WT and corresponding para-tumoral tissues were investigated by qRT-PCR and Western blot, respectively. Differences in patient survival were determined using the Kaplan-Meier method and the log-rank test. A Cox proportional hazards regression analysis was used for univariate and multivariate analyses of prognostic values. RESULTS Compared with para-tumoral renal tissues, the expression levels of miR-21 were significantly upregulated in WT tissues, while the PTEN protein were significantly downregulated (P<0.05). Analyses of the clinicopathological parameters showed that the miR-21 expression level was significantly associated with age, late clinical stage, histopathological tumor type and lymphatic metastasis (P<0.05). PTEN protein expression was significantly associated with age, late clinical stage and histopathological tumor type (P<0.05). The univariate linear regression analysis illustrated a significant negative correlation between miR-21 and PTEN expression (r=-0.687, P<0.05). The Kaplan-Meier curve showed that patients with high miR-21 and low PTEN protein expression survived significantly longer (P<0.05). However, a multivariate analysis suggested that neither the expression level of miR-21 nor that of PTEN is an independent prognostic factor for overall survival. CONCLUSIONS Both upregulated miR-21 and downregulated PTEN expression have a possible correlation with the aggressive progression and poor prognosis of WT, which suggests that upregulated miR-21 and downregulated PTEN expression may be valuable markers of tumor progression and indicators of the prognosis of WT.
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Clinical Outcome and Biological Predictors of Relapse After Nephrectomy Only for Very Low-risk Wilms Tumor: A Report From Children's Oncology Group AREN0532. Ann Surg 2017; 265:835-840. [PMID: 27811504 DOI: 10.1097/sla.0000000000001716] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine if observation alone after nephrectomy in very low-risk Wilms tumor (defined as stage I favorable histology Wilms tumors with nephrectomy weight <550g and age at diagnosis <2 years) results in satisfactory event-free survival and overall survival, and to correlate relapse with biomarkers. PATIENTS AND METHODS The AREN0532 study enrolled patients with very low-risk Wilms tumor confirmed by central review of pathology, diagnostic imaging, and surgical reports. After nephrectomy, patients were followed without adjuvant chemotherapy. Evaluable tumors were analyzed for WT1mutation, 1p and 16q copy loss, 1q copy gain, and 11p15 imprinting. The study was powered to detect a reduction in 4-year EFS from 87% to 75% and overall survival from 95% to 88%. RESULTS A total of 116 eligible patients enrolled with a median follow up of 80 months (range: 5-97 months). Twelve patients relapsed. Estimated 4-year event-free survival was 89.7% (95% confidence interval 84.1-95.2%) and overall survival was 100%. First sites of relapse were lung (n = 5), tumor bed (n = 4), and abdomen (n = 2), with one metachronous tumor in the contralateral kidney (n = 1) at a median time of 4.3 months for those who relapsed (range 2.3-44 months). The presence of intralobar (P = 0.46) or perilobar rests (P = 1.0) were not associated with relapse (P = 0.16). 1q gain, 1p and 16q loss, and WT1 mutation status were not associated with relapse. 11p15 methylation status was associated relapse (20% relapse with loss of heterozygosity, 25% with loss of imprinting, and 3.3% relapse with retention of the normal imprinting (P = 0.011)). CONCLUSIONS Most patients meeting very low-risk criteria can be safely managed by nephrectomy alone with resultant reduced exposure to chemotherapy. Expansion of an observation alone strategy for low-risk Wilms tumor incorporating both clinical features and biomarkers should be considered.
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Spreafico F, Ciceri S, Gamba B, Torri F, Terenziani M, Collini P, Macciardi F, Radice P, Perotti D. Chromosomal anomalies at 1q, 3, 16q, and mutations of SIX1 and DROSHA genes underlie Wilms tumor recurrences. Oncotarget 2017; 7:8908-15. [PMID: 26802027 PMCID: PMC4891013 DOI: 10.18632/oncotarget.6950] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 12/08/2015] [Indexed: 12/22/2022] Open
Abstract
Approximately half of children suffering from recurrent Wilms tumor (WT) develop resistance to salvage therapies. Hence the importance to disclose events driving tumor progression/recurrence. Future therapeutic trials, conducted in the setting of relapsing patients, will need to prioritize targets present in the recurrent lesions. Different studies identified primary tumor-specific signatures associated with poor prognosis. However, given the difficulty in recruiting specimens from recurrent WTs, little work has been done to compare the molecular profile of paired primary/recurrent diseases. We studied the genomic profile of a cohort of eight pairs of primary/recurrent WTs through whole-genome SNP arrays, and investigated known WT-associated genes, including SIX1, SIX2 and micro RNA processor genes, whose mutations have been recently proposed as associated with worse outcome. Through this approach, we sought to uncover anomalies characterizing tumor recurrence, either acquired de novo or already present in the primary disease, and to investigate whether they overlapped with known molecular prognostic signatures. Among the aberrations that we disclosed as potentially acquired de novo in recurrences, some had been already recognized in primary tumors as associated with a higher risk of relapse. These included allelic imbalances of chromosome 1q and of chromosome 3, and CN losses on chromosome 16q. In addition, we found that SIX1 and DROSHA mutations can be heterogeneous events (both spatially and temporally) within primary tumors, and that their co-occurrence might be positively selected in the progression to recurrent disease. Overall, these results provide new insights into genomic and genetic events underlying WT progression/recurrence.
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Affiliation(s)
- Filippo Spreafico
- Pediatric Unit, Department of Hematology and Pediatric Onco-Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Ciceri
- Molecular Bases of Genetic Risk and Genetic Testing Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Beatrice Gamba
- Molecular Bases of Genetic Risk and Genetic Testing Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Federica Torri
- Genomics and Bioinformatics Unit, University of Milan-Fondazione Filarete, Milan, Italy
| | - Monica Terenziani
- Pediatric Unit, Department of Hematology and Pediatric Onco-Hematology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Paola Collini
- Department of Pathology and Laboratory Medicine Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Fabio Macciardi
- Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine, CA, USA
| | - Paolo Radice
- Molecular Bases of Genetic Risk and Genetic Testing Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniela Perotti
- Molecular Bases of Genetic Risk and Genetic Testing Unit, Department of Preventive and Predictive Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Multicystic dysplastic kidney: Assessment of the need for renal scintigraphy and the safety of conservative treatment. Actas Urol Esp 2017; 41:62-67. [PMID: 27666954 DOI: 10.1016/j.acuro.2016.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 05/14/2016] [Accepted: 05/17/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess the need for implementing renal scintigraphy in the diagnosis of the multicystic dysplastic kidney (MCDK) and the safety of its conservative treatment. MATERIAL AND METHODS A retrospective study of patients with unilateral MCDK was conducted at our centre from January 2005 to August 2015. We calculated the positive predictive value (PPV) of ultrasonography, taking renal scintigraphy and pathology as the gold standard. We calculated a survival curve according to the Kaplan-Meier method to assess the annual probability of spontaneous resolution of the multicystic kidney. RESULTS Fifty-six patients were identified, 48 (85.7%) of whom had a prenatal diagnosis. Thirty eight (67.9%) of the patients were males, and the left side was affected in 33 (58.9%) of the patients. We observed associated urological abnormalities in 22 (39.29%) patients, with vesicoureteral reflux the most common (8, 14.29%). Seven patients (12.5%) developed renal failure. Forty-nine (87.5%) patients developed compensatory contralateral renal hypertrophy. Of the 33 patients who underwent surgery, the pathology results confirmed the MCDK diagnosis in 32. Compared with scintigraphy and pathology, the PPV of ultrasonography was 100% and 97%, respectively. The rate of spontaneous involution was 5.4% at 3 months of life, 11.3% at 2 years and 38.4% at 5 years. CONCLUSIONS In our experience, the conservative treatment of MCDK, until at least 5 years of age, is safe. Our data suggest that performing scintigraphy is not required for these patients, which means lower radiation exposure, as well as financial savings.
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Chang HB, Zou JZ, He C, Zeng R, Li YY, Ma FF, Liu Z, Ye H, Wu JX. Association between Long Interspersed Nuclear Element-1 Methylation and Relative Telomere Length in Wilms Tumor. Chin Med J (Engl) 2016; 128:3055-61. [PMID: 26608986 PMCID: PMC4795265 DOI: 10.4103/0366-6999.169071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: DNA hypomethylation of long interspersed nuclear elements-1 (LINEs-1) occurs during carcinogenesis, whereas information addressing LINE-1 methylation in Wilms tumor (WT) is limited. The main purpose of our study was to quantify LINE-1 methylation levels and evaluate their relationship with relative telomere length (TL) in WT. Methods: We investigated LINE-1 methylation and relative TL using bisulfite-polymerase chain reaction (PCR) pyrosequencing and quantitative PCR, respectively, in 20 WT tissues, 10 normal kidney tissues and a WT cell line. Significant changes were analyzed by t-tests. Results: LINE-1 methylation levels were significantly lower (P < 0.05) and relative TLs were significantly shorter (P < 0.05) in WT compared with normal kidney. There was a significant positive relationship between LINE-1 methylation and relative TL in WT (r = 0.671, P = 0.001). LINE-1 Methylation levels were significantly associated with global DNA methylation (r = 0.332, P < 0.01). In addition, relative TL was shortened and LINE-1 methylation was decreased in a WT cell line treated with the hypomethylating agent 5-aza-2′-deoxycytidine compared with untreated WT cell line. Conclusion: These results suggest that LINE-1 hypomethylation is common and may be linked to telomere shortening in WT.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jian-Xin Wu
- Department of Biochemistry, Capital Institute of Pediatrics, Beijing 100020, China
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Ooms AHAG, Gadd S, Gerhard DS, Smith MA, Guidry Auvil JM, Meerzaman D, Chen QR, Hsu CH, Yan C, Nguyen C, Hu Y, Ma Y, Zong Z, Mungall AJ, Moore RA, Marra MA, Huff V, Dome JS, Chi YY, Tian J, Geller JI, Mullighan CG, Ma J, Wheeler DA, Hampton OA, Walz AL, van den Heuvel-Eibrink MM, de Krijger RR, Ross N, Gastier-Foster JM, Perlman EJ. Significance of TP53 Mutation in Wilms Tumors with Diffuse Anaplasia: A Report from the Children's Oncology Group. Clin Cancer Res 2016; 22:5582-5591. [PMID: 27702824 PMCID: PMC5290091 DOI: 10.1158/1078-0432.ccr-16-0985] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/17/2016] [Accepted: 08/14/2016] [Indexed: 12/24/2022]
Abstract
PURPOSE To investigate the role and significance of TP53 mutation in diffusely anaplastic Wilms tumors (DAWTs). EXPERIMENTAL DESIGN All DAWTs registered on National Wilms Tumor Study-5 (n = 118) with available samples were analyzed for TP53 mutations and copy loss. Integrative genomic analysis was performed on 39 selected DAWTs. RESULTS Following analysis of a single random sample, 57 DAWTs (48%) demonstrated TP53 mutations, 13 (11%) copy loss without mutation, and 48 (41%) lacked both [defined as TP53-wild-type (wt)]. Patients with stage III/IV TP53-wt DAWTs (but not those with stage I/II disease) had significantly lower relapse and death rates than those with TP53 abnormalities. In-depth analysis of a subset of 39 DAWTs showed seven (18%) to be TP53-wt: These demonstrated gene expression evidence of an active p53 pathway. Retrospective pathology review of TP53-wt DAWT revealed no or very low volume of anaplasia in six of seven tumors. When samples from TP53-wt tumors known to contain anaplasia histologically were available, abnormal p53 protein accumulation was observed by immunohistochemistry. CONCLUSIONS These data support the key role of TP53 loss in the development of anaplasia in WT, and support its significant clinical impact in patients with residual anaplastic tumor following surgery. These data also suggest that most DAWTs will show evidence of TP53 mutation when samples selected for the presence of anaplasia are analyzed. This suggests that modifications of the current criteria to also consider volume of anaplasia and documentation of TP53 aberrations may better reflect the risk of relapse and death and enable optimization of therapeutic stratification. Clin Cancer Res; 22(22); 5582-91. ©2016 AACR.
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Affiliation(s)
- Ariadne H A G Ooms
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois
- Princess Maxima Centre for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pathology, Pathan BV, Sint Franciscus Gasthuis, Rotterdam, the Netherlands
| | - Samantha Gadd
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois
| | - Daniela S Gerhard
- Office of Cancer Genomics, National Cancer Institute, Bethesda, Maryland
| | - Malcolm A Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland
| | | | - Daoud Meerzaman
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland
| | - Qing-Rong Chen
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland
| | - Chih Hao Hsu
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland
| | - Chunhua Yan
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland
| | - Cu Nguyen
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland
| | - Ying Hu
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland
| | - Yussanne Ma
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
| | - Zusheng Zong
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
| | - Andrew J Mungall
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
| | - Richard A Moore
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency (BCCA), Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vicki Huff
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S Dome
- Division of Pediatric Hematology/Oncology, Children's National Medical Center, Washington, DC
| | - Yueh-Yun Chi
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Jing Tian
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - James I Geller
- Division of Pediatric Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Charles G Mullighan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jing Ma
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - David A Wheeler
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Oliver A Hampton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas
| | - Amy L Walz
- Division of Hematology-Oncology and Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, Chicago, Illinois
- Northwestern Medicine Developmental Therapeutics Institute, Northwestern Memorial Hospital, Chicago, Illinois
| | | | - Ronald R de Krijger
- Princess Maxima Centre for Pediatric Oncology, Utrecht, the Netherlands
- Department of Pathology, Reinier de Graaf Hospital, Delft, the Netherlands
| | - Nicole Ross
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio
| | - Julie M Gastier-Foster
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio
- Departments of Pathology and Pediatrics, Ohio State University College of Medicine, Columbus, Ohio
| | - Elizabeth J Perlman
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois.
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Brok J, Treger TD, Gooskens SL, van den Heuvel-Eibrink MM, Pritchard-Jones K. Biology and treatment of renal tumours in childhood. Eur J Cancer 2016; 68:179-195. [PMID: 27969569 DOI: 10.1016/j.ejca.2016.09.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 08/25/2016] [Accepted: 09/01/2016] [Indexed: 02/08/2023]
Abstract
In Europe, almost 1000 children are diagnosed with a malignant renal tumour each year. The vast majority of cases are nephroblastoma, also known as Wilms' tumour (WT). Most children are treated according to Société Internationale d'Oncologie Pédiatrique Renal Tumour Study Group (SIOP-RTSG) protocols with pre-operative chemotherapy, surgery, and post-operative treatment dependent on stage and histology. Overall survival approaches 90%, but a subgroup of WT, with high-risk histology and/or relapsed disease, still have a much poorer prognosis. Outcome is similarly poor for the rare non-WT, particularly for malignant rhabdoid tumour of the kidney, metastatic clear cell sarcoma of the kidney (CCSK), and metastatic renal cell carcinoma (RCC). Improving outcome and long-term quality of life requires more accurate risk stratification through biological insights. Biomarkers are also needed to signpost potential targeted therapies for high-risk subgroups. Our understanding of Wilms' tumourigenesis is evolving and several signalling pathways, microRNA processing and epigenetics are now known to play pivotal roles. Most rhabdoid tumours display somatic and/or germline mutations in the SMARCB1 gene, whereas CCSK and paediatric RCC reveal a more varied genetic basis, including characteristic translocations. Conducting early-phase trials of targeted therapies is challenging due to the scarcity of patients with refractory or relapsed disease, the rapid progression of relapse and the genetic heterogeneity of the tumours with a low prevalence of individual somatic mutations. A further consideration in improving population survival rates is the geographical variation in outcomes across Europe. This review provides a comprehensive overview of the current biological knowledge of childhood renal tumours alongside the progress achieved through international collaboration. Ongoing collaboration is needed to ensure consistency of outcomes through standardised diagnostics and treatment and incorporation of biomarker research. Together, these objectives constitute the rationale for the forthcoming SIOP-RTSG 'UMBRELLA' study.
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Affiliation(s)
- Jesper Brok
- Cancer Section, University College London, Institute of Child Health, UK; Department of Paediatric Haematology and Oncology, Rigshospitalet, Copenhagen University Hospital, Denmark.
| | - Taryn D Treger
- Cancer Section, University College London, Institute of Child Health, UK
| | - Saskia L Gooskens
- Department of Paediatric Oncology, Princess Máxima Center for Pediatric Oncology and University of Utrecht, The Netherlands; Department of Paediatric Haematology and Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- Department of Paediatric Oncology, Princess Máxima Center for Pediatric Oncology and University of Utrecht, The Netherlands
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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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Chagtai T, Zill C, Dainese L, Wegert J, Savola S, Popov S, Mifsud W, Vujanić G, Sebire N, Le Bouc Y, Ambros PF, Kager L, O'Sullivan MJ, Blaise A, Bergeron C, Mengelbier LH, Gisselsson D, Kool M, Tytgat GAM, van den Heuvel-Eibrink MM, Graf N, van Tinteren H, Coulomb A, Gessler M, Williams RD, Pritchard-Jones K. Gain of 1q As a Prognostic Biomarker in Wilms Tumors (WTs) Treated With Preoperative Chemotherapy in the International Society of Paediatric Oncology (SIOP) WT 2001 Trial: A SIOP Renal Tumours Biology Consortium Study. J Clin Oncol 2016; 34:3195-203. [PMID: 27432915 PMCID: PMC5505170 DOI: 10.1200/jco.2015.66.0001] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE Wilms tumor (WT) is the most common pediatric renal tumor. Treatment planning under International Society of Paediatric Oncology (SIOP) protocols is based on staging and histologic assessment of response to preoperative chemotherapy. Despite high overall survival (OS), many relapses occur in patients without specific risk factors, and many successfully treated patients are exposed to treatments with significant risks of late effects. To investigate whether molecular biomarkers could improve risk stratification, we assessed 1q status and other potential copy number biomarkers in a large WT series. MATERIALS AND METHODS WT nephrectomy samples from 586 SIOP WT 2001 patients were analyzed using a multiplex ligation-dependent probe amplification (MLPA) assay that measured the copy number of 1q and other regions of interest. RESULTS One hundred sixty-seven (28%) of 586 WTs had 1q gain. Five-year event-free survival (EFS) was 75.0% in patients with 1q gain (95% CI, 68.5% to 82.0%) and 88.2% in patients without gain (95% CI, 85.0% to 91.4%). OS was 88.4% with gain (95% CI, 83.5% to 93.6%) and 94.4% without gain (95% CI, 92.1% to 96.7%). In univariable analysis, 1q gain was associated with poorer EFS (P < .001; hazard ratio, 2.33) and OS (P = .01; hazard ratio, 2.16). The association of 1q gain with poorer EFS retained significance in multivariable analysis adjusted for 1p and 16q loss, sex, stage, age, and histologic risk group. Gain of 1q remained associated with poorer EFS in tumor subsets limited to either intermediate-risk localized disease or nonanaplastic localized disease. Other notable aberrations associated with poorer EFS included MYCN gain and TP53 loss. CONCLUSION Gain of 1q is a potentially valuable prognostic biomarker in WT, in addition to histologic response to preoperative chemotherapy and tumor stage.
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Affiliation(s)
- Tasnim Chagtai
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Christina Zill
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Linda Dainese
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Jenny Wegert
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Suvi Savola
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Sergey Popov
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - William Mifsud
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Gordan Vujanić
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Neil Sebire
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Yves Le Bouc
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Peter F Ambros
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Leo Kager
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Maureen J O'Sullivan
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Annick Blaise
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Christophe Bergeron
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Linda Holmquist Mengelbier
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - David Gisselsson
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Marcel Kool
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Godelieve A M Tytgat
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Marry M van den Heuvel-Eibrink
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Norbert Graf
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Harm van Tinteren
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Aurore Coulomb
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Manfred Gessler
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Richard Dafydd Williams
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden
| | - Kathy Pritchard-Jones
- Tasnim Chagtai, William Mifsud, Neil Sebire, Richard Dafydd Williams, and Kathy Pritchard-Jones, University College London Institute of Child Health, London; Sergey Popov, University Hospital of Wales; Gordan Vujanić, Cardiff University School of Medicine, Cardiff, United Kingdom; Christina Zill, Jenny Wegert, and Manfred Gessler, Wuerzburg University, Wuerzburg; Marcel Kool, German Cancer Research Center, Heidelberg; Norbert Graf, Saarland University Hospital, Homburg, Germany; Linda Dainese, Yves Le Bouc, Annick Blaise, and Aurore Coulomb, Sorbonne Universités; Linda Dainese, Yves Le Bouc, and Aurore Coulomb, Assistance Publique Hôpitaux de Paris-Hôpital Armand Trousseau, Paris; Christophe Bergeron, Centre Léon Bérard, Lyon, France; Suvi Savola, MRC-Holland; Harm van Tinteren, Netherlands Cancer Institute, Amsterdam; Godelieve A.M. Tytgat and Marry M. van den Heuvel-Eibrink, Princess Maxima Center for Pediatric Oncology/Hematology, Utrecht, the Netherlands; Peter F. Ambros and Leo Kager, Children's Cancer Research Institute; Leo Kager, St Anna Children's Hospital, Vienna, Austria; Maureen J. O'Sullivan, Our Lady's Children's Hospital, Dublin, Ireland; and Linda Holmquist Mengelbier and David Gisselsson, Lund University, Lund, Sweden.
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Cresswell GD, Apps JR, Chagtai T, Mifsud B, Bentley CC, Maschietto M, Popov SD, Weeks ME, Olsen ØE, Sebire NJ, Pritchard-Jones K, Luscombe NM, Williams RD, Mifsud W. Intra-Tumor Genetic Heterogeneity in Wilms Tumor: Clonal Evolution and Clinical Implications. EBioMedicine 2016; 9:120-129. [PMID: 27333041 PMCID: PMC4972528 DOI: 10.1016/j.ebiom.2016.05.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/23/2016] [Accepted: 05/25/2016] [Indexed: 11/30/2022] Open
Abstract
The evolution of pediatric solid tumors is poorly understood. There is conflicting evidence of intra-tumor genetic homogeneity vs. heterogeneity (ITGH) in a small number of studies in pediatric solid tumors. A number of copy number aberrations (CNA) are proposed as prognostic biomarkers to stratify patients, for example 1q+ in Wilms tumor (WT); current clinical trials use only one sample per tumor to profile this genetic biomarker. We multisampled 20 WT cases and assessed genome-wide allele-specific CNA and loss of heterozygosity, and inferred tumor evolution, using Illumina CytoSNP12v2.1 arrays, a custom analysis pipeline, and the MEDICC algorithm. We found remarkable diversity of ITGH and evolutionary trajectories in WT. 1q+ is heterogeneous in the majority of tumors with this change, with variable evolutionary timing. We estimate that at least three samples per tumor are needed to detect >95% of cases with 1q+. In contrast, somatic 11p15 LOH is uniformly an early event in WT development. We find evidence of two separate tumor origins in unilateral disease with divergent histology, and in bilateral WT. We also show subclonal changes related to differential response to chemotherapy. Rational trial design to include biomarkers in risk stratification requires tumor multisampling and reliable delineation of ITGH and tumor evolution.
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Affiliation(s)
| | - John R Apps
- UCL Institute of Child Health, London, United Kingdom; Department of Paediatric Haematology and Oncology, Great Ormond Street Hospital, London, United Kingdom
| | | | | | - Christopher C Bentley
- The Francis Crick Institute, London, United Kingdom; UCL Genetics Institute, Department of Genetics, Evolution & Environment, University College London, United Kingdom
| | | | - Sergey D Popov
- Divisions of Molecular Pathology and Cancer Therapeutics, Institute of Cancer Research, London, United Kingdom
| | - Mark E Weeks
- UCL Institute of Child Health, London, United Kingdom
| | - Øystein E Olsen
- Department of Radiology, Great Ormond Street Hospital, London, United Kingdom
| | - Neil J Sebire
- UCL Institute of Child Health, London, United Kingdom; Department of Histopathology, Great Ormond Street Hospital, London, United Kingdom
| | - Kathy Pritchard-Jones
- UCL Institute of Child Health, London, United Kingdom; Department of Paediatric Haematology and Oncology, Great Ormond Street Hospital, London, United Kingdom
| | - Nicholas M Luscombe
- The Francis Crick Institute, London, United Kingdom; UCL Genetics Institute, Department of Genetics, Evolution & Environment, University College London, United Kingdom; Okinawa Institute of Science & Technology, Okinawa, Japan
| | | | - William Mifsud
- UCL Institute of Child Health, London, United Kingdom; Department of Histopathology, Great Ormond Street Hospital, London, United Kingdom.
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Abstract
PURPOSE Wilms tumor is the most common childhood renal malignancy and the fourth most common childhood cancer. Many biomarkers have been studied but there has been no comprehensive summary. We systematically reviewed the literature on biomarkers in Wilms tumor to quantify the prognostic implications of the presence of individual tumor markers. MATERIALS AND METHODS We searched for English language studies from 1980 to 2015 performed in patients younger than 18 years with Wilms tumor and prognostic data. The protocol was conducted per PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Two reviewers abstracted data in duplicate using a standard evaluation form. We performed descriptive statistics, then calculated relative risks and 95% confidence intervals for markers appearing in multiple level II or III studies. RESULTS A total of 40 studies were included examining 32 biomarkers in 7,381 patients with Wilms tumor. Studies had a median of 61 patients, 24 biomarker positive patients per series and a median followup of 68.4 months. Median percentages of patients with stages 1, 2, 3, 4 and 5 tumors were 28.5%, 26.4%, 24.5%, 14.1% and 1.7%, respectively, and 10.2% had anaplasia. The strongest negative prognostic association was loss of heterozygosity at 11p15, with a risk of recurrence of 5.00, although loss of heterozygosity at 1p and gain of function at 1q were also strongly linked to increased recurrence (2.93 and 2.86, respectively). CONCLUSIONS Several tumor markers are associated with an increased risk of recurrence or a decreased risk of overall survival in patients with Wilms tumor. These data suggest targets for development of diagnostic tests and potential therapies.
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Deng C, Dai R, Li X, Liu F. Genetic variation frequencies in Wilms' tumor: A meta-analysis and systematic review. Cancer Sci 2016; 107:690-9. [PMID: 26892980 PMCID: PMC4970837 DOI: 10.1111/cas.12910] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/11/2016] [Accepted: 02/12/2016] [Indexed: 12/11/2022] Open
Abstract
Over the last few decades, numerous biomarkers in Wilms' tumor have been confirmed and shown variations in prevalence. Most of these studies were based on small sample sizes. We carried out a meta-analysis of the research published from 1992 to 2015 to obtain more precise and comprehensive outcomes for genetic tests. In the present study, 70 out of 5175 published reports were eligible for the meta-analysis, which was carried out using Stata 12.0 software. Pooled prevalence for gene mutations WT1, WTX, CTNNB1, TP53, MYCN, DROSHA, and DGCR8 was 0.141 (0.104, 0.178), 0.147 (0.110, 0.184), 0.140 (0.100, 0.190), 0.410 (0.214, 0.605), 0.071 (0.041, 0.100), 0.082 (0.048, 0.116), and 0.036 (0.026, 0.046), respectively. Pooled prevalence of loss of heterozygosity at 1p, 11p, 11q, 16q, and 22q was 0.109 (0.084, 0.133), 0.334 (0.295, 0.373), 0.199 (0.146, 0.252), 0.151 (0.129, 0.172), and 0.148 (0.108, 0.189), respectively. Pooled prevalence of 1q and chromosome 12 gain was 0.218 (0.161, 0.275) and 0.273 (0.195, 0.350), respectively. The limited prevalence of currently known genetic alterations in Wilms' tumors indicates that significant drivers of initiation and progression remain to be discovered. Subgroup analyses indicated that ethnicity may be one of the sources of heterogeneity. However, in meta-regression analyses, no study-level characteristics of indicators were found to be significant. In addition, the findings of our sensitivity analysis and possible publication bias remind us to interpret results with caution.
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Affiliation(s)
- Changkai Deng
- Department of Urology Surgery, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorder, Key Laboratory of Pediatrics in Chongqing (CSTC2009CA5002), Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China.,Chengdu Women and Children's Central Hospital, Chengdu, China
| | - Rong Dai
- Chengdu Center for Disease Control and Prevention, Chengdu, China
| | - Xuliang Li
- Department of Urology Surgery, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorder, Key Laboratory of Pediatrics in Chongqing (CSTC2009CA5002), Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Feng Liu
- Department of Urology Surgery, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorder, Key Laboratory of Pediatrics in Chongqing (CSTC2009CA5002), Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
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Krepischi ACV, Maschietto M, Ferreira EN, Silva AG, Costa SS, da Cunha IW, Barros BDF, Grundy PE, Rosenberg C, Carraro DM. Genomic imbalances pinpoint potential oncogenes and tumor suppressors in Wilms tumors. Mol Cytogenet 2016; 9:20. [PMID: 26913079 PMCID: PMC4765068 DOI: 10.1186/s13039-016-0227-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/06/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Wilms tumor (WT) has a not completely elucidated pathogenesis. DNA copy number alterations (CNAs) are common in cancer, and often define key pathogenic events. The aim of this work was to investigate CNAs in order to disclose new candidate genes for Wilms tumorigenesis. RESULTS Array-CGH of 50 primary WTs without pre-chemotherapy revealed a few recurrent CNAs not previously reported, such as 7q and 20q gains, and 7p loss. Genomic amplifications were exclusively detected in 3 cases of WTs that later relapsed, which also exhibited an increased frequency of gains affecting a 16.2 Mb 1q21.1-q23.2 region, losses at 11p, 11q distal, and 16q, and WT1 deletions. Conversely, aneuploidies of chromosomes 13 and 19 were found only in WTs without further relapse. The 1q21.1-q23.2 gain associated with WT relapse harbours genes such as CHD1L, CRABP2, GJA8, MEX3A and MLLT11 that were found to be over-expressed in WTs. In addition, down-regulation of genes encompassed by focal deletions highlighted new potential tumor suppressors such as CNKSR1, MAN1C1, PAQR7 (1p36), TWIST1, SOSTDC1 (7p14.1-p12.2), BBOX and FIBIN (11p13), and PLCG2 (16q). CONCLUSION This study confirmed the presence of CNAs previously related to WT and characterized new CNAs found only in few cases. The later were found in higher frequency in relapsed cases, suggesting that they could be associated with WT progression.
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Affiliation(s)
- A. C. V. Krepischi
- />International Research Center, AC Camargo Cancer Center, São Paulo, Brazil
- />Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - M. Maschietto
- />International Research Center, AC Camargo Cancer Center, São Paulo, Brazil
- />Brazilian Biosciences National Laboratory, National Center for Research in Energy and Materials, Campinas, São Paulo, Brazil
| | - E. N. Ferreira
- />International Research Center, AC Camargo Cancer Center, São Paulo, Brazil
| | - A. G. Silva
- />Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - S. S. Costa
- />Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - I. W. da Cunha
- />Department of Surgical and Investigative Pathology, AC Camargo Cancer Center, São Paulo, Brazil
| | - B. D. F. Barros
- />International Research Center, AC Camargo Cancer Center, São Paulo, Brazil
| | - P. E. Grundy
- />Alberta Health Services, Cancer Control Alberta, Alberta, Canada
| | - C. Rosenberg
- />Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - D. M. Carraro
- />International Research Center, AC Camargo Cancer Center, São Paulo, Brazil
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Perlman EJ, Gadd S, Arold ST, Radhakrishnan A, Gerhard DS, Jennings L, Huff V, Guidry Auvil JM, Davidsen TM, Dome JS, Meerzaman D, Hsu CH, Nguyen C, Anderson J, Ma Y, Mungall AJ, Moore RA, Marra MA, Mullighan CG, Ma J, Wheeler DA, Hampton OA, Gastier-Foster JM, Ross N, Smith MA. MLLT1 YEATS domain mutations in clinically distinctive Favourable Histology Wilms tumours. Nat Commun 2015; 6:10013. [PMID: 26635203 PMCID: PMC4686660 DOI: 10.1038/ncomms10013] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 10/23/2015] [Indexed: 12/11/2022] Open
Abstract
Wilms tumour is an embryonal tumour of childhood that closely resembles the developing kidney. Genomic changes responsible for the development of the majority of Wilms tumours remain largely unknown. Here we identify recurrent mutations within Wilms tumours that involve the highly conserved YEATS domain of MLLT1 (ENL), a gene known to be involved in transcriptional elongation during early development. The mutant MLLT1 protein shows altered binding to acetylated histone tails. Moreover, MLLT1-mutant tumours show an increase in MYC gene expression and HOX dysregulation. Patients with MLLT1-mutant tumours present at a younger age and have a high prevalence of precursor intralobar nephrogenic rests. These data support a model whereby activating MLLT1 mutations early in renal development result in the development of Wilms tumour.
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Affiliation(s)
- Elizabeth J. Perlman
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, Illinosis 60611, USA
| | - Samantha Gadd
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, Illinosis 60611, USA
| | - Stefan T. Arold
- King Abdullah University of Science and Technology, Department of Biochemistry and Molecular Biology, Division of Biological and Environmental Sciences and Engineering, Computational Bioscience Research Center, Thuwal 23955, Saudi Arabia
| | - Anand Radhakrishnan
- King Abdullah University of Science and Technology, Department of Biochemistry and Molecular Biology, Division of Biological and Environmental Sciences and Engineering, Computational Bioscience Research Center, Thuwal 23955, Saudi Arabia
| | - Daniela S. Gerhard
- Office of Cancer Genomics, National Cancer Institute, 31 Center Drive, Bethesda, Maryland 20892, USA
| | - Lawrence Jennings
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, Illinosis 60611, USA
| | - Vicki Huff
- Department of Genetics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, Texas 77030, USA
| | - Jaime M. Guidry Auvil
- Office of Cancer Genomics, National Cancer Institute, 31 Center Drive, Bethesda, Maryland 20892, USA
| | - Tanja M. Davidsen
- Office of Cancer Genomics, National Cancer Institute, 31 Center Drive, Bethesda, Maryland 20892, USA
| | - Jeffrey S. Dome
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, Children's National Medical Center, 111 Michigan Avenue, NW, Washington DC 20010, USA
| | - Daoud Meerzaman
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, Maryland 20892, USA
| | - Chih Hao Hsu
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, Maryland 20892, USA
| | - Cu Nguyen
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, Bethesda, Maryland 20892, USA
| | - James Anderson
- Frontier Science and Technology Research Foundation, 505 S. Rosa Rd #100, Madison, Wisconsin 53719, USA
| | - Yussanne Ma
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada V5Z 4S6
| | - Andrew J. Mungall
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada V5Z 4S6
| | - Richard A. Moore
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada V5Z 4S6
| | - Marco A. Marra
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, British Columbia, Canada V5Z 4S6
| | - Charles G. Mullighan
- Department of Pathology, St Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 342, Memphis, Tennessee 38105, USA
| | - Jing Ma
- Department of Pathology, St Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 342, Memphis, Tennessee 38105, USA
| | - David A. Wheeler
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio 43205, USA
| | - Oliver A. Hampton
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio 43205, USA
| | - Julie M. Gastier-Foster
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
- Departments of Pathology and Pediatrics, Ohio State University College of Medicine, 700 Children's Drive, Columbus, Ohio 43205, USA
| | - Nicole Ross
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas 77030, USA
| | - Malcolm A. Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, 9609 Medical Center Drive, RM 5-W414, MSC 9737, Bethesda, Maryland 20892, USA
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Dome JS, Perlman EJ, Graf N. Risk stratification for wilms tumor: current approach and future directions. Am Soc Clin Oncol Educ Book 2015:215-23. [PMID: 24857079 DOI: 10.14694/edbook_am.2014.34.215] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Wilms tumor, or nephroblastoma, has provided a paradigm for progressive improvement in clinical outcomes achieved through serial cooperative group studies. With modern surgery, chemotherapy, and radiation therapy approaches, the overall survival rate for patients with Wilms tumor has reached 90%. Remarkably, the increase in survival has been achieved with a reduction in therapy for most patient subgroups, leading not only to more survivors, but also to healthier survivors. A key contributor to improved outcomes has been the development of clinical and biologic prognostic markers that have enabled risk-directed therapy. Whereas the early cooperative group studies used only tumor stage for risk stratification, current Children's Oncology Group (COG) and International Society of Pediatric Oncology (SIOP) protocols employ a multitude of prognostic factors to guide therapy. Prognostic factors used in the current generation of COG studies include stage, histology, patient age, tumor weight, completeness of lung nodule response, and loss of heterozygosity at chromosomes 1p and 16q. Future COG studies seek to incorporate gain of chromosome 1q and methylation pattern of chromosome 11p15 into the risk classification schema. Prognostic factors used in the current SIOP studies include stage, histology, tumor volume, and responsiveness to therapy. Future SIOP studies seek to incorporate absolute blastemal volume and novel molecular markers for resistant blastema into the risk stratification approach.
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Affiliation(s)
- Jeffrey S Dome
- From the Division of Oncology, Children's National Medical Center, Washington DC; Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatric Oncology and Hematology, Saarland University, Homburg, Germany
| | - Elizabeth J Perlman
- From the Division of Oncology, Children's National Medical Center, Washington DC; Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatric Oncology and Hematology, Saarland University, Homburg, Germany
| | - Norbert Graf
- From the Division of Oncology, Children's National Medical Center, Washington DC; Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatric Oncology and Hematology, Saarland University, Homburg, Germany
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Dome JS, Graf N, Geller JI, Fernandez CV, Mullen EA, Spreafico F, Van den Heuvel-Eibrink M, Pritchard-Jones K. Advances in Wilms Tumor Treatment and Biology: Progress Through International Collaboration. J Clin Oncol 2015; 33:2999-3007. [PMID: 26304882 PMCID: PMC4567702 DOI: 10.1200/jco.2015.62.1888] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Clinical trials in Wilms tumor (WT) have resulted in overall survival rates of greater than 90%. This achievement is especially remarkable because improvements in disease-specific survival have occurred concurrently with a reduction of therapy for large patient subgroups. However, the outcomes for certain patient subgroups, including those with unfavorable histologic and molecular features, bilateral disease, and recurrent disease, remain well below the benchmark survival rate of 90%. Therapy for WT has been advanced in part by an increasingly complex risk-stratification system based on patient age; tumor stage, histology, and volume; response to chemotherapy; and loss of heterozygosity at chromosomes 1p and 16q. A consequence of this system has been the apportionment of patients into such small subgroups that only collaboration between large international WT study groups will support clinical trials that are sufficiently powered to answer challenging questions that move the field forward. This article gives an overview of the Children's Oncology Group and International Society of Pediatric Oncology approaches to WT and focuses on four subgroups (stage IV, initially inoperable, bilateral, and relapsed WT) for which international collaboration is pressing. In addition, biologic insights resulting from collaborative laboratory research are discussed. A coordinated expansion of international collaboration in both clinical trials and laboratory science will provide real opportunity to improve the treatment and outcomes for children with renal tumors on a global level.
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Affiliation(s)
- Jeffrey S Dome
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom.
| | - Norbert Graf
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom
| | - James I Geller
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom
| | - Conrad V Fernandez
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom
| | - Elizabeth A Mullen
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom
| | - Filippo Spreafico
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom
| | - Marry Van den Heuvel-Eibrink
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom
| | - Kathy Pritchard-Jones
- Jeffrey S. Dome, Children's National Health System, Washington, DC; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber Cancer Institute, Boston, MA; Norbert Graf, Saarland University, Homburg, Germany; Conrad V. Fernandez, IWK Health Centre, Halifax, Nova Scotia, Canada; Filippo Spreafico, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Nazionale dei Tumori, Milan, Italy; Marry Van den Heuvel-Eibrink, Princess Màxima Center for Pediatric Oncology, Utrecht, the Netherlands; and Kathy Pritchard-Jones, University College London Institute of Child Health, London, United Kingdom
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49
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Lovvorn HN, Pierce J, Libes J, Li B, Wei Q, Correa H, Gouffon J, Clark PE, Axt JR, Hansen E, Newton M, O'Neill JA. Genetic and chromosomal alterations in Kenyan Wilms Tumor. Genes Chromosomes Cancer 2015; 54:702-15. [PMID: 26274016 PMCID: PMC4567398 DOI: 10.1002/gcc.22281] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 06/08/2015] [Accepted: 06/08/2015] [Indexed: 12/31/2022] Open
Abstract
Wilms tumor (WT) is the most common childhood kidney cancer worldwide and poses a cancer health disparity to black children of sub-Saharan African ancestry. Although overall survival from WT at 5 years exceeds 90% in developed countries, this pediatric cancer is alarmingly lethal in sub-Saharan Africa and specifically in Kenya (36% survival at 2 years). Although multiple barriers to adequate WT therapy contribute to this dismal outcome, we hypothesized that a uniquely aggressive and treatment-resistant biology compromises survival further. To explore the biologic composition of Kenyan WT (KWT), we completed a next generation sequencing analysis targeting 10 WT-associated genes and evaluated whole-genome copy number variation. The study cohort was comprised of 44 KWT patients and their specimens. Fourteen children are confirmed dead at 2 years and 11 remain lost to follow-up despite multiple tracing attempts. TP53 was mutated most commonly in 11 KWT specimens (25%), CTNNB1 in 10 (23%), MYCN in 8 (18%), AMER1 in 5 (11%), WT1 and TOP2A in 4 (9%), and IGF2 in 3 (7%). Loss of heterozygosity (LOH) at 17p, which covers TP53, was detected in 18% of specimens examined. Copy number gain at 1q, a poor prognostic indicator of WT biology in developed countries, was detected in 32% of KWT analyzed, and 89% of these children are deceased. Similarly, LOH at 11q was detected in 32% of KWT, and 80% of these patients are deceased. From this genomic analysis, KWT biology appears uniquely aggressive and treatment-resistant.
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Affiliation(s)
- Harold N Lovvorn
- Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Janene Pierce
- Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Jaime Libes
- Department of Pediatrics, University of Illinois College of Medicine, Peoria, IL.,Division of Hematology/Oncology, University of Illinois College of Medicine, Peoria, IL
| | - Bingshan Li
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Qiang Wei
- Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN
| | - Hernan Correa
- Division of Pediatric Pathology, Vanderbilt University School of Medicine, Nashville, TN
| | | | - Peter E Clark
- Department of Urologic Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Jason R Axt
- Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Erik Hansen
- Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN
| | - Mark Newton
- Division of Pediatric Anesthesia, Vanderbilt University School of Medicine, Nashville, TN
| | - James A O'Neill
- Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN
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50
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Romao RLP, Lorenzo AJ. Renal function in patients with Wilms tumor. Urol Oncol 2015; 34:33-41. [PMID: 26278364 DOI: 10.1016/j.urolonc.2015.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 12/18/2022]
Abstract
Survival in patients with Wilms tumor (WT) is excellent compared with other pediatric malignancies and adult renal tumors. Treatment-related long-term morbidity and mortality in WT survivors is an area of increasing concern. Renal dysfunction is an example of one of the most feared long-term issues observed in these survivors. Direct toxicity from chemotherapy and radiation as well as direct nephron ablation from surgical treatment (nephrectomy) renders the kidney susceptible to a multitude of problems over time in patients with WT. In this article, we review the existing literature pertaining to renal function in these patients. Incidence rates, causes, and methods to mitigate renal dysfunction are presented in 3 distinct clinical situations: sporadic unilateral WT, syndromic unilateral WT, and bilateral WT. We also offer a critical lens on the current role of nephron-sparing surgery as a means to preserve renal function in these patients. Finally, we discuss potential avenues for refining renal function preservation in patients with WT in the future. We conclude that: (1) renal function in pediatric cancer survivors must be carefully ascertained prospectively using methods that allow diagnosis of mild cases (rather than focus solely on extreme cases represented by the development of end-stage renal disease), (2) every effort should be made to recognize subtle features of predisposition syndromes to avoid syndromic cases from being misclassified and treated as sporadic, (3) molecular stratification for disease aggressiveness as well as multifocality and renal dysfunction will be very important to tailor treatment and balance survival with preservation of renal function, and (4) the role and potential benefits of nephron-sparing surgery deserves careful exploration under well-designed protocols.
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Affiliation(s)
- Rodrigo L P Romao
- Division of Urology, Division of Pediatric General Surgery, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Armando J Lorenzo
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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