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Wojcik HM, Lovvorn HN, Hollingshead M, Pierce J, Stotler H, Murphy AJ, Borgel S, Phelps HM, Correa H, Perantoni AO. Exploiting embryonic niche conditions to grow Wilms tumor blastema in culture. Front Oncol 2023; 13:1091274. [PMID: 37007076 PMCID: PMC10061139 DOI: 10.3389/fonc.2023.1091274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionWilms Tumor (WT), or nephroblastoma, is the most common pediatric kidney cancer. Most WTs display a “favorable” triphasic histology, in which the tumor is comprised of blastemal, stromal, and epithelial cell types. Blastemal predominance after neoadjuvant chemotherapy or diffuse anaplasia (“unfavorable” histology; 5-8%) portend a worse prognosis. Blastema likely provide the putative cancer stem cells (CSCs), which retain molecular and histologic features characteristic of nephron progenitor cells (NPCs), within WTs. NPCs arise in the metanephric mesenchyme (MM) and populate the cap mesenchyme (CM) in the developing kidney. WT blastemal cells, like NPCs, similarly express markers, SIX2 and CITED1. Tumor xenotransplantation is currently the only dependable method to propagate tumor tissue for research or therapeutic screening, since efforts to culture tumors in vitro as monolayers have invariably failed. Therefore, a critical need exists to propagate WT stem cells rapidly and efficiently for high-throughput, real-time drug screening.MethodsPreviously, our lab developed niche conditions that support the propagation of murine NPCs in culture. Applying similar conditions to WTs, we assessed our ability to maintain key NPC "stemness" markers, SIX2, NCAM, and YAP1, and CSC marker ALDHI in cells from five distinct untreated patient tumors.ResultsAccordingly, our culture conditions maintained the expression of these markers in cultured WT cells through multiple passages of rapidly dividing cells.DiscussionThese findings suggest that our culture conditions sustain the WT blastemal population, as previously shown for normal NPCs. As a result, we have developed new WT cell lines and a multi-passage in vitro model for studying the blastemal lineage/CSCs in WTs. Furthermore, this system supports growth of heterogeneous WT cells, upon which potential drug therapies could be tested for efficacy and resistance.
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Affiliation(s)
- Heather M. Wojcik
- Cancer and Developmental Biology Laboratory, National Cancer Institute, Frederick, MD, United States
| | - Harold N. Lovvorn
- Department of Pediatric Surgery, Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, TN, United States
| | - Melinda Hollingshead
- Biological Testing Branch/Developmental Therapeutics Program, National Cancer Institute, Frederick, MD, United States
| | - Janene Pierce
- Department of Pediatric Surgery, Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, TN, United States
| | - Howard Stotler
- Leidos Biomedical Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Andrew J. Murphy
- Department of Pediatric Surgery, Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, TN, United States
| | - Suzanne Borgel
- Leidos Biomedical Research, National Cancer Institute at Frederick, Frederick, MD, United States
| | - Hannah M. Phelps
- Department of Pediatric Surgery, Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, TN, United States
| | - Hernan Correa
- Division of Pediatric Pathology, Monroe Carell Jr. Children’s Hospital at Vanderbilt University, Nashville, TN, United States
| | - Alan O. Perantoni
- Cancer and Developmental Biology Laboratory, National Cancer Institute, Frederick, MD, United States
- *Correspondence: Alan O. Perantoni,
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Ceylan O, Caglar O. Importance of COX-2 expression in Wilms' tumour: A preliminary study. Int J Clin Pract 2021; 75:e14146. [PMID: 33713389 DOI: 10.1111/ijcp.14146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/10/2021] [Accepted: 03/07/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES In Wilms' tumour (WT), secondary malignancies caused by the side effects of intensive treatments remain one of the important problems. Therefore, there is a need for new studies to identify low- and high-risk groups for WT and to improve the treatment regimens of children in the low-risk group. In our study, we aimed to determine the prognostic significance of the cyclooxygenase-2 (COX-2) biomarker in WT. MATERIALS AND METHODS Our study included 24 patients diagnosed with WT between January 2010 and December 2019. The correlation between COX-2 expression and significant prognostic parameters was investigated by studying the COX-2 antibody using the immunohistochemical method. RESULTS COX-2 expression was observed in 22 of the patients and it was more evident in the epithelial component. No significant correlation was observed between COX-2 positivity and prognostic parameters. There was also no statistically significant difference between the two groups regarding survival (P = .563). CONCLUSIONS In our study, no significant relationship was found between significant prognostic parameters and COX-2 expression. Since COX-2 expression was observed in almost all patients, we consider that the COX-2 pathway is effective during the development phase of WT.
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Affiliation(s)
- Onur Ceylan
- Department of Pathology, Ataturk University, Faculty of Medicine Erzurum, Erzurum, Turkey
| | - Ozgur Caglar
- Department of Pediatric Surgery, Ataturk University, Faculty of Medicine, Erzurum, Turkey
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Huang J, Zhang Y, Zhen Z, Lu S, Zhu J, Wang J, Sun F, Liu Z, Gao Y, Li H, Zhang Y, Sun X. The prognosis of prechemotherapy blastemal predominant histology subtype in Wilms tumor: A retrospective study in China. Pediatr Blood Cancer 2020; 67:e28567. [PMID: 32813315 DOI: 10.1002/pbc.28567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 11/06/2022]
Abstract
PURPOSE This study aimed to retrospectively analyze survival outcomes for Chinese patients with prechemotherapy blastemal predominant histology type Wilms tumors (WTs). METHODS We collected and analyzed clinical data concerning patients aged <15 years with favorable histology (FH) WTs treated at the Sun Yat-Sen University Cancer Center from December 2005 to May 2016, based on the Children's Oncology Group protocol. Pathological specimens were collected through biopsy or surgical resection before initiation of chemotherapy. We analyzed survival outcomes involving different prechemotherapy histology subtypes. RESULTS We enrolled 97 patients with FH WTs (median follow-up, 71.5 months; range, 22.2-170.7). The total recurrence rate was 17.5%, and the subtype recurrence rates were as follows: blastemal predominant (45.5%), mixed (7.5%), epithelial (14.3%), and mesenchymal (9.5%) (P = .010). Five-year event-free survival (EFS) and overall survival (OS) rates were 84.9% and 81.4%, respectively. Respective 5-year EFS and OS rates for subtypes were as follows: blastemal predominant (54.5% and 68.2%), mixed (90.0% and 88.9%), epithelial (85.7% and 85.1%), and mesenchymal (90.5% and 94.7%). Multivariate survival analyses showed that the blastemal predominant subtype was an independent prognostic factor of EFS (P = .001) and OS (P = .017). CONCLUSIONS Our findings showed that prechemotherapy blastemal predominant WTs had higher recurrence and lower EFS and OS rates. Our findings suggested that, albeit with some deficiencies, blastemal predominant histology WT-diagnosed prechemotherapy may have prognostic relevance. Further research into other potential confounding variables are required to determine whether such patients warrant altered risk-stratified therapy.
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Affiliation(s)
- Junting Huang
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Yu Zhang
- Department of Pathology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Zijun Zhen
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Suying Lu
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Jia Zhu
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Juan Wang
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Feifei Sun
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Zhuowei Liu
- Department of Urological, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Yuanhong Gao
- Department of Radiotherapy, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Hui Li
- Department of Imaging, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Yizhuo Zhang
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
| | - Xiaofei Sun
- Department of Pediatric Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, P. R. China
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Herrera Toro N, Peña Aguirre L, Molina CF. Factores asociados a la sobrevida en pacientes con tumor de Wilms. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. El tumor de Wilms es el segundo tumor abdominal más frecuente en la edad pediátrica y responde por más del 90 % de los tumores renales en pediatría. A pesar de que la sobrevida descrita es mayor del 90 %, en nuestro medio encontramos que solo alcanza al 70 %, por lo que deseamos evaluar cuáles son los factores asociados con dichos resultados desfavorables, con el fin de implementar medidas para mejorar la sobrevida de nuestros pacientes.
Métodos. Se realizó un estudio observacional, transversal, en dos centros de alto nivel de atención, que incluyó una muestra de 84 pacientes menores de 15 años, con diagnóstico de tumor de Wilms.
Resultados. Los factores que se asociaron significativamente con un aumento en la probabilidad de morir fueron: no completar el protocolo de quimioterapia, (OR 34; IC95% 3,7-312; p 0,000) y presentar recidiva tumoral (OR 35,7; IC95% 6,9-184; p 0,000). Otros factores que aumentaron esta probabilidad sin alcanzar a ser significativos, pero mostrando una evidente tendencia fueron: presentación bilateral (OR 4,1; IC95% 0,6-5,5; p 0,147), complicaciones quirúrgicas (OR 3,2; IC95% 0,7-14,6; p 0,136), compromiso de ganglios linfáticos en tomografía (OR 2,4; IC95% 0,7-8,4; p 0,139) y las metástasis a distancia (OR 2,5; IC95% 0,7-9; p 0,143).
Discusión. La sobrevida de nuestros niños con tumor de Wilms es menor que la reportada en la literatura mundial, siendo la falla en terminar la quimioterapia, la recidiva y la necesidad de cirugía bilateral, los factores asociados con este desenlace.
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Shin HJ, Kwak JY, Lee E, Lee MJ, Yoon H, Han K, Kim MJ. Texture Analysis to Differentiate Malignant Renal Tumors in Children Using Gray-Scale Ultrasonography Images. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:2205-2212. [PMID: 31076232 DOI: 10.1016/j.ultrasmedbio.2019.03.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/18/2019] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
We assessed the feasibility of texture analysis to differentiate Wilms tumor, clear cell sarcoma and rhabdoid tumor of the kidney in children using gray-scale ultrasonography images. Children who had pre-operative renal ultrasonography images of the three tumors from January 2002 to February 2017 were retrospectively included as the test set, and children with the same criteria from March 2017 to December 2018 were included as the validation set. From histogram and second-order statistics, features were compared between the tumors, and diagnostic performances were assessed. Among a total of 32 children (24 children with Wilms tumors, five children with clear cell sarcomas and three children with rhabdoid tumors) from the test set, features from the second-order statistics showed an area under the curve greater than 0.89 for differentiating Wilms tumor from the others. These features aided in the differentiation of tumor type in the two children with Wilms tumors in the validation set. Therefore, texture analysis from gray-scale ultrasonography images can be used to differentiate Wilms tumors from clear cell sarcomas and rhabdoid tumors in children.
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Affiliation(s)
- Hyun Joo Shin
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Young Kwak
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Eunjung Lee
- Department of Computational Science and Engineering, Yonsei University, Seoul, South Korea
| | - Mi-Jung Lee
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Haesung Yoon
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Kyunghwa Han
- Department of Radiology, Research Institute of Radiological Science, Center for Clinical Imaging Data Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Myung-Joon Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea.
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Buglyó G, Magyar Z, Romicsné Görbe É, Bánusz R, Csóka M, Micsik T, Berki Z, Varga P, Sápi Z, Nagy B. Quantitative RT-PCR-based miRNA profiling of blastemal Wilms' tumors from formalin-fixed paraffin-embedded samples. J Biotechnol 2019; 298:11-15. [PMID: 30959135 DOI: 10.1016/j.jbiotec.2019.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 02/08/2023]
Abstract
Blastemal Wilms' tumors are associated with poor chemo-responsiveness and an adverse prognosis. Our aim was to contribute to the miRNA profiling of the disease, while demonstrating the value of archived formalin-fixed, paraffin-embedded (FFPE) samples as miRNA sources. MiRNA was extracted from tumor and normal tissues of 8 patients diagnosed with blastemal Wilms' tumor in Hungary. A quantitative real-time PCR-based protocol was used to identify miRNAs of interest and study the expression of selected miRNAs in all samples. Profiling of miRNA expression from FFPE samples turned out to be cost-effective in Wilms' tumor, as most miRNAs (including miRNA-194-5p, which was studied in all patients) showed expression alterations similar to the ones reported in the literature. MiR-184 expression was found to be lower than in previous studies, while the downregulation of miR-203a is a novel finding. MiR-184 may be downregulated in a subset of blastemal and other Wilms' tumors. A loss of miR-203a may or may not be specific to blastemal cells, but available evidence hints at its importance in the pathogenesis of Wilms' tumor. It should be considered for inclusion in future studies of miRNA expression.
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Affiliation(s)
- Gergely Buglyó
- Department of Human Genetics, Faculty of Medicine, University of Debrecen, 1 Egyetem tér, 4032, Debrecen, Hungary.
| | - Zsófia Magyar
- Department of Obstetrics and Gynaecology, Baross Street Division, Semmelweis University, 27 Baross utca, 1088, Budapest, Hungary.
| | - Éva Romicsné Görbe
- Department of Obstetrics and Gynaecology, Baross Street Division, Semmelweis University, 27 Baross utca, 1088, Budapest, Hungary.
| | - Rita Bánusz
- 2(nd) Department of Paediatrics, Semmelweis University, 7-9 Tűzoltó utca, 1094, Budapest, Hungary.
| | - Monika Csóka
- 2(nd) Department of Paediatrics, Semmelweis University, 7-9 Tűzoltó utca, 1094, Budapest, Hungary.
| | - Tamás Micsik
- 1(st) Department of Pathology and Experimental Cancer Research, Semmelweis University, 26 Üllői út, 1085, Budapest, Hungary.
| | - Zsanett Berki
- Department of Human Genetics, Faculty of Medicine, University of Debrecen, 1 Egyetem tér, 4032, Debrecen, Hungary.
| | - Péter Varga
- Department of Obstetrics and Gynaecology, Baross Street Division, Semmelweis University, 27 Baross utca, 1088, Budapest, Hungary.
| | - Zoltán Sápi
- 1(st) Department of Pathology and Experimental Cancer Research, Semmelweis University, 26 Üllői út, 1085, Budapest, Hungary.
| | - Bálint Nagy
- Department of Human Genetics, Faculty of Medicine, University of Debrecen, 1 Egyetem tér, 4032, Debrecen, Hungary.
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Koshinaga T, Takimoto T, Okita H, Tanaka Y, Inoue E, Oue T, Nozaki M, Tsuchiya K, Haruta M, Kaneko Y, Fukuzawa M. Blastemal predominant type Wilms tumor in Japan: Japan Children's Cancer Group. Pediatr Int 2019; 61:351-357. [PMID: 30786111 DOI: 10.1111/ped.13811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 11/25/2018] [Accepted: 12/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Persistence of blastemal components after chemotherapy is a marker of poor outcome in Wilms tumor (WT). Recent reports from local Japanese areas have described pre-chemotherapy blastemal predominant type WT to also be a risk factor for relapse. The significance, however, of blastemal predominant WT remains to be evaluated in a larger study. This study retrospectively evaluated the prognostic significance of pre-chemotherapy blastemal predominant type WT in the Japan Wilms tumor Study (JWiTS) trials. METHODS The JWiTS trial (1996-2013) was a prospective, single-arm study. The outcomes of blastemal predominant type WT were retrospectively evaluated compared with non-blastemal type WT excluding anaplasia between 1996 and 2013. Relapse-free survival (RFS) and overall survival (OS) were estimated. RESULTS Of 319 primary renal tumors diagnosed by the central pathology review system, advanced stage of pre-chemotherapy blastemal predominant type WT (n = 53; 16.1%) occurred more frequently in older children than non-blastemal type WT (n = 225), and was especially frequent in female patients registered in the JWiTS trials. No significant difference in 10 years RFS and OS (78.8% vs 84.5; P = 0.201) or in 10 years RFS and OS (89.3% vs 93.5; P = 0.45) was seen between pre-chemotherapy blastemal predominant type and non-blastemal type WT. CONCLUSIONS Relapse-free survival and OS are not significantly different between pre-chemotherapy blastemal predominant type and non-blastemal type WT.
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Affiliation(s)
- Tsugumichi Koshinaga
- Department of Pediatric Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Tetsuya Takimoto
- Division of Registration and Research for Childhood Cancer, Research Institute, National Center for Child Health and Development, Tokyo, Japan
| | - Hajime Okita
- Department of Pediatric Hematology and Oncology Research, Research Institute, National Center for Child Health and Development, Tokyo, Japan.,Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Yukichi Tanaka
- Department of Pathology and Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Eisuke Inoue
- Division of Medical Informatics, St Marianna University School of Medicine, Kawasaki, Japan
| | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Miwako Nozaki
- Department of Radiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Kunihiko Tsuchiya
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Masayuki Haruta
- Research Institute for Clinical Oncology, Saitama Cancer Center, Saitama, Japan
| | - Yasuhiko Kaneko
- Research Institute for Clinical Oncology, Saitama Cancer Center, Saitama, Japan
| | - Masahiro Fukuzawa
- Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan
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van Poll D, Wilde J, van de Ven K, Asimakidou M, Heij H, Wijnen M. Higher incidence of surgery-related complications in Wilms tumor nephrectomy from clinical records analysis compared with central database registration. Pediatr Blood Cancer 2019; 66:e27502. [PMID: 30393993 DOI: 10.1002/pbc.27502] [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: 05/10/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/OBJECTIVES Central database registrations are widely used tools for assessment of clinical results, but their reliability is subject to debate. The aim of this study is to evaluate the reliability of central database registration for Wilms tumor (WT) nephrectomy-related complications. DESIGN/METHODS All Dutch patients undergoing WT nephrectomy according to the International Society of Paediatric Oncology (SIOP) 2001 protocol between 2001 and 2013 were evaluated. Results from the central database were analyzed and compared with data found via individual medical records analysis (gold standard). RESULTS A total of 179 patients were included. Fourteen (7.8%) patients with a total of 17 complications were identified in the central database. The medical records revealed that 33 (18.4%) of patients had undergone a total of 41 complications (P < 0.001). Operative complications were similar between the groups (P = 0.157). Eleven short-term complications were noted in the central database versus 27 in the medical records (P = 0.059). Significantly more long-term complications, namely, adhesive small-bowel obstruction, were noted from the medical records compared with the central database (7 vs 1, respectively, P < 0.001). Postoperative chemotherapy was significantly delayed by on average 6 days (P < 0.0001) in patients with complications. No significant effect of complications on event-free survival, overall survival, or the relapse rate was recorded. CONCLUSION Central database registrations underestimate the incidence of surgery-related complications after WT nephrectomy and need to be regarded with caution.
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Affiliation(s)
- Daan van Poll
- Pediatric Surgical Center Amsterdam, Amsterdam, the Netherlands
| | - Jim Wilde
- Department of Pediatric Surgery, Hôpitaux Universitaires Genève, Geneva, Switzerland
| | - Kees van de Ven
- Department of Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Maria Asimakidou
- Great Ormond Street Hospital for Children, Specialist Neonatal and Paediatric Surgery, London, United Kingdom
| | - Hugo Heij
- Pediatric Surgical Center Amsterdam, Amsterdam, the Netherlands
| | - Marc Wijnen
- Department of Pediatric Surgery, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Glypican-3 mRNA expression level in Wilms tumor: correlation with histological type, stage, and outcome. Pediatr Surg Int 2017; 33:695-703. [PMID: 28432433 DOI: 10.1007/s00383-017-4087-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To correlate expression of Glypican-3 in Wilms tumor with histopathology, stage, and outcome. METHODS Glypican-3 mRNA expression by real-time PCR on tumor and normal germline samples from 75 fresh nephrectomies for Wilms tumor with fold change after normalization against GAPDH was compared. Survival analysis for event-free and overall survival (EFS, OS) with 2-year follow-up for Glypican-3 overexpression (>1.5 times) and clinicopathological parameters was performed. RESULTS Glypican-3 was overexpressed in 37/75 (49.3%). It was overexpressed in 77% (10/13) cases with blastema predominance or anaplastic histology, as compared to 44% of other histologies (27/62) (p = 0.03). OS was 73 and 93%, respectively (p = 0.016), for those with and without GPC-3 overexpression. EFS was not significantly different with Glypican-3 overexpression (p = 0.11). All 5 deaths among blastema predominant tumors and 4/5 deaths among triphasic tumors had overexpressed Glypican-3. Most deaths in Stage IV, Stage III, and Stage I + II (5/7, 3/3, 1/1) had GPC-3 overexpression. On multivariate analysis, only histology and stage were found to have independent prognostic value. CONCLUSION Glypican-3 overexpression in Wilms tumor correlates with poor OS on univariate analysis. However, only histology and stage have independent prognostic value. Glypican-3 levels may help to stratify intermediate outcome histology (triphasic) and Stage III Wilms tumors.
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Oue T, Fukuzawa M, Koshinaga T, Okita H, Nozaki M, Chin M, Kaneko Y, Tanaka Y, Haruta M, Tsuchiya K, Kuwajima S, Takimoto T. Management of pediatric renal tumor: Past and future trials of the Japan Wilms Tumor Study Group. Pediatr Int 2015; 57:828-31. [PMID: 26267611 DOI: 10.1111/ped.12787] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/15/2015] [Accepted: 07/29/2015] [Indexed: 11/30/2022]
Abstract
The Japan Wilms Tumor Study group (JWiTS) was founded in 1996 to improve outcomes for children with renal tumor in Japan, and a nationwide multicenter cooperative study was initiated thereafter. JWiTS-1 (1996-2005) was analyzed, and JWiTS-2 (2005-2014) is now under analysis; the following problems have been identified and used to decide future study protocol: (i) there has been a decline in survival rate for patients with rhabdoid tumor of the kidney (RTK) and new treatment strategies are required; (ii) the survival rate for bilateral Wilms tumors (BWT) has improved, but results for renal preservation are unsatisfactory; (iii) the prognosis of stage IV favorable nephroblastoma is very good, suggesting that the current protocols provide overtreatment, particularly for patients with lung metastasis; and (iv) no effective biological risk factors exist for predicting the outcome of Wilms tumor, and a study of the genetic changes of these tumors is necessary to determine biological markers for use in risk classification. To solve these issues, the development of a new risk classification of pediatric renal tumors is required. In addition, different study protocols should be developed according to the risk-based classification of the patients. Further, a new study protocol for BWT began in 2015, and new study protocols are being prepared for RTK, and for Wilms tumor with lung metastasis. In addition, an analysis of biological markers with regard to risk classification is to be performed. Furthermore, to create new protocols for patients with rare renal tumors, international collaboration with Children's Oncology Group and International Society of Pediatric Oncology is necessary.
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Affiliation(s)
- Takaharu Oue
- Japan Wilms Tumor Study Group (JWiTS), Itabashi, Tokyo, Japan
| | | | | | - Hajime Okita
- Japan Wilms Tumor Study Group (JWiTS), Itabashi, Tokyo, Japan
| | - Miwako Nozaki
- Japan Wilms Tumor Study Group (JWiTS), Itabashi, Tokyo, Japan
| | - Motoki Chin
- Japan Wilms Tumor Study Group (JWiTS), Itabashi, Tokyo, Japan
| | - Yasuhiko Kaneko
- Japan Wilms Tumor Study Group (JWiTS), Itabashi, Tokyo, Japan
| | - Yukichi Tanaka
- Japan Wilms Tumor Study Group (JWiTS), Itabashi, Tokyo, Japan
| | - Masayuki Haruta
- Japan Wilms Tumor Study Group (JWiTS), Itabashi, Tokyo, Japan
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Matondo FK, Budiongo AN, Tady BM, Lebwaze BM, Lelo MT, Gini-Ehungu JL, Mwepu I, Nkidiaka ED, Aloni MN. A rare occurrence of neonatal nephroblastoma in sub-saharan Africa: a case report and management in a resource-constrained region. Rare Tumors 2015; 7:5657. [PMID: 25918609 PMCID: PMC4387355 DOI: 10.4081/rt.2015.5657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 02/13/2015] [Accepted: 02/19/2015] [Indexed: 11/22/2022] Open
Abstract
Neonatal nephroblastoma has been rarely reported in African neonate. A premature newborn (a 5-day-old male) was transferred with a history of neonatal abdominal mass. Ultrasonography revealed 75×46 mm, well-defined mass with mixed echogenicity replacing the right kidney. The patient underwent right radical nephrectomy and the tumor was confirmed to be a blastemal predominant Wilms’ tumor by the histopathological examination and has an unfavorable prognosis. The child died secondary to multiple organ failure, three days after surgery. Our case report serves to remind us the need to bear in mind the possibility of the diagnosis of neonatal nephroblastoma in neonate with renal mass.
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Affiliation(s)
- Féfé Khuabi Matondo
- Division of Hematology/Oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa School of Medicine, University of Kinshasa , Democratic Republic of Congo
| | - Aléine Nzazi Budiongo
- Division of Hematology/Oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa School of Medicine, University of Kinshasa , Democratic Republic of Congo
| | - Bruno Muyala Tady
- Division of Neonatology, Department of Pediatrics, University Hospital of Kinshasa School of Medicine, University of Kinshasa , Democratic Republic of Congo
| | - Bienvenu Massamba Lebwaze
- Division of Pathology, University Hospital of Kinshasa School of Medicine, University of Kinshasa , Democratic Republic of Congo
| | - Michel Tshikwela Lelo
- Division of Radiology, University Hospital of Kinshasa School of Medicine, University of Kinshasa , Democratic Republic of Congo
| | - Jean Lambert Gini-Ehungu
- Division of Hematology/Oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa School of Medicine, University of Kinshasa , Democratic Republic of Congo
| | - Idesbald Mwepu
- Division of Pediatric Surgery, Department of Surgery, University Hospital of Kinshasa School of Medicine, University of Kinshasa , Democratic Republic of Congo
| | - Emmanuel Dimbu Nkidiaka
- Division of Neonatology, Department of Pediatrics, University Hospital of Kinshasa School of Medicine, University of Kinshasa , Democratic Republic of Congo
| | - Michel Ntetani Aloni
- Division of Hematology/Oncology and Nephrology, Department of Pediatrics, University Hospital of Kinshasa School of Medicine, University of Kinshasa , Democratic Republic of Congo
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12
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Fukuzawa H, Aoba T, Yoshida M, Iwafuchi H, Koike J, Kitagawa H, Urushihara N, Yokoi A, Maeda K. Pathological Features of the Unilateral Favorable Histology Nephroblastoma with Relapse. Fetal Pediatr Pathol 2015; 34:383-90. [PMID: 26470944 DOI: 10.3109/15513815.2015.1095258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To evaluate the pathological features of the primary lesion in patients with relapse of unilateral favorable histology nephroblastoma. MATERIAL AND METHODS Fifty-eight patients with unilateral favorable histology nephroblastoma who underwent initial nephrectomy before chemotherapy were categorized into one of two groups: the nonrelapsed group (n = 52) and the relapsed group (n = 6). The histological subtypes of both groups and pathological features of the relapsed group were re-evaluated retrospectively. RESULTS The histological subtypes of all relapsed cases were classified as blastemal predominant. In three of six cases with relapse, sheets of spindle-shaped blastemal cells that were histologically reminiscent of synovial sarcoma were predominant (massive sarcomatoid pattern). CONCLUSIONS The histological blastemal predominant subtype of nephroblastoma is a strong indicator of relapse. In particular, the blastemal predominant subtype with massive sarcomatoid pattern may have a higher risk of relapse.
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Affiliation(s)
- Hiroaki Fukuzawa
- a Department of Pediatric Surgery , Kobe Children's Hospital , Kobe , Japan
| | - Takeshi Aoba
- b Division of Pediatric Surgery , St. Marianna University School of Medicine , Kawasaki , Japan
| | - Makiko Yoshida
- c Department of Pathology , Kobe Children's Hospital , Kobe , Japan
| | - Hideto Iwafuchi
- d Department of Pathology , Shizuoka Children's Hospital , Shizuoka , Japan
| | - Junki Koike
- e Department of Diagnostic Pathology , St. Marianna University School of Medicine , Kawasaki , Japan
| | - Hiroaki Kitagawa
- b Division of Pediatric Surgery , St. Marianna University School of Medicine , Kawasaki , Japan
| | - Naoto Urushihara
- f Department of Pediatric Surgery , Shizuoka Children's Hospital , Shizuoka , Japan
| | - Akiko Yokoi
- a Department of Pediatric Surgery , Kobe Children's Hospital , Kobe , Japan
| | - Kosaku Maeda
- a Department of Pediatric Surgery , Kobe Children's Hospital , Kobe , Japan
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13
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Littooij AS, Humphries PD, Olsen ØE. Intra- and interobserver variability of whole-tumour apparent diffusion coefficient measurements in nephroblastoma: a pilot study. Pediatr Radiol 2015; 45:1651-60. [PMID: 25951925 PMCID: PMC4577543 DOI: 10.1007/s00247-015-3354-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 02/19/2015] [Accepted: 04/01/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The apparent diffusion coefficient (ADC) is potentially useful for assessing treatment response in nephroblastoma (Wilms tumour). However the precision of ADC measurements in these heterogeneous lesions is unknown. OBJECTIVE To assess intra- and interobserver variability of whole-tumour ADC measurements in viable parts of nephroblastomas at diagnosis and after preoperative chemotherapy. MATERIALS AND METHODS We included children with histopathologically proven nephroblastoma who had undergone MRI with diffusion-weighted imaging before and after preoperative chemotherapy. Three independent observers performed whole-tumour ADC measurements of all lesions, excluding non-enhancing areas. One observer evaluated all lesions on two occasions. We performed analyses using Bland-Altman plots and concordance correlation coefficient (CCC) calculations with 95% limits of agreement for median ADC, difference between pre- and post-chemotherapy median ADC (ADC shift) and percentage of pixels with ADC values <1.0 × 10(-3) mm(2)/s. RESULTS In 22 lesions (13 pretreatment and 9 post-treatment) in 10 children the interobserver variability in median ADC and ADC shift were within the interval of approximately ±0.1 × 10(-3) mm(2)/s (limits of agreement for median ADC ranged -0.08-0.11 × 10(-3) mm(2)/s and for ADC-shift -0.11-0.09 × 10(-3) mm(2)/s). The interobserver variability for percentage of low-ADC pixels was larger and also biased. The calculated CCC confirmed good intra- and interobserver agreement (ρ-c ranging from 0.968 to 0.996). CONCLUSION Measurements of whole-tumour ADC values excluding necrotic areas seem to be sufficiently precise for detection of chemotherapy-related change.
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Affiliation(s)
- Annemieke S Littooij
- Department of Radiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Paul D Humphries
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
- Department of Radiology, University College London Hospital, London, UK
| | - Øystein E Olsen
- Department of Radiology, Great Ormond Street Hospital for Children, London, UK
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14
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Pierce J, Murphy AJ, Panzer A, de Caestecker C, Ayers GD, Neblett D, Saito-Diaz K, de Caestecker M, Lovvorn HN. SIX2 Effects on Wilms Tumor Biology. Transl Oncol 2014; 7:800-11. [PMID: 25500091 PMCID: PMC4311027 DOI: 10.1016/j.tranon.2014.09.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/17/2014] [Indexed: 11/25/2022] Open
Abstract
Wilms tumor (WT) blastema retains gene expression profiles characteristic of the multipotent nephron progenitor pool, or cap mesenchyme (CM), in the developing kidney. As a result, WT blastema and the CM are believed to represent contextual analogues of one another. Sine oculis homeobox 2 (SIX2) is a transcription factor expressed specifically in the CM, provides a critical mechanism for CM self-renewal, and remains persistently active in WT blastema, although its purpose in this childhood malignancy remains unclear. We hypothesized that SIX2, analogous to its function in development, confers a survival pathway to blastema, the putative WT stem cell. To test its functional significance in WT biology, wild-type SIX2 was overexpressed in the human WT cell line, WiT49. After validating this model, SIX2 effects on anchorage-independent growth, proliferation, invasiveness, canonical WNT pathway signaling, and gene expression of specific WNT pathway participants were evaluated. Relative to controls, WiT49 cells overexpressing SIX2 showed significantly enhanced anchorage-independent growth and early-passage proliferation representing surrogates of cell survival. Interestingly, overexpression of SIX2 generally repressed TCF/LEF-dependent canonical WNT signaling, which activates and coordinates both differentiation and stem pathways, but significantly heightened canonical WNT signaling through the survivin promoter, a mechanism that exclusively maintains the stem state. In summary, when overexpressed in a human WT cell line, SIX2 enhances cell survival and appears to shift the balance in WNT/β-catenin signaling away from a differentiation path and toward a stem cell survival path.
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Affiliation(s)
- Janene Pierce
- Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Andrew J Murphy
- Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Alexis Panzer
- Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Christian de Caestecker
- Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Gregory D Ayers
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - David Neblett
- Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Kenyi Saito-Diaz
- Departments of Medicine and Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Mark de Caestecker
- Departments of Medicine and Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Harold N Lovvorn
- Department of Pediatric Surgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
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15
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Jaing TH, Hung IJ, Yang CP, Lai JY, Tseng CK, Chang TY, Hsueh C, Tsay PK. Malignant renal tumors in childhood: report of 54 cases treated at a single institution. Pediatr Neonatol 2014; 55:175-80. [PMID: 24279977 DOI: 10.1016/j.pedneo.2013.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 09/16/2013] [Accepted: 09/24/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Wilms tumor is the most common primary renal malignancy occurring in childhood. Significant improvement has been made in the treatment of children with Wilms tumor. However, the treatment of patients with non-Wilms renal tumors remains challenging. METHODS Between 1991 and 2010, 70 children with renal tumors were diagnosed at a single institution. Fifty-four patients were histologically confirmed and divided into three groups, including 42 Wilms tumors, seven clear cell sarcomas of kidney, and five malignant rhabdoid tumors. Most patients underwent unilateral nephrectomy and lymph node sampling followed by adjuvant chemotherapy. Twenty-one of these patients subsequently received radiotherapy. RESULTS During follow-up, 12 patients died of progressive disease and one died of operative mortality. One patient with unilateral pleural metastases subsequently underwent hematopoietic stem cell transplantation. The median survival time of all patients was 88 months. Children under 2 years of age at diagnosis with Wilms tumor or clear cell sarcoma of kidney had an excellent survival rate of 100% compared to the 0% survival rate of MRT. CONCLUSION Younger age at diagnosis bore a better prognosis than did older age, whereas a diagnosis of malignant rhabdoid tumor portended a worse prognosis. Younger patients and appropriate treatment may have contributed to the improved prognosis of clear cell sarcoma of kidney.
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Affiliation(s)
- Tang-Her Jaing
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan, Taiwan.
| | - Iou-Jih Hung
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan, Taiwan
| | - Chao-Ping Yang
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan, Taiwan
| | - Jin-Yao Lai
- Department of Pediatric Surgery, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan, Taiwan
| | - Chen-Kan Tseng
- Department of Radiation Oncology, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan, Taiwan
| | - Tsung-Yen Chang
- Divisions of Hematology and Oncology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan, Taiwan
| | - Chuen Hsueh
- Department of Pathology, Chang Gung Children's Hospital, Chang Gung University, Linkou, Taoyuan, Taiwan
| | - Pei-Kwei Tsay
- Department of Public Health and Center of Biostatistics, College of Medicine, Chang Gung University, Linkou, Taoyuan, Taiwan
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16
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Kieran K, Williams MA, McGregor LM, Dome JS, Krasin MJ, Davidoff AM. Repeat nephron-sparing surgery for children with bilateral Wilms tumor. J Pediatr Surg 2014; 49:149-53. [PMID: 24439600 DOI: 10.1016/j.jpedsurg.2013.09.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 09/30/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Renal insufficiency is a significant complication of Wilms tumor treatment in the 5% with bilateral disease. Nephron-sparing surgery (NSS) is recommended after neoadjuvant chemotherapy initially. However, the role of NSS in recurrent disease is unknown. We reviewed our experience to assess the feasibility and oncologic and functional outcomes of repeat NSS for children with recurrent disease. METHODS A retrospective review was performed of all children treated at our institution for bilateral, favorable histology (FH) Wilms tumor. Patients undergoing repeat NSS for locally recurrent disease were identified. The outcomes evaluated included tumor recurrence, renal function, and patient survival. RESULTS Since 2001, 36 children with bilateral FH Wilms tumor have been treated at our institution. Eight patients (22%) underwent repeat NSS for locally recurrent disease. Two patients had a second local recurrence and underwent a third NSS. Six patients are alive without disease (75%) with an average follow-up of 4.5years. Two patients have died, each with blastemal-predominant histology at repeat NSS. The surviving patients have normal renal function, although two patients require medical management of hypertension. CONCLUSIONS Our experience suggests that repeat NSS for local recurrence of FH bilateral Wilms tumor is feasible and affords acceptable oncologic outcome with preservation of renal function. However, more aggressive therapy may be required for patients whose recurrence has blastemal-predominant histology, given the poor outcome for these patients in our series.
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Affiliation(s)
- Kathleen Kieran
- Department of Urology, University of Iowa Hospitals and Clinics, Iowa City, IA.
| | - Mark A Williams
- Division of Urology, University of Tennessee Health Science Center, Memphis, TN
| | - Lisa M McGregor
- Division of Pediatric Hematology/Oncology, Penn State Hershey Children's Hospital, Hershey, PA
| | - Jeffrey S Dome
- Division of Oncology, Children's National Medical Center, Washington, DC
| | - Matthew J Krasin
- Department of Radiological Sciences, St Jude Children's Research Hospital, Memphis, TN
| | - Andrew M Davidoff
- Department of Surgery, St Jude Children's Research Hospital, Memphis, TN
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17
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Oue T. New risk classification is necessary in the treatment of Wilms tumor. Transl Pediatr 2014; 3:39-41. [PMID: 26835322 PMCID: PMC4728854 DOI: 10.3978/j.issn.2224-4336.2014.01.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The National Wilms Tumor Group (NWTS) presented the clinicopathological findings predicting relapse in children with stage III favorable-histology (FH) Wilms tumor (WT) treated in the NWTS-5 study. They reported that lymph node involvement and a microscopic residual tumor were highly predictive of the EFS and OS, and concluded that patients with different stage III criteria may receive different therapies. These data suggest that the current risk classification of WT is not satisfactory. Like other pediatric tumors, such as neuroblastoma and rhabdomyosarcoma, more systemic and detailed risk classification for WT should be established using various clinical and biological markers. In the previous therapeutic protocols for WT, no biological marker was used for risk classification. Therefore, it is important to identify effective biological markers related to the prognosis of WT. The presence of LOH at 1p and 16q was associated with a worse EFS and OS, and was used for risk classification to choose the treatment regimens used in the recent COG clinical trials. There are some candidate prognostic factors that can be used in the future risk classification of WT, such as the methylation status of RASSF1A. A worldwide cooperative study should be conducted in the future to confirm whether these factors are useful in the risk classification. The goal of treatment for WT is to identify approaches that provide excellent outcomes for children with low-risk tumors without the need for chemotherapy or XRT. Conversely, more aggressive therapy may be used for children with high-risk tumors in an effort to improve their survival. To meet these goals, a new effective risk classification for WT should be established via collaborative clinical trials.
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Affiliation(s)
- Takaharu Oue
- Department of Surgery, Division of Pediatric Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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