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Pachl M, Lautz TB, Aldrink JH, Abdelhafeez H, Irtan S. Minimally invasive and robotic-assisted approaches applied to pediatric surgical oncology. Pediatr Blood Cancer 2024:e31162. [PMID: 38987997 DOI: 10.1002/pbc.31162] [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: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 07/12/2024]
Abstract
The management of pediatric tumors is complex, with surgery, chemotherapy, and radiotherapy being cornerstones in their treatment. Tumor removal is increasingly performed by a minimally invasive approach, which allows for quicker postoperative recovery and less postoperative pain. The goal of this report is to give an overview of minimally invasive surgical approaches for common pediatric tumors, with a focus on technical considerations and postoperative outcomes.
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Affiliation(s)
- Max Pachl
- Department of Pediatric Surgery and Urology, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Timothy B Lautz
- Division of Pediatric Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois, 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
| | - Hafeez Abdelhafeez
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
- Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sabine Irtan
- Department of Visceral and Neonatal Pediatric Surgery, Hôpital Armand Trousseau - APHP, Sorbonne University, Paris, France
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2
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Youlden DR, Gupta S, Frazier AL, Moore AS, Gottardo NG, Aitken JF. Incidence and survival for childhood cancer by endorsed non-stage prognostic indicators in Australia. Pediatr Blood Cancer 2024; 71:e30889. [PMID: 38265260 DOI: 10.1002/pbc.30889] [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: 11/30/2023] [Revised: 01/07/2024] [Accepted: 01/13/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND An international expert panel recently recommended 15 'non-stage prognostic indicators' (NSPIs) across eight childhood cancers, classified as essential or additional, for collection in population-based cancer registries. We aimed to describe the incidence distribution and survival of each of these NSPIs. PROCEDURES Cases were extracted from the Australian Childhood Cancer Registry. The study cohort (n = 4187) comprised all children aged under 15 years diagnosed with an eligible cancer between 2010 and 2018, with follow-up until 31 December 2020. NSPI data were collected directly from each patient's medical records. Differences in 5-year relative survival were assessed using multivariable flexible parametric models, adjusted for sex and age group at diagnosis. RESULTS The availability of data varied, exceeding 85% for all essential NSPIs apart from histologic subtype for Wilms tumours (69%) and lineage for acute lymphoblastic leukaemia (78%). Information on additional NSPIs tended to be recorded less often, particularly cytogenetic subtype for non-alveolar rhabdomyosarcoma (28%) and astrocytoma (4%). Eight NSPIs exhibited a significant difference in survival, with the largest disparity occurring among children with astrocytoma according to tumour grade (5-year relative survival of 18% for grade IV disease compared with 99% for grade I disease; p < .001). CONCLUSIONS Our findings demonstrate that most of the recommended NSPIs can be retrieved from medical records in Australia in recent years, allowing the capability of assessing survival within patient subgroups of clinical interest. Reporting of NSPI data has the capability to inform local and global understanding of population-level disparities in childhood cancer survival.
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Affiliation(s)
- Danny R Youlden
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Sumit Gupta
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - A Lindsay Frazier
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Andrew S Moore
- Oncology Service, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Nicholas G Gottardo
- Department of Paediatric and Adolescent Oncology/Haematology, Perth Children's Hospital, Perth, Western Australia, Australia
- Brain Tumour Research Program, Telethon Kids Cancer Centre, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Joanne F Aitken
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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Liu M, Lu J, Yu C, Zhao J, Wang L, Hu Y, Chen L, Han R, Liu Y, Sun M, Wei G, Wu S. Differentiation Potential of Hypodifferentiated Subsets of Nephrogenic Rests and Its Relationship to Prognosis in Wilms Tumor. Fetal Pediatr Pathol 2024; 43:123-139. [PMID: 38217324 DOI: 10.1080/15513815.2024.2303081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/02/2024] [Indexed: 01/15/2024]
Abstract
Background Wilms tumor (WT) is highly curable, although anaplastic histology or relapse imparts a worse prognosis. Nephrogenic rests (NR) associated with a high risk of developing WT are abnormally retained embryonic kidney precursor cells. Methods After pseudo-time analysis using single-cell RNA sequencing (scRNA-seq) data, we generated and validated a WT differentiation-related gene (WTDRG) signature to predict overall survival (OS) in children with a poor OS. Results A differentiation trajectory from NR to WT was identified and showed that hypodifferentiated subsets of NR could differentiate into WT. Classification of WT children with anaplastic histology or relapse based on the expression patterns of WTDRGs suggested that patients with relatively high levels of hypodifferentiated NR presented a poorer prognosis. A WTDRG-based risk model and a clinically applicable nomogram was developed. Conclusions These findings may inform oncogenesis of WT and interventions directed toward poor prognosis in WT children of anaplastic histology or relapse.
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Affiliation(s)
- Maolin Liu
- Department of Urology, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jiandong Lu
- Department of Urology, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chengjun Yu
- Department of Urology, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jie Zhao
- Department of Urology, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ling Wang
- Department of Urology, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Hu
- Department of Urology, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Long Chen
- Department of Urology, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Rong Han
- Department of Urology, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yan Liu
- Department of Urology, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Miao Sun
- Department of Urology, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Guanghui Wei
- Department of Urology, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Shengde Wu
- Department of Urology, Chongqing Key Laboratory of Pediatrics, Chongqing Key Laboratory of Children Urogenital Development and Tissue Engineering, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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Tagoe LG, Bonney NYA, Amoako E, Amegan-Aho KH, Gbadamosi H, Dadzie MA, Segbefia CI. Unusual Metastatic Patterns of Wilms Tumor: A Case Series. Cureus 2024; 16:e54640. [PMID: 38523916 PMCID: PMC10959588 DOI: 10.7759/cureus.54640] [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] [Accepted: 02/17/2024] [Indexed: 03/26/2024] Open
Abstract
Wilms tumor (WT) is the most common renal malignancy of childhood. The common metastatic sites are the lungs, liver, and lymph nodes, with brain and bone metastases occurring rarely. Metastatic disease can be present at initial diagnosis or may occur with relapse or disease progression. The majority of relapses in WT occur within the first two years post-treatment. Late relapses are rare. This article describes four cases of WT, each demonstrating an unusual site or timing of metastases. Case 1 presented primarily with jaw metastases, Case 2 presented with bone (vertebrae) and spinal metastases manifesting as paraplegia, at relapse one year after completion of treatment, Case 3 presented with isolated liver metastases four years after treatment completion, and Case 4 presented with brain metastases after six weeks of treatment abandonment. This case series demonstrates the varied pattern of metastases of WT and highlights the need for a high index of suspicion for WT among patients who present with unusual sites of tumor or for metastasis in those who present with neurologic symptoms during or after treatment.
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Affiliation(s)
- Lily G Tagoe
- Child Health, Korle Bu Teaching Hospital, Accra, GHA
| | | | | | - Kokou H Amegan-Aho
- Pediatrics and Child Health, University of Health and Allied Sciences, Ho, GHA
| | | | - Mary-Ann Dadzie
- Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, GHA
| | - Catherine I Segbefia
- Child Health, University of Ghana Medical School, Accra, GHA
- Child Health, Korle Bu Teaching Hospital, Accra, GHA
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5
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Le Quellenec G, Bernier-Chastagner V, Sellami N, Helfre S, Satragno C, Leseur J, Escande A, Jolnerovski M, Noel G, Missohou F, Claude L, Cantaloube M, Laprie A, Huchet A, Scouarnec C, Guimard G, Muracciole X, Paul J, Supiot S, Jouglar E. Post-operative flank irradiation using conformal versus highly conformal radiotherapy techniques for paediatric renal tumours: Results from the French registry PediaRT. Pediatr Blood Cancer 2023; 70:e30627. [PMID: 37580901 DOI: 10.1002/pbc.30627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/11/2023] [Accepted: 08/05/2023] [Indexed: 08/16/2023]
Abstract
PURPOSE Three-dimensional conformal RT (3D-RT) techniques are gold standard for post-operative flank radiotherapy (RT) in paediatric renal tumours. Recently, highly conformal RT (HC-RT) techniques have been implemented without comparative clinical data. The main objective of this multicentre study was to compare locoregional control (LRC) in children treated either with HC-RT or 3D-RT techniques. METHODS Patients treated with post-operative flank RT for renal tumour registered in the national cohort PediaRT between March 2013 and September 2019 were included. Treatment and follow-up data, including toxicities and outcomes, were retrieved from the database. LRC was calculated, and dose reconstruction was performed in case of an event. RESULTS Seventy-nine patients were included. Forty patients were treated with HC-RT and 39 with 3D-RT. Median follow-up was 4.5 years. Three patients had locoregional failure (LRF; 4%). HC-RT was not associated with a higher risk of LRF. Three-year LRC were 97.4% and 94.7% in the HC-RT and 3D-RT groups, respectively. The proportion of planning target volumes receiving 95% or more of the prescribed dose did not significantly differ between both groups (HC-RT 88%; 3D-RT 69%; p = .05). HC-RT was better achieving dose constraints, and a significant mean dose reduction was observed in the peritoneal cavity and pancreas associated with lower incidence of acute gastrointestinal toxicity. CONCLUSION LRF after post-operative flank RT for renal tumours was rare and did not increase using HC-RT versus 3D-RT techniques. Dose to the pancreas and the peritoneal cavity, as well as acute toxicity, were reduced with HC-RT compared to 3D-RT.
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Affiliation(s)
- Gaelle Le Quellenec
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | | | - Noura Sellami
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Sylvie Helfre
- Department of Radiation Oncology, Institut Curie, PSL Research University, Paris, France
| | - Camilla Satragno
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
- Dipartimento di Medicina Sperimentale (DIMES), Università degli studi di Genova, Genoa, Italy
| | - Julie Leseur
- Department of Radiation Oncology, Centre Eugène Marquis, Rennes, France
| | - Alexandre Escande
- Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | - Maria Jolnerovski
- Department of Radiation Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - Georges Noel
- Department of Radiation Oncology, Centre Paul Strauss, Strasbourg, France
| | - Fernand Missohou
- Department of Radiation Oncology, Centre François Baclesse, Caen, France
| | - Line Claude
- Department of Radiation Oncology, Centre Léon Bérard, Lyon, France
| | - Marie Cantaloube
- Department of Radiation Oncology, Institut du cancer de Montpellier, Montpellier, France
| | - Anne Laprie
- Department of Radiation Oncology, Institut Claudius Regaud, IUCT-Oncopôle, Toulouse, France
| | - Aymeri Huchet
- Department of Radiation Oncology, Centre Hospitalier Universitaire, Bordeaux, France
| | - Cyrielle Scouarnec
- Department of Radiation Oncology, Centre Antoine Lacassagne, Nice, France
| | - Gregory Guimard
- Department of Paediatric Oncology, Centre Hospitalier Universitaire, Reims, France
| | - Xavier Muracciole
- Department of Radiation Oncology, La Timone Hospital, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Julie Paul
- Department of Biostatistics, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Emmanuel Jouglar
- Department of Radiation Oncology, Institut Curie, PSL Research University, Paris, France
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Ekuk E, Odongo CN, Tibaijuka L, Oyania F, Egesa WI, Bongomin F, Atwiine R, Acan M, Situma M. One year overall survival of wilms tumor cases and its predictors, among children diagnosed at a teaching hospital in South Western Uganda: a retrospective cohort study. BMC Cancer 2023; 23:196. [PMID: 36864435 PMCID: PMC9979450 DOI: 10.1186/s12885-023-10601-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 02/01/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Wilms tumor (WT) is the second most common solid tumor in Africa with both low overall survival (OS) and event-free survival (EFS) rates. However, no known factors are predicting this poor overall survival. OBJECTIVE The study was to determine the one-year overall survival of WT cases and its predictors among children diagnosed in the pediatric oncology and surgical units of Mbarara regional referral hospital (MRRH), western Uganda. METHODOLOGY Children's treatment charts and files diagnosed and managed for WT were retrospectively followed up for the period between January 2017 to January 2021. Charts of children with histologically confirmed diagnoses were reviewed for demographics, clinical and histological characteristics, as well as treatment modalities. RESULTS One-year overall survival was found to be 59.3% (95% CI: 40.7-73.3), with tumor size greater than 15 cm (p 0.021) and unfavorable WT type (p 0.012) being the predominant predictors. CONCLUSION Overall survival (OS) of WT at MRRH was found to be 59.3%, and predictive factors noted were unfavorable histology and tumor size greater than 115 cm.
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Affiliation(s)
- Eddymond Ekuk
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda.
| | - Charles Newton Odongo
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
- Department of Anatomy, Faculty of Medicine Soroti University, Soroti, Uganda
| | - Leevan Tibaijuka
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Felix Oyania
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Walufu Ivan Egesa
- Department of Pediatrics, Faculty of Clinical Medicine and Dentistry, Kampala International, Kampala, Uganda
| | - Felix Bongomin
- Department of Microbiology, Mycology, and Immunology, Internal Medicine Gulu University, Gulu, Uganda
| | - Raymond Atwiine
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Moses Acan
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
| | - Martin Situma
- Department of Surgery, Mbarara University of Science and Technology, Faculty of Medicine, Mbarara, Uganda
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Rahiman EA, Trehan A, Jain R, Menon P, Kakkar N, Srinivasan R, Sodhi KS, Saxena AK, Kapoor R, Bansal D. A higher tumor volume and undernutrition at diagnosis adversely affect the survival of children with Wilms tumor: A study of 200 patients. Pediatr Blood Cancer 2022; 69:e29880. [PMID: 35841309 DOI: 10.1002/pbc.29880] [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: 02/14/2022] [Revised: 05/19/2022] [Accepted: 06/22/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Distinct prognostic factors for Wilms tumor (WT) in low- and middle-income countries need identification. METHODS Retrospective study of patients with WT managed by the International Society of Pediatric Oncology (SIOP) approach for over 11 years (2005-2016) at a single center in Chandigarh, India. RESULTS The study included 200 patients (median age: 33.5 months). The tumor stage (SIOP) distribution included stage I (30%), II (36%), III (14%), IV (17%), and V (3%). The histology-risk groups were low (8%), intermediate (84%), and high risk (9%). At diagnosis, 68 out of 190 (36%) patients were underweight. The median tumor volume at diagnosis was 481 ml (interquartile ratio [IQR]: 306.9, 686.8, n = 146). Following neoadjuvant chemotherapy, it reduced to 110 ml (IQR: 151.2, 222, n = 77). Treatment was abandoned in 20.5% of the patients. Treatment-related mortality occurred in 13 of 179 (7.2%) patients. Relapse occurred in 26 of 158 (16.5%) patients. The 3-year overall survival (OS) and event-free survival (EFS) of patients who completed therapy were 78.3 and 72%, respectively. The stage (p = .013) and histology (p = .023) influenced OS. A lower OS in stage II (75.4%) versus stage III disease (83.7%) suggested understaging. Patients with a higher tumor volume at diagnosis (p = .005; odds ratio [OR]: 0.99; 95% confidence interval [CI]: 0.99-1.00) or a lower weight-for-age z-score (p = .002; OR: 1.68; 95% CI: 1.21-2.33) had an increased risk of death or relapse. CONCLUSIONS The 3-year OS and EFS of children who completed therapy were 78.3 and 72%, respectively. A higher tumor volume and lower weight-for-age z-score at diagnosis were identified as distinct adverse prognostic factors. A likely suboptimal lymph node assessment (intraoperative and histopathology) contributed to the understaging of stage III to II disease and reduced survival.
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Affiliation(s)
- Emine A Rahiman
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,Department of Pediatrics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telangana, India
| | - Amita Trehan
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Richa Jain
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prema Menon
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nandita Kakkar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kushaljit Singh Sodhi
- Department of Radio-diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akshay Kumar Saxena
- Department of Radio-diagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rakesh Kapoor
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Bansal
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Khan MR, Maaz AUR, Ashraf MS. Challenges in the Management of Wilms Tumor in a Developing Country: A Twenty Years' Experience From a Single Center in Pakistan. J Pediatr Hematol Oncol 2022; 44:454-461. [PMID: 35917164 DOI: 10.1097/mph.0000000000002507] [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: 09/10/2021] [Accepted: 06/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Wilms Tumor (WT) is one of the most curable childhood cancers. High cure rates seen in the developed countries are not reproduced in developing countries. Lack of access to cancer treatment facilities, financial constraints, late presentation, and abandonment have previously been described. We reviewed our data over the last 20 years to highlight some of these challenges. METHODS This is a retrospective chart review of children with WT at our center up to the age of 18 years between 1 November 1997 and 30 November 2017. Demographic details, presentation characteristics and treatment details were recorded. Factors associated with poor outcome were analyzed. RESULTS Two hundred eleven children were registered; 117(55.5%) were males. Median age at presentation was 3 (range 0 to 18) years. Presentation data were available for 184/211 patients, staging details for 159/211 and metastatic status for 178/211. Of the available dataset, 60% presented without prior treatment, whereas 40% presented atleast after primary surgical excision. High-stage (stage III or above) disease was present in 79 (49.7%) patients; 61 (34.3%) was presented with metastases or recurrence; 63 (29.8%) abandoned or refused treatment; 99/172 (57.6%) patients finished treatment, 23 (13.4%) died during treatment, and 6 died before treatment. Of the 99 patients who finished treatment 83 (83.8%) are well off therapy; 15(15.2%) relapsed; 6 (40%) are alive after salvage therapy, while 9 (60%) died. CONCLUSIONS Our data highlights the challenges of managing WT in resource poor environments. Prior surgery, incomplete staging work-up and abandonment are some of the most frequently encountered barriers. A multipronged approach is required to overcome these challenges.
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Affiliation(s)
- Muhammad Rahil Khan
- Department of Paediatrics, King Faisal Specialist Hospital and Research Center, Al Madinah Al Munawwarah, Kingdom of Saudi Arabia
| | - Ata Ur Rehman Maaz
- Department of Pediatric Haematology/Oncology, Sidra Medicine, Doha, Qatar
| | - Muhammad Shamvil Ashraf
- Department of Pediatric Haematology/Oncology, Indus Hospital and Health Network, Karachi, Opposite Darussalam Society, Korangi Crossing, Karachi, Pakistan
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9
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Høgsholt S, Asdahl PH, Rechnitzer C, Winther J, Birn H, Hasle H. Kidney disease in very long-term survivors of Wilms tumor: A nationwide cohort study with sibling controls. Cancer Med 2022; 12:1330-1338. [PMID: 35841204 PMCID: PMC9883410 DOI: 10.1002/cam4.5010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/14/2022] [Accepted: 06/30/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Survival after Wilms tumor has significantly increased and focus on late effects has become increasingly important. However, knowledge about long-term renal function in survivors of Wilms tumor is missing. Our aim was to investigate evidence of kidney disease in 20- or more-year survivors of Wilms tumor in a clinical setting, with siblings as comparisons. METHODS In this cross-sectional study, we established a cohort of Danish 20-plus-year survivors of Wilms tumor and siblings as controls. Participants answered a comprehensive health questionnaire supplemented by measurements of estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio, and blood pressure and were categorized according to the chronic kidney disease classification. Multiple linear regression analysis, taking family membership into account, was used to describe the differences in eGFR. Logistic regression analysis was performed to describe risk factors for the development of kidney disease. RESULTS We included 99 survivors of Wilms tumor and 38 sibling controls with a median of 37 years of follow-up. The eGFR of Wilms tumor survivors was 13 ml/min/1.73 m2 (95% CI -20; -5) lower when compared to sibling control. Evidence of kidney disease, with risk factors as hypertension and diabetes, was found in 19% of the Wilms tumor survivors and 2% developed end-stage renal disease. Ninety-two percent of the Wilms tumor survivors had an eGFR >60 ml/min/1.732 . CONCLUSION Long-term Wilms tumor survivors have on average a significantly decreased renal function along with the increased prevalence of kidney disease and end-stage renal disease when compared to sibling controls. Still, most survivors had kidney function within the normal range.
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Affiliation(s)
- Stine Høgsholt
- Pediatrics and Adolescent MedicineAarhus University HospitalAarhusDenmark,Department of Clinical Medicine, Faculty of HealthAarhus UniversityAarhusDenmark
| | | | - Catherine Rechnitzer
- Pediatrics and Adolescent MedicineCopenhagen University HospitalCopenhagenDenmark
| | - Jeanette Falck Winther
- Department of Clinical Medicine, Faculty of HealthAarhus UniversityAarhusDenmark,Childhood Cancer Research GroupDanish Cancer Society Research CenterCopenhagenDenmark
| | - Henrik Birn
- Department of Clinical Medicine, Faculty of HealthAarhus UniversityAarhusDenmark,Department of Renal MedicineAarhus University HospitalAarhusDenmark,Department of Biomedicine, Faculty of HealthAarhus UniversityAarhusDenmark
| | - Henrik Hasle
- Pediatrics and Adolescent MedicineAarhus University HospitalAarhusDenmark,Department of Clinical Medicine, Faculty of HealthAarhus UniversityAarhusDenmark
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10
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Alakaloko FM, Akinsete AM, Seyi-Olajide JO, Joseph AO, Elebute OO, Ladipo-Ajayi OA, Odubanjo MO, Olowoyeye OA, Ademuyiwa AO, Temiye EO, Akinsulie AA, Bode CO. A 5-year multidisciplinary care outcomes in children with wilms' tumour managed at a tertiary centre: A retrospective observational study. Afr J Paediatr Surg 2022; 19:83-88. [PMID: 35017377 PMCID: PMC8809472 DOI: 10.4103/ajps.ajps_155_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/25/2021] [Accepted: 03/26/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Over the last two decades, there has been significant improvement in the outcomes of children with Wilms' tumour (WT) in high income countries (HICs) with approximately 85% survival rate globally. This is partly attributable to a multi-disciplinary team approach to care and the evolution of more robust treatment measures. A previous review in our centre prior to multi-disciplinary team shows a survival rate of 31.48%, However, the survival rates from low- and middle-income countries are still low when compared to HICs due to delays in access to care at all levels, poor to non-existent health insurance coverage, limited workforce resources, weak health-care systems and infrastructure. The aim of this study is to determine the impact of a multi-disciplinary team approach on the treatment outcomes of children with WT. METHODOLOGY This is a 5-year retrospective review of all patients managed with WT at the Lagos University Teaching Hospital, Lagos, Nigeria. Information was extracted from the patients' case notes, operation notes and ward admission records. The data were analysed with SPSS 25, and P < 0.05 was considered to be statistically significant. RESULTS Forty patients were included in the study; male to female ratio was 1.6:1. The disease occurred in the right kidney in 23 patients (57.5%) and on the left in 17 patients (42.5%). The average duration of symptoms before presentation was 3.6 months (range 1-7 months), majority of patients presented with abdominal masses and were assessed as per unit protocol with abdominal Computerized tomography scan, chest X-ray and abdominal ultrasound scan to assign the patient International Society of Paediatric oncology regimen. The predominant stage at surgery was Stage III 26 (65%), while Stage IV was 9 (22.5%). Morbidity after chemotherapy was 10 (25%). Twenty-five patients (63%) completed chemotherapy while 15 patients (37%) started chemotherapy but defaulted midway. The 5-year survival rate was 75%. Increasing age and male sex were associated with reduced odds of mortality; however, this was not statistically significant. Increased duration of treatment, being treated with chemotherapy alone, as well as advanced tumour stage and histology were associated with increased odds of mortality, however, this was not statistically significant. CONCLUSION The development of an institutional WT treatment pathway involving a multidisciplinary team has resulted in improved outcomes. There is need for increased community awareness to improve the time to presentation.
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Affiliation(s)
- Felix M. Alakaloko
- Pediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adeseye M Akinsete
- Paediatric Hematology & Oncology Unit, Department of Pediatrics, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Justina O. Seyi-Olajide
- Pediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adedayo O Joseph
- Lagos University Teaching Hospital (LUTH) Cancer Center and Nigerian Sovereign Investment Authority (NSIA), Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olumide O. Elebute
- Pediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
- Pediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital; Paediatric Surgery Unit, Department of Surgery, College of Medicine, University of Lagos & Pediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | | | - M. Olatokunboh Odubanjo
- Department of Anatomic and Molecular Pathology, College of Medicine, University of Lagos/ Lagos University Teaching Hospital, Lagos, Nigeria
| | - Omodele A. Olowoyeye
- Department of Radiology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Adesoji O. Ademuyiwa
- Pediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
- Pediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital; Paediatric Surgery Unit, Department of Surgery, College of Medicine, University of Lagos & Pediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Edamisan O. Temiye
- Paediatric Hematology & Oncology Unit, Department of Pediatrics, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adebola A Akinsulie
- Paediatric Hematology & Oncology Unit, Department of Pediatrics, College of Medicine, University of Lagos/Lagos University Teaching Hospital, Lagos, Nigeria
| | - Christopher O. Bode
- Pediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
- Pediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital; Paediatric Surgery Unit, Department of Surgery, College of Medicine, University of Lagos & Pediatric Surgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria
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11
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van der Perk MEM, Cost NG, Bos AME, Brannigan R, Chowdhury T, Davidoff AM, Daw NC, Dome JS, Ehrlich P, Graf N, Geller J, Kalapurakal J, Kieran K, Malek M, McAleer MF, Mullen E, Pater L, Polanco A, Romao R, Saltzman AF, Walz AL, Woods AD, van den Heuvel-Eibrink MM, Fernandez CV. White paper: Onco-fertility in pediatric patients with Wilms tumor. Int J Cancer 2022; 151:843-858. [PMID: 35342935 PMCID: PMC9541948 DOI: 10.1002/ijc.34006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/11/2022] [Accepted: 02/17/2022] [Indexed: 11/18/2022]
Abstract
The survival of childhood Wilms tumor is currently around 90%, with many survivors reaching reproductive age. Chemotherapy and radiotherapy are established risk factors for gonadal damage and are used in both COG and SIOP Wilms tumor treatment protocols. The risk of infertility in Wilms tumor patients is low but increases with intensification of treatment including the use of alkylating agents, whole abdominal radiation or radiotherapy to the pelvis. Both COG and SIOP protocols aim to limit the use of gonadotoxic treatment, but unfortunately this cannot be avoided in all patients. Infertility is considered one of the most important late effects of childhood cancer treatment by patients and their families. Thus, timely discussion of gonadal damage risk and fertility preservation options is important. Additionally, irrespective of the choice for preservation, consultation with a fertility preservation (FP) team is associated with decreased patient and family regret and better quality of life. Current guidelines recommend early discussion of the impact of therapy on potential fertility. Since most patients with Wilms tumors are prepubertal, potential FP methods for this group are still considered experimental. There are no proven methods for FP for prepubertal males (testicular biopsy for cryopreservation is experimental), and there is just a single option for prepubertal females (ovarian tissue cryopreservation), posing both technical and ethical challenges. Identification of genetic markers of susceptibility to gonadotoxic therapy may help to stratify patient risk of gonadal damage and identify patients most likely to benefit from FP methods.
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Affiliation(s)
| | - Nicholas G Cost
- Department of Surgery, Division of Urology, University of Colorado School of Medicine and the Surgical Oncology Program of the Children's Hospital Colorado, Aurora, CO, USA
| | - Annelies M E Bos
- University Medical Center Utrecht, Reproductive Medicine and Gynaecology, Utrecht, Netherlands
| | - Robert Brannigan
- Department of Urology, Northwestern University, Chicago, Illinois, USA
| | - Tanzina Chowdhury
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Andrew M Davidoff
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, USA
| | - Najat C Daw
- Department of Pediatrics - Patient Care, MD Anderson Cancer Center, Houston, TX, USA
| | - Jeffrey S Dome
- Division of Oncology at Children's National Hospital, Washington, DC, USA
| | - Peter Ehrlich
- University of Michigan, C.S. Mott Children's Hospital Section of Pediatric Surgery, Ann Arbor, MI, USA
| | - Norbert Graf
- Department for Pediatric Oncology and Hematology, Saarland University Medical Center, Homburg, Germany
| | - James Geller
- Division of Pediatric Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - John Kalapurakal
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois, USA
| | - Kathleen Kieran
- Department of Urology, University of Washington, and Division of Urology, Seattle Children's Hospital, Seattle, USA
| | - Marcus Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA
| | - Mary F McAleer
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth Mullen
- Department of Pediatric Oncology, Children's Hospital Boston/Dana-Farber Cancer Institute, Boston, MA, USA
| | - Luke Pater
- Department of Radiation Oncology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Angela Polanco
- National Cancer Research Institute Children's Group Consumer Representative, London, UK
| | - Rodrigo Romao
- Departments of Surgery and Urology, IWK Health Centre, Dalhousie University, Halifax, Canada
| | | | - Amy L Walz
- Division of Hematology, Oncology, Neuro-Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - Andrew D Woods
- Children's Cancer Therapy Development Institute, Beaverton, Oregon, USA
| | | | - Conrad V Fernandez
- Department of Pediatric Hematology/Oncology, IWK Health Centre and Dalhousie University, Halifax, Canada
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12
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Crocoli A, Martucci C, Persano G, De Pasquale MD, Serra A, Accinni A, Aloi IP, Bertocchini A, Frediani S, Madafferi S, Pardi V, Inserra A. Vascular Access in Pediatric Oncology and Hematology: State of the Art. CHILDREN 2022; 9:children9010070. [PMID: 35053694 PMCID: PMC8774620 DOI: 10.3390/children9010070] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/15/2021] [Accepted: 12/30/2021] [Indexed: 12/27/2022]
Abstract
Management and successful use of vascular access are critical issues in pediatric patients affected by malignancies. Prolonged course of disease, complex and various treatment protocols require long-lasting vascular access providing adequate tools to administrate those therapies and to collect routine blood sampling without painful and repeated venipuncture. For these reasons, central venous catheters are currently an important component in pediatric onco-hematological care, with a direct influence on outcome. Indeed, there are peculiar issues (techniques of insertion, management, complications etc.) which must be well-known in order to improve the outcome and the quality of life of children with cancer.
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Affiliation(s)
- Alessandro Crocoli
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Cristina Martucci
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
- Correspondence: ; Tel.: +39-0668592155
| | - Giorgio Persano
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Maria Debora De Pasquale
- Paediatric Haematology/Oncology Cell and Gene Therapy Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.D.D.P.); (A.S.)
| | - Annalisa Serra
- Paediatric Haematology/Oncology Cell and Gene Therapy Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.D.D.P.); (A.S.)
| | - Antonella Accinni
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Ivan Pietro Aloi
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Arianna Bertocchini
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Simone Frediani
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Silvia Madafferi
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Valerio Pardi
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
| | - Alessandro Inserra
- General Surgery Department, Bambino Gesu Children’s Hospital, IRCCS, 00165 Rome, Italy; (A.C.); (G.P.); (A.A.); (I.P.A.); (A.B.); (S.F.); (S.M.); (V.P.); (A.I.)
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Characteristics of Nephroblastoma/Nephroblastomatosis in Children with a Clinically Reported Underlying Malformation or Cancer Predisposition Syndrome. Cancers (Basel) 2021; 13:cancers13195016. [PMID: 34638500 PMCID: PMC8507684 DOI: 10.3390/cancers13195016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/29/2021] [Accepted: 09/29/2021] [Indexed: 01/03/2023] Open
Abstract
Simple Summary It is well known that different cancer predisposition syndromes are associated with characteristic WT-features. The following findings from our retrospective analysis of patients with nephroblastoma treated according to the SIOP/GPOH trials between 1989 and 2017 are relevant: (1) The outcome of patients with a cancer predisposition syndrome is not always favorable despite early diagnosis, small tumors and less metastatic disease. This finding is partly depending on complications related to the underlying syndrome. (2) Predisposition syndromes seem to be underdiagnosed as several clinical and pathological features of Wilms tumor being clearly linked to a cancer predisposition syndrome did not lead to genetic counseling before and after WT diagnosis. As a conclusion, in children with a nephroblastoma and specific clinical and pathological features that are in line with a nephroblastoma cancer predisposition syndrome such a syndrome should always be considered and ruled out if unknown at the time of tumor diagnosis. Abstract (1) Background: about 10% of Wilms Tumor (WT) patients have a malformation or cancer predisposition syndrome (CPS) with causative germline genetic or epigenetic variants. Knowledge on CPS is essential for genetic counselling. (2) Methods: this retrospective analysis focused on 2927 consecutive patients with WTs registered between 1989 and 2017 in the SIOP/GPOH studies. (3) Results: Genitourinary malformations (GU, N = 66, 2.3%), Beckwith-Wiedemann spectrum (BWS, N = 32, 1.1%), isolated hemihypertrophy (IHH, N = 29, 1.0%), Denys-Drash syndrome (DDS, N = 24, 0.8%) and WAGR syndrome (N = 20, 0.7%) were reported most frequently. Compared to others, these patients were younger at WT diagnosis (median age 24.5 months vs. 39.0 months), had smaller tumors (349.4 mL vs. 487.5 mL), less often metastasis (8.2% vs. 18%), but more often nephroblastomatosis (12.9% vs. 1.9%). WT with IHH was associated with blastemal WT and DDS with stromal subtype. Bilateral WTs were common in WAGR (30%), DDS (29%) and BWS (31%). Chemotherapy induced reduction in tumor volume was poor in DDS (0.4% increase) and favorable in BWS (86.9% reduction). The event-free survival (EFS) of patients with BWS was significantly (p = 0.002) worse than in others. (4) Conclusions: CPS should be considered in WTs with specific clinical features resulting in referral to a geneticist. Their outcome was not always favorable.
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Nakata K, Williams R, Kinoshita Y, Koshinaga T, Moroz V, Al-Saadi R, Vujanic G, Oue T, Pritchard-Jones K. Comparative analysis of the clinical characteristics and outcomes of patients with Wilms tumor in the United Kingdom and Japan. Pediatr Blood Cancer 2021; 68:e29143. [PMID: 34056846 DOI: 10.1002/pbc.29143] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/28/2021] [Accepted: 05/07/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Wilms tumor (WT) demonstrates epidemiological differences by world region and ethnicity. To enhance understanding of these differences, we retrospectively analyzed clinical trial data sets from the UK and Japan over a 20-year period. PROCEDURE We used data from three consecutive clinical trials in the UK and a single study in Japan that enrolled patients diagnosed during 1996-2015, to compare clinical characteristics and outcomes between countries. RESULTS During 1996-2015, 1395 patients in the UK and 537 in Japan were included. Japanese patients have a significantly younger median age at diagnosis than those in the UK (28 months vs 39 months). The proportion of patients with stage IV, large tumors, and anaplastic histology appears to be higher in the UK than in Japan (18% vs 11%, 62% vs 49%, 8% vs 3%, respectively). During 2005-2015, 77 hospitals treated WT in Japan compared with only 20 hospitals in the UK. Five-year overall survival of patients with WT was over 90% in both countries, but five-year event-free survival of patients with stage IV was significantly lower in Japan than in the UK (50.0% vs 76.2%, P = 0.001). CONCLUSIONS Differences in age of onset, tumor size at diagnosis, and histology may reflect differences in the genetic background of patients with WT between countries, but population-based phenotype-genotype data are lacking. The difference in survival probability for stage IV patients may be due to different diagnostic criteria or different treatment strategies. Prospective, international clinical studies including genomic analyses are needed to confirm these findings and improve clinical practice.
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Affiliation(s)
- Kayo Nakata
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Richard Williams
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Imperial BRC Genomics Facility, Imperial College London, London, UK
| | - Yoshiaki Kinoshita
- Malignant Tumor Committee, Japanese Society of Pediatric Surgeons, Tokyo, Japan
| | | | - Veronica Moroz
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - 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 NHS Foundation Trust, London, UK
| | | | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - 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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15
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Bilateral Wilms' tumour: An international comparison of treatments and outcomes. J Pediatr Surg 2021; 56:1487-1493. [PMID: 33573802 DOI: 10.1016/j.jpedsurg.2021.01.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/11/2020] [Accepted: 01/12/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Wilms' tumour is the most common childhood renal malignancy, with 5-10% of cases presenting bilaterally 1. However, there is currently no consensus between centres on optimal management of bilateral Wilms' tumours. This is an international multi-centre case series comparing management and outcomes of bilateral Wilms' tumours between low-income centres (LIC) and high-income centres (HIC). METHODS Patients with bilateral Wilms' tumour were identified from four tertiary referral centres internationally. Data were collected on baseline characteristics, disease status, treatment used and clinical outcomes. Results were compared between individual centres as well as between groups of low-income centres (LIC) and high-income centres (HIC). RESULTS Data were collected for forty patients. Most patients received preoperative chemotherapy (n = 38, 95%). The most common surgical procedures were bilateral nephron-sparing surgery (n = 10, 25%) and nephrectomy with partial nephrectomy (n = 20, 50%). Ten-year survival after treatment was as follows: LIC's n = 13 (65%); HIC's n = 20 (100%) (p = 0.01). DISCUSSION Ten-year survival was significantly higher in HIC's. Our results show this may be caused by patient factors such as later presentation with more advanced disease in low-income centres. This comparative case series is the first to report on a large number of cases from multiple international centres, and to compare key outcomes.
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Groenendijk A, Spreafico F, de Krijger RR, Drost J, Brok J, Perotti D, van Tinteren H, Venkatramani R, Godziński J, Rübe C, Geller JI, Graf N, van den Heuvel-Eibrink MM, Mavinkurve-Groothuis AMC. Prognostic Factors for Wilms Tumor Recurrence: A Review of the Literature. Cancers (Basel) 2021; 13:cancers13133142. [PMID: 34201787 PMCID: PMC8268923 DOI: 10.3390/cancers13133142] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/08/2021] [Accepted: 06/18/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary A Wilms tumor is a childhood kidney tumor. In high-income countries, 90% of patients with this tumor survive. However, the tumor recurs in 15% of patients. It is important to identify the patients at risk of recurrence in order to adjust treatment in such a way that recurrence may potentially be prevented. However, we are currently unable to determine precisely which patients are at risk of recurrence. Therefore, we present an overview of factors that influence the risk of recurrence, also known as prognostic factors. These factors range from patient-, tumor- and treatment-related characteristics to geographic and socioeconomic factors. In addition to these factors, biological markers, such as genetic alterations, should be studied more intensively as these markers may be able to better identify patients at risk of tumor recurrence. Abstract In high-income countries, the overall survival of children with Wilms tumors (WT) is ~90%. However, overall, 15% of patients experience tumor recurrence. The adverse prognostic factors currently used for risk stratification (advanced stage, high risk histology, and combined loss of heterozygosity at 1p and 16q in chemotherapy-naïve WTs) are present in only one third of these cases, and the significance of these factors is prone to change with advancing knowledge and improved treatment regimens. Therefore, we present a comprehensive, updated overview of the published prognostic variables for WT recurrence, ranging from patient-, tumor- and treatment-related characteristics to geographic and socioeconomic factors. Improved first-line treatment regimens based on clinicopathological characteristics and advancing knowledge on copy number variations unveil the importance of further investigating the significance of biological markers for WT recurrence in international collaborations.
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Affiliation(s)
- Alissa Groenendijk
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
- Correspondence:
| | - Filippo Spreafico
- Department of Medical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Ronald R. de Krijger
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
- Department of Pathology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Jarno Drost
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
- Oncode Institute, 3584 CS Utrecht, The Netherlands
| | - Jesper Brok
- Department of Pediatric Oncology and Hematology, Rigshospitalet, 2100 Copenhagen, Denmark;
- Developmental Biology and Cancer Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London WC1N 1EH, UK
| | - Daniela Perotti
- Molecular Bases of Genetic Risk and Genetic Testing Unit, Department of Research, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy;
| | - Harm van Tinteren
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
| | | | - Jan Godziński
- Department of Pediatric Surgery, Marciniak Hospital, Fieldorfa 2, 54-049 Wroclaw, Poland;
- Department of Pediatric Traumatology and Emergency Medicine, Wroclaw Medical University, Bujwida 44a, 50-345 Wroclaw, Poland
| | - Christian Rübe
- Department of Radiation Oncology, Saarland University Medical Center and Saarland University Faculty of Medicine, D-66421 Homburg, Germany;
| | - James I. Geller
- Division of Oncology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229, USA;
| | - Norbert Graf
- Department of Pediatric Oncology and Hematology, Saarland University Medical Center and Saarland University Faculty of Medicine, D-66421 Homburg, Germany;
| | - Marry M. van den Heuvel-Eibrink
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
| | - Annelies M. C. Mavinkurve-Groothuis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS Utrecht, The Netherlands; (R.R.d.K.); (J.D.); (H.v.T.); (M.M.v.d.H.-E.); (A.M.C.M.-G.)
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Abstract
Wilms’ tumor is the most common kidney tumor of childhood. The outcome of this malignant tumor has improved due to the improvement of therapeutic strategies. The most important factor in determining the prognosis of these patients is the histopathology subtype of the tumor; unfavorable histopathology is seen in only 11.5% of the patients, which accounts for 52% of deaths. Therefore, the aim of this study was to determine the outcome of children with Wilms’ tumor referred to our hospital over a period of 10 years. This is a retrospective cohort study, and the target population included all patients with Wilms’ tumor referred to Ali Asghar Hospital and were treated according to the National Wilms tumor study 4 (NWTS-4) protocol. All patients’ data were extracted from the medical records of the department. Overall survival and event-free survival (EFS) were analyzed by the Kaplan Mayer method in the SPSS software, version 23. Fifty-two patients (24 male and 28 female patients) with Wilms’ tumor were included. The mean age of the subjects was 40 months. The most common stage among boys and girls was stage II (23.08% and 28.85%, respectively). Our findings revealed that the overall five-year survival of patients was 87±5%; this figure was determined as 100% for boys and 76.8% ± 1.6 for girls (P = 0.018). Our findings show a dramatic improvement in the outcome of children with Wilms’s tumor, and our results are comparable with other results from developed countries. Gender may be an independent prognostic factor of children with Wilms’ tumor.
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Affiliation(s)
- Gholamreza Bahoush
- Department of Pediatrics, Ali-Asghar Children Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Elahe Saeedi
- Department of Pediatrics, Ali-Asghar Children Hospital, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Cheng J, Zhuo Z, Yang L, Zhao P, Zhang J, Zhou H, He J, Li P. HMGA2 gene polymorphisms and Wilms tumor susceptibility in Chinese children: a four-center case-control study. Biotechnol Appl Biochem 2020; 67:939-945. [PMID: 31746066 DOI: 10.1002/bab.1857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 11/14/2019] [Indexed: 02/05/2023]
Abstract
Wilms tumor is a kidney malignancy that typically occurs in children. Aberrant expression of HMGA2 gene is commonly seen in many malignant tumors. Yet, HMGA2 gene polymorphisms on Wilms tumor risk are not established. We carried out the first four-center case-control study with 355 patients and 1,070 controls to assess the association of HMGA2 polymorphisms (rs6581658 A>G, rs8756 A>C, and rs968697 T>C) with Wilms tumor risk. All of these three polymorphisms in single could not impact Wilms tumor risk. Stratified analysis revealed a contributing Wilms tumor risk role of rs968697 TC/CC in subgroup of male (TC/CC vs. TT: adjusted odds ratio [OR] = 1.46, 95% confidence interval [CI] = 1.03-2.08, P = 0.035). However, we found that presence of 1-3 protective genotypes were less likely to develop tumor in subgroup of female (adjusted OR = 0.69, 95% CI = 0.48-0.99, P = 0.045). Our findings suggest that HMGA2 gene polymorphisms might influence Wilms tumor predisposition in a weak manner, under certain circumstances.
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Affiliation(s)
- Jiwen Cheng
- Department of Pediatric Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhenjian Zhuo
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Liu Yang
- Clinical Laboratory Medicine Center of PLA, Xijing Hospital, Air Force Medical University, Xi'an, Shaanxi, China
| | - Pu Zhao
- Department of Neonatology, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Jiao Zhang
- Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Haixia Zhou
- Department of Hematology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jing He
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Peng Li
- Department of Pediatric Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Calandrini C, Schutgens F, Oka R, Margaritis T, Candelli T, Mathijsen L, Ammerlaan C, van Ineveld RL, Derakhshan S, de Haan S, Dolman E, Lijnzaad P, Custers L, Begthel H, Kerstens HHD, Visser LL, Rookmaaker M, Verhaar M, Tytgat GAM, Kemmeren P, de Krijger RR, Al-Saadi R, Pritchard-Jones K, Kool M, Rios AC, van den Heuvel-Eibrink MM, Molenaar JJ, van Boxtel R, Holstege FCP, Clevers H, Drost J. An organoid biobank for childhood kidney cancers that captures disease and tissue heterogeneity. Nat Commun 2020; 11:1310. [PMID: 32161258 PMCID: PMC7066173 DOI: 10.1038/s41467-020-15155-6] [Citation(s) in RCA: 161] [Impact Index Per Article: 40.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/21/2020] [Indexed: 01/02/2023] Open
Abstract
Kidney tumours are among the most common solid tumours in children, comprising distinct subtypes differing in many aspects, including cell-of-origin, genetics, and pathology. Pre-clinical cell models capturing the disease heterogeneity are currently lacking. Here, we describe the first paediatric cancer organoid biobank. It contains tumour and matching normal kidney organoids from over 50 children with different subtypes of kidney cancer, including Wilms tumours, malignant rhabdoid tumours, renal cell carcinomas, and congenital mesoblastic nephromas. Paediatric kidney tumour organoids retain key properties of native tumours, useful for revealing patient-specific drug sensitivities. Using single cell RNA-sequencing and high resolution 3D imaging, we further demonstrate that organoid cultures derived from Wilms tumours consist of multiple different cell types, including epithelial, stromal and blastemal-like cells. Our organoid biobank captures the heterogeneity of paediatric kidney tumours, providing a representative collection of well-characterised models for basic cancer research, drug-screening and personalised medicine. Pre-clinical cell culture models capturing the heterogeneity of childhood kidney tumours are limited. Here, the authors establish and characterise an organoid biobank of tumour and matched normal organoid cultures from over 50 children with different subtypes of kidney cancer.
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Affiliation(s)
- Camilla Calandrini
- Oncode Institute, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Frans Schutgens
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences and University Medical Center, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands.,University Medical Center, Department of Nephrology and Hypertension, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Rurika Oka
- Oncode Institute, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Thanasis Margaritis
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Tito Candelli
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Luka Mathijsen
- Oncode Institute, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Carola Ammerlaan
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences and University Medical Center, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands.,University Medical Center, Department of Nephrology and Hypertension, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Ravian L van Ineveld
- Oncode Institute, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Sepide Derakhshan
- Oncode Institute, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Sanne de Haan
- Oncode Institute, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Emmy Dolman
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Philip Lijnzaad
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Lars Custers
- Oncode Institute, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Harry Begthel
- Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences and University Medical Center, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands
| | - Hindrik H D Kerstens
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Lindy L Visser
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Maarten Rookmaaker
- University Medical Center, Department of Nephrology and Hypertension, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Marianne Verhaar
- University Medical Center, Department of Nephrology and Hypertension, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Godelieve A M Tytgat
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Patrick Kemmeren
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Ronald R de Krijger
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.,University Medical Center, Department of Pathology, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Reem Al-Saadi
- University College London, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Kathy Pritchard-Jones
- University College London, UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK
| | - Marcel Kool
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.,Hopp Children's Cancer Center (KiTZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ) and German Cancer Research Consortium (DKTK), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Anne C Rios
- Oncode Institute, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | | | - Jan J Molenaar
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Ruben van Boxtel
- Oncode Institute, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Frank C P Holstege
- Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands
| | - Hans Clevers
- Oncode Institute, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.,Oncode Institute, Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences and University Medical Center, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands
| | - Jarno Drost
- Oncode Institute, Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands.
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20
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Fajardo RD, van den Heuvel-Eibrink MM, van Tinteren H, Spreafico F, Acha T, Bergeron C, de Camargo B, Oldenburger F, Rübe C, Oue T, Vokuhl C, de Krijger RR, Vujanic G, Sebire N, Coulomb-L'Hermine A, Collini P, Gandola L, Pritchard-Jones K, Graf N, Janssens GO, van Grotel M. Is radiotherapy required in first-line treatment of stage I diffuse anaplastic Wilms tumor? A report of SIOP-RTSG, AIEOP, JWiTS, and UKCCSG. Pediatr Blood Cancer 2020; 67:e28039. [PMID: 31625685 DOI: 10.1002/pbc.28039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 09/05/2019] [Accepted: 09/23/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND As a significant proportion of relapses occurred in the tumor bed or abdomen on patients with the fifth National Wilms Tumor Study stage I anaplastic Wilms tumor (WT), flank radiotherapy was added for stage I anaplastic WT in the subsequent study of the Children's Oncology Group (AREN0321). Preliminary results revealed reduction of relapse rate and improved survival. In cases treated with preoperative chemotherapy, such as in International Society of Pediatric Oncology (SIOP), the value of radiotherapy has never been studied. The aim of this observational study is to describe the pattern of recurrence and survival of patients with stage I diffuse anaplastic WT (DAWT) after induction chemotherapy. METHODS Retrospective data analysis of the pattern of relapse and survival of all patients with stage I DAWT were included in recent SIOP, L'Associazone Italiana Ematologica Oncologia Pediatrica (AIEOP), Japan Wilms Tumor Study Group (JWiTS), United Kingdom Children's Cancer Study Group (UKCCSG) renal tumor registries. Postoperative treatment consisted of actinomycin D, vincristine, and doxorubicin for 28 weeks without local irradiation. RESULTS One hundred nine cases with stage I DAWT were identified, of which 95 cases received preoperative chemotherapy. Of these, seven patients underwent preoperative true-cut biopsy. Sixteen of the 95 patients relapsed (17%), six locally, four at distant site, and six combined, and all treated according to SIOP 2001 relapse protocol, which resulted in a 5-year overall survival of 93%. CONCLUSION Despite 13% locoregional relapse rate, an excellent rescue rate was achieved after salvage treatment, in patients with stage I DAWT whose first-line treatment comprised three-drug chemotherapy (including doxorubicin), without flank irradiation. Therefore, we continue not to advocate the use of radiotherapy in first-line treatment after preoperative chemotherapy in stage I DAWT in the next SIOP protocol.
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Affiliation(s)
- Raquel Dávila Fajardo
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Harm van Tinteren
- Department of Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Filippo Spreafico
- Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Thomas Acha
- Department of Pediatric Oncology, Hospital Materno-Infantil, Málaga, Spain
| | | | - Beatriz de Camargo
- Department of Pediatric Hematology and Oncology, Instituto Nacional Do Cancer (INCA), Rio de Janeiro, Brazil
| | - Foppe Oldenburger
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
| | - Christian Rübe
- Department of Radio-Oncology, University Hospital of Saarland, Homburg, Germany
| | - Takaharu Oue
- Department of Pediatric Surgery, Hyogo College of Medicine, Nishinomiya City, Hyogo Prefecture, Osaka, Japan
| | - Christian Vokuhl
- Institute of Pediatric Pathology, University of Kiel, Kiel, Germany
| | - Ronald R de Krijger
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | | | - Neil Sebire
- Department of Histopathology, Great Ormond Street Hospital, London, UK
| | | | - Paola Collini
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Lorenza Gandola
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Norbert Graf
- Department of Pediatric Oncology, University Hospital of Saarland, Homburg, Germany
| | - Geert O Janssens
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Martine van Grotel
- Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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21
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Liu J, Hua RX, Fu W, Zhu J, Jia W, Zhang J, Zhou H, Cheng J, Xia H, Liu G, He J. MYC gene associated polymorphisms and Wilms tumor risk in Chinese children: a four-center case-control study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:475. [PMID: 31700911 PMCID: PMC6803173 DOI: 10.21037/atm.2019.08.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Wilms tumor (WT) is a common embryonal malignancy in the kidney, ranking fourth in childhood cancer worldwide. MYC, a critical proto-oncogene, plays an important role in tumorigenesis. Single nucleotide polymorphisms in the MYC gene may lead to the deregulation of MYC proto-oncogene protein and thereby promote the initiation and development of tumors. METHODS Here, we assessed the association between MYC gene associated polymorphisms and WT susceptibility by performing a case-control study with 355 cases and 1070 controls. Two MYC gene associated polymorphisms (rs4645943 C > T, rs2070583 A > G) were genotyped by TaqMan technique. Odds ratios (ORs) and 95% confidence intervals (CIs) were used for evaluating the association between these two polymorphisms and WT susceptibility. RESULTS No significant association was detected between the selected polymorphisms and WT risk in the overall analysis as well as stratification analysis. CONCLUSIONS These results indicate that neither of two selected MYC gene associated polymorphisms might affect WT susceptibility in the Chinese population. Large well-designed studies with diverse ethnicities are warranted to verify these results.
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Affiliation(s)
- Jiabin Liu
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Rui-Xi Hua
- Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Wen Fu
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Jinhong Zhu
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China
- Department of Clinical Laboratory, Molecular Epidemiology Laboratory, Harbin Medical University Cancer Hospital, Harbin 150040, China
| | - Wei Jia
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Jiao Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Haixia Zhou
- Department of Hematology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Jiwen Cheng
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, China
| | - Huimin Xia
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Guochang Liu
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China
| | - Jing He
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou 510623, China
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23
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Irtan S, Van Tinteren H, Graf N, van den Heuvel-Eibrink MM, Heij H, Bergeron C, de Camargo B, Acha T, Spreafico F, Vujanic G, Powis M, Okoye B, Wilde J, Godzinski J, Pritchard-Jones K. Evaluation of needle biopsy as a potential risk factor for local recurrence of Wilms tumour in the SIOP WT 2001 trial. Eur J Cancer 2019; 116:13-20. [PMID: 31163337 DOI: 10.1016/j.ejca.2019.04.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/25/2019] [Accepted: 04/10/2019] [Indexed: 10/26/2022]
Abstract
RATIONALE The impact of biopsying Wilms tumour (WT) at diagnosis on assigning the tumour stage and recommended treatment remains controversial. To address this important question, we analysed the potential association of all types of biopsy with local recurrence in patients treated in the SIOP WT 2001 trial, where needle biopsy was permitted without 'upstaging' the tumour to stage III. Only open biopsy required treatment as stage III. METHODS Among 2971 patients with unilateral WT (stages I-IV), 420 relapsed (139 local). Risk factors for recurrence were analysed by Cox proportional hazard methods. RESULTS Biopsy was performed in 969 of 2971 (33%) patients (64% cutting needle, 30% fine needle aspiration [FNA] and 6% open biopsy). Biopsied patients were older, with larger tumours and a greater proportion with high-risk histology. In multivariate analysis that included all factors associated with local recurrence in univariate analysis, only high-risk histology (hazard ratio [HR] = 2.32; 95% confidence interval [CI]: 1.58-3.42, p=<0.0001), age≥2 years (HR = 2.24; 95% CI: 1.22-4.09, p = 0.01) and preoperative tumour volume (HR = 1.07 per 100 ml; 95% CI: 1.02-1.12, p = 0.01) were significant. The HR for the association of local recurrence and event-free and overall survival with biopsy was not significant (HR = 1.4; 95% CI: 0.9-2.17, p = 0.13; HR = 1.1; 95% CI: 0.85-1.42, p = 0.46 and HR = 1.13; 95% CI: 0.79-1.62, p = 0.51, respectively). These results were not materially different whether FNA or open biopsy were included in the biopsy group or not. CONCLUSIONS This post hoc analysis provides some reassurance that needle biopsy is not an independent adverse factor for either local recurrence or survival after adjustment for all relevant risk factors. Needle biopsy should not be an automatic criterion to 'upstage' WT.
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Affiliation(s)
- Sabine Irtan
- Cancer Section, Developmental Biology & Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London, London, UK; Paediatric Surgery Department, Trousseau Hospital - Assistance Publique des Hôpitaux de Paris, Paris, France.
| | - Harm Van Tinteren
- Biostatistics Department, Netherlands Cancer Institute - Antonie van Leeuwenhoekhuis Plesmanlaan, Amsterdam, Netherlands.
| | - Norbert Graf
- Saarland University, Department of Pediatric Oncology & Hematology, Homburg, Germany.
| | | | - Hugo Heij
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
| | | | - Beatriz de Camargo
- Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
| | - Tomas Acha
- Department of Pediatric Oncology, Hospital Materno-Infantil, Malaga, Spain.
| | - Filippo Spreafico
- Department of Clinical Oncology and Hematology, Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
| | | | - Mark Powis
- Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Bruce Okoye
- St. Georges Healthcare NHS Trust, Tooting, London, UK.
| | - Jim Wilde
- Division of Pediatric Surgery, Geneva University Hospitals, University Center of Pediatric Surgery of Western Switzerland, Geneva, Switzerland.
| | - Jan Godzinski
- Department of Paediatric Surgery, Marciniak Hospital, and Dept. of Paediatric Traumatology and Emergency Medicine, Medical University, Wroclaw, Poland.
| | - Kathy Pritchard-Jones
- Cancer Section, Developmental Biology & Cancer Programme, UCL Great Ormond Street Institute of Child Health, University College London, London, UK.
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Wilms tumour event-free and overall survival in Southern and Eastern Europe: Pooled analyses of clinical data from four childhood cancer registries (1999-2017). Eur J Cancer 2019; 115:37-46. [PMID: 31082691 DOI: 10.1016/j.ejca.2019.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/22/2019] [Accepted: 04/04/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Wilms tumour (WT) management represents a success story in pediatric oncology. We aimed to assess, for the first time, the event-free survival (EFS) vs. overall survival (OS) in Southern and Eastern Europe (SEE) using harmonised clinical data collected by childhood cancer registries and to identify respective prognostic factors. METHODS From 1999 to 2017, data for incident WT cases aged 0-14 years from 3 nationwide (Greece, Belarus and Slovenia) and one regional (Greater Poland) SEE registries were collected following common coding. Kaplan-Meier curves were constructed, and EFS vs. OS values were derived from Cox proportional hazard models by study variables. RESULTS A total of 338 WT cases (45.6% males; median age, 3.19 years; age<5 years, 75%) were included in the analyses. Bilateral were 21 tumours (6.2%). Among the 317 unilateral cases, the majority (93.7%) received International Society of Pediatric Oncology-based protocols; EFS5-year was 85.1%, and OS5-year 91.1%; both outcomes were significantly worse in stage IV patients or in those with high-risk/unfavourable histology. Relapse rate among high-risk/unfavourable histology cases was 2.3 times higher than among low-intermediate risk/favourable histology cases, with respective death rate 5.6 times higher. Both relapse and death rates increased significantly in patients with advanced anatomical stage and high-risk/unfavourable histology. Finally, significantly worse was the outcome in bilateral tumours (OS5-year: 76.3%) vs. unilateral non-metastatic tumours (OS5-year: 94.7%). CONCLUSIONS Our results delineate the potential of high-quality childhood cancer registration entailing clinical data to assess predictors of WT outcome over and beyond those derived from enrolment into clinical trials. Specifically, outcomes among children with WT residing in the four participating SEE countries were comparable with those reported by major cooperative international groups, albeit somehow inferior. Despite the excellent overall prognosis, however, subgroups of patients with advanced or bilateral disease and/or high-risk histology still suffer poor outcomes.
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25
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Wellens LM, Meulstee J, van de Ven CP, Terwisscha van Scheltinga CEJ, Littooij AS, van den Heuvel-Eibrink MM, Fiocco M, Rios AC, Maal T, Wijnen MHWA. Comparison of 3-Dimensional and Augmented Reality Kidney Models With Conventional Imaging Data in the Preoperative Assessment of Children With Wilms Tumors. JAMA Netw Open 2019; 2:e192633. [PMID: 31002326 PMCID: PMC6481457 DOI: 10.1001/jamanetworkopen.2019.2633] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Nephron-sparing surgery can be considered in well-defined cases of unilateral and bilateral Wilms tumors, but the surgical procedure can be very challenging for the pediatric surgeon to perform. OBJECTIVE To assess the added value of personalized 3-dimensional (3-D) kidney models derived from conventional imaging data to enhance preoperative surgical planning. DESIGN, SETTING, AND PARTICIPANTS In a survey study, the conventional imaging data of 10 Dutch children with Wilms tumors were converted to 3-D prints and augmented reality (AR) holograms and a panel of pediatric oncology surgeons (n = 7) assessed the quality of the different imaging methods during preoperative evaluation. Kidney models were created with 3-D printing and AR using a mixed reality headset for visualization. MAIN OUTCOMES AND MEASURES Differences in the assessment of 4 anatomical structures (tumor, arteries, veins, and urinary collecting structures) using questionnaires. A Likert scale measured differences between the imaging methods, with scores ranging from 1 (completely disagree) to 5 (completely agree). RESULTS Of the 10 patients, 7 were girls, and the mean (SD) age was 3.7 (1.7) years. Compared with conventional imaging, the 3-D print and the AR hologram models were evaluated by the surgeons to be superior for all anatomical structures: tumor (median scores for conventional imaging, 4.07; interquartile range [IQR], 3.62-4.15 vs 3-D print, 4.67; IQR, 4.14-4.71; P = .008 and AR hologram, 4.71; IQR, 4.26-4.75; P = .002); arteries (conventional imaging, 3.62; IQR, 3.43-3.93 vs 3-D print, 4.54; IQR, 4.32-4.71; P = .002 and AR hologram, 4.83; IQR, 4.64-4.86; P < .001), veins (conventional imaging, 3.46; IQR 3.39-3.62 vs 3-D print, 4.50; IQR, 4.39-4.68; P < .001 and AR hologram, 4.83; IQR, 4.71-4.86; P < .001), and urinary collecting structures (conventional imaging, 2.76; IQR, 2.42-3.00 vs 3-D print, 3.86; IQR, 3.64-4.39; P < .001 and AR hologram, 4.00; IQR, 3.93-4.58; P < .001). There were no differences in anatomical assessment between the two 3-D techniques (the 3-D print and AR hologram). CONCLUSIONS AND RELEVANCE In this study, the 3-D kidney models were associated with improved anatomical understanding among the surgeons and can be helpful in future preoperative planning of nephron-sparing surgery for Wilms tumors. These models may be considered as a supplementary visualization in clinical care.
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Affiliation(s)
- Lianne M. Wellens
- Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Jene Meulstee
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cornelis P. van de Ven
- Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Annemieke S. Littooij
- Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Department of Radiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | - Marta Fiocco
- Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
- Division of Medical Statistics, Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, the Netherlands
- Mathematical Institute, Leiden University, Leiden, the Netherlands
| | - Anne C. Rios
- Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Thomas Maal
- Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marc H. W. A. Wijnen
- Department of Pediatric Surgery, Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
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Fu W, Zhuo Z, Hua RX, Fu K, Jia W, Zhu J, Zhang J, Cheng J, Zhou H, Xia H, He J, Liu G. Association of KRAS and NRAS gene polymorphisms with Wilms tumor risk: a four-center case-control study. Aging (Albany NY) 2019; 11:1551-1563. [PMID: 30860980 PMCID: PMC6428095 DOI: 10.18632/aging.101855] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/06/2019] [Indexed: 02/07/2023]
Abstract
Wilms tumor is a type of pediatric solid tumor that arises partly due to somatic and germline mutations. Single-nucleotide polymorphisms (SNPs) in the RAS gene reportedly modify the risk for several types of human malignancies. We conducted a multicenter study to investigate whether RAS gene variants predispose individuals to Wilms tumor. Four SNPs in RAS were genotyped in 355 Wilms tumor cases and 1070 controls. The SNPs included rs12587 G>T, rs7973450 A>G and rs7312175 G>A in KRAS, and rs2273267 A>T in NRAS. Individuals harboring the rs12587 GT genotype were more likely to develop Wilms tumor than those carrying the GG genotype (adjusted odds ratio [OR]=1.30, 95% confidence interval [CI]=1.004-1.68, P=0.046). However, the other three SNPs seemed not to influence the risk for Wilms tumor. Compared to individuals without a risk genotype, those harboring one to three KRAS risk genotypes had an adjusted OR of 1.28 for developing Wilms tumor (95% CI=1.002-1.64, P=0.048). Stratification analysis revealed that rs12587 GT/TT was associated with Wilms tumor risk in children >18 months old (adjusted OR=1.39, 95% CI=1.02-1.89, P=0.037). Our findings indicate that the rs12587 G>T polymorphism in KRAS is associated with increased Wilms tumor susceptibility.
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Affiliation(s)
- Wen Fu
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
- Equal contribution
| | - Zhenjian Zhuo
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
- Equal contribution
| | - Rui-Xi Hua
- Department of Oncology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China
- Equal contribution
| | - Kai Fu
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Wei Jia
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Jinhong Zhu
- Department of Clinical Laboratory, Molecular Epidemiology Laboratory, Harbin Medical University Cancer Hospital, Harbin 150040, Heilongjiang, China
| | - Jiao Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Jiwen Cheng
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China
| | - Haixia Zhou
- Department of Hematology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Huimin Xia
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Jing He
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Guochang Liu
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
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Vujanić GM, D'Hooghe E, Popov SD, Sebire NJ, Kelsey A. The effect of preoperative chemotherapy on histological subtyping and staging of Wilms tumors: The United Kingdom Children's Cancer Study Group (UKCCSG) Wilms tumor trial 3 (UKW3) experience. Pediatr Blood Cancer 2019; 66:e27549. [PMID: 30408319 DOI: 10.1002/pbc.27549] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/08/2018] [Accepted: 10/18/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Two principal approaches to Wilms tumor (WT) treatment are immediate surgery (IS) and preoperative chemotherapy (PCT), and both treatments use the risk-adapted approach that includes histological subclassification of the tumor, combined with additional prognostic factors. In the UKW3 trial, these two approaches were compared. The aim of the present study was to compare histological features between the two groups, to assess the impact of PCT on distribution of histological subtyping and staging and to evaluate whether PCT resulted in more staging discrepancies between local and central pathology review (CPR). MATERIALS AND METHODS The cases were identified from the UKW3 trial database. The criteria for inclusion in the study were unilateral, nonmetastatic, nonanaplastic WTs, and submitted for CPR with an adequate number of slides. They were subclassified according to the NWTS and later the SIOP 9301 criteria. RESULTS There were 244 WTs in the IS and 182 in the PCT group subclassified as follows: blastemal 86 (35%) vs 9 (5%), epithelial 34 (14%) vs 12 (7%), stromal 12 (5%) vs 25 (14%), mixed 112 (46%) vs 45 (25%), respectively, plus 40% regressive and 10% completely necrotic WTs in the PCT group. The differences between the two groups for blastemal and mixed types were statistically significant. In the PCT group, there was a significant decrease in stage III tumors. The discrepancies in staging between local and CPR were not significant. CONCLUSION PCT significantly altered histological features and typing of WTs. It resulted in fewer stage III tumors, and staging discrepancies were equally represented in both groups.
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Affiliation(s)
| | - Ellen D'Hooghe
- Department of Pathology, Oslo University Hospital, Oslo, Norway
| | - Sergey D Popov
- Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK
| | - Neil J Sebire
- Department of Histopathology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Anna Kelsey
- Department of Diagnostic Paediatric Histopathology, Royal Manchester Children's Hospital, Manchester, UK
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Liu P, Zhuo Z, Li W, Cheng J, Zhou H, He J, Zhang J, Wang J. TP53 rs1042522 C>G polymorphism and Wilms tumor susceptibility in Chinese children: a four-center case-control study. Biosci Rep 2019; 39:BSR20181891. [PMID: 30610160 PMCID: PMC6340947 DOI: 10.1042/bsr20181891] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/20/2018] [Accepted: 01/03/2019] [Indexed: 02/07/2023] Open
Abstract
Wilms tumor is the most common renal malignancy that occurs in children. TP53 gene is considered as a tumor-suppressing gene through controlling cell growth. TP53 gene rs1042522 C>G (Arg72Pro) polymorphism is widely investigated in various types of cancers. However, it is not established if TP53 rs1042522 C>G polymorphism is a candidate variant for Wilms tumor risk. The aim of the study was to determine whether TP53 rs1042522 C>G polymorphism is responsible for the risk of Wilms tumor in Chinese children. All subjects (355 cases and 1070 controls) from four centers of China were genotyped for rs1042522 C>G polymorphism. The effect of rs1042522 C>G polymorphism on Wilms tumor prevalence was analyzed using logistic regression models. We failed to detect a significant relationship between rs1042522 C>G polymorphism and Wilms tumor risk. Further stratification analysis also could not detect a significant relationship. We conclude that TP53 rs1042522 C>G polymorphism might not have enough impact on the risk of Wilms tumor. More validation study with larger sample size will be required to better define the role of TP53 rs1042522 C>G polymorphism in Wilms tumor risk.
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Affiliation(s)
- Peng Liu
- Department of Pediatric Intensive Care Unit, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Zhenjian Zhuo
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Wenya Li
- Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Jiwen Cheng
- Department of Pediatric Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710004, Shaanxi, China
| | - Haixia Zhou
- Department of Hematology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang, China
| | - Jing He
- Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Jiao Zhang
- Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
| | - Jiaxiang Wang
- Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan, China
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Lu T, Li L, Zhu J, Liu J, Lin A, Fu W, Liu G, Xia H, Zhang T, He J. AURKA rs8173 G>C Polymorphism Decreases Wilms Tumor Risk in Chinese Children. JOURNAL OF ONCOLOGY 2019; 2019:9074908. [PMID: 31636670 PMCID: PMC6766156 DOI: 10.1155/2019/9074908] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 08/14/2019] [Accepted: 08/23/2019] [Indexed: 02/07/2023]
Abstract
Wilms tumor is the most common type of renal malignancy in children. Previous studies have demonstrated that single nucleotide polymorphisms (SNPs) in the AURKA gene could predispose to several human malignancies. We recruited 145 cases and 531 cancer-free controls to investigate whether AURKA gene variants modify Wilms tumor susceptibility. Three AURKA SNPs (rs1047972 C>T, rs2273535 T>A, and rs8173 G>C) were genotyped by the Taqman methodology. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to assess the strength of association between AURKA SNPs and Wilms tumor risk. We found that only the rs8173 G>C polymorphism was significantly associated with Wilms tumor risk (GC vs. GG: adjusted OR (AOR) = 0.50, 95% CI = 0.35-0.73, P=0.0002; GC/CC vs. GG: AOR = 0.60, 95% CI = 0.42-0.88, P=0.008). Stratification analysis revealed that rs8173 GC/CC genotypes were associated with Wilms tumor risk among children aged >18 months (AOR = 0.56, 95% CI = 0.34-0.93, P=0.024), male children (AOR = 0.54, 95% CI = 0.33-0.90, P=0.017), and children with clinical stage III + IV diseases (AOR = 0.56, 95% CI = 0.35-0.90, P=0.017). Haplotype analysis indicated that the CAG haplotype was significantly associated with increased Wilms tumor risk. In conclusion, our findings indicated that the AURKA rs8173 G>C polymorphism was associated with decreased Wilms tumor risk in Chinese children.
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Affiliation(s)
- Tongyi Lu
- 1Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Li Li
- 2Kunming Key Laboratory of Children Infection and Immunity, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Institute of Pediatrics Research, Yunnan Medical Center for Pediatric Diseases, Kunming Children's Hospital, Kunming 650228, Yunnan, China
| | - Jinhong Zhu
- 3Department of Clinical Laboratory, Biobank, Harbin Medical University Cancer Hospital, Harbin 150040, Heilongjiang, China
| | - Jiabin Liu
- 1Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Ao Lin
- 1Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Wen Fu
- 1Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Guochang Liu
- 1Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Huimin Xia
- 1Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Tiesong Zhang
- 2Kunming Key Laboratory of Children Infection and Immunity, Yunnan Key Laboratory of Children's Major Disease Research, Yunnan Institute of Pediatrics Research, Yunnan Medical Center for Pediatric Diseases, Kunming Children's Hospital, Kunming 650228, Yunnan, China
| | - Jing He
- 1Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
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Outcomes of non-anaplastic stage III and 'inoperable' Wilms tumour treated in the UKW3 trial. Radiother Oncol 2018; 131:1-7. [PMID: 30773174 DOI: 10.1016/j.radonc.2018.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 10/21/2018] [Accepted: 10/23/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND PURPOSE To describe the outcome of patients with stage III Wilms tumours (WT) treated in the UKW3 trial. MATERIAL AND METHODS Patients with a pathologically confirmed stage III non-anaplastic WT at nephrectomy (Group A) or with an 'inoperable' tumour at diagnosis managed by biopsy and pre-operative chemotherapy (Actinomycin D-Vincristine-Doxorubicin) but stage I or II at subsequent nephrectomy (Group B) were included. RESULTS The 4-year overall (OS)/event free survival (EFS) for Group A (n = 117) patients was 90%(95%CI:83-94)/81%(CI:73-87) and for Group B (n = 32) 94%(CI:77-98)/88%(CI:70-95). The 4-year OS/EFS of patients with pathological stage III WT according to whether they received flank/abdominal radiotherapy (95 patients) or not (37 patients, 22 from UKW3 pooled with 17 patients from UKW2) were 91%(CI:83-95)/82%(CI:73-89), and 84%(CI:67-92)/78%(CI:61-89), respectively. The 4-year OS/EFS for patients having one reason to be stage III versus two or three was 92%(CI:84-96)/83%(CI:73-90) and 85%(CI:70-93)/78%(CI:61-88), respectively. CONCLUSION Our findings question the inclusion of biopsy or pre-operative chemotherapy as sole criterion for assigning a tumour stage III. Selected patients with pathological stage III WT can survive without radiotherapy. Whilst cautious interpretation is needed due to the post hoc nature of these analyses, further biological studies may better characterise those who could benefit from reduced therapy.
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Vujanić GM, Gessler M, Ooms AHAG, Collini P, Coulomb-l'Hermine A, D'Hooghe E, de Krijger RR, Perotti D, Pritchard-Jones K, Vokuhl C, van den Heuvel-Eibrink MM, Graf N. The UMBRELLA SIOP-RTSG 2016 Wilms tumour pathology and molecular biology protocol. Nat Rev Urol 2018; 15:693-701. [PMID: 30310143 PMCID: PMC7136175 DOI: 10.1038/s41585-018-0100-3] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
On the basis of the results of previous national and international trials and studies, the Renal Tumour Study Group of the International Society of Paediatric Oncology (SIOP-RTSG) has developed a new study protocol for paediatric renal tumours: the UMBRELLA SIOP-RTSG 2016 protocol (the UMBRELLA protocol). Currently, the overall outcomes of patients with Wilms tumour are excellent, but subgroups with poor prognosis and increased relapse rates still exist. The identification of these subgroups is of utmost importance to improve treatment stratification, which might lead to reduction of the direct and late effects of chemotherapy. The UMBRELLA protocol aims to validate new prognostic factors, such as blastemal tumour volume and molecular markers, to further improve outcome. To achieve this aim, large, international, high-quality databases are needed, which dictate optimization and international harmonization of specimen handling and comprehensive sampling of biological material, refine definitions and improve logistics for expert review. To promote broad implementation of the UMBRELLA protocol, the updated SIOP-RTSG pathology and molecular biology protocol for Wilms tumours has been outlined, which is a consensus from the SIOP-RTSG pathology panel.
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Affiliation(s)
| | - Manfred Gessler
- Theodor-Boveri-Institute/Biocenter, Developmental Biochemistry, Wuerzburg University, Wuerzburg, Germany
- Comprehensive Cancer Center Mainfranken, Wuerzburg University, Wuerzburg, Germany
| | | | - Paola Collini
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Aurore Coulomb-l'Hermine
- Sorbonne Université, Department of Pathology, Hopitaux Universitaires Est Parisien, Paris, France
| | - Ellen D'Hooghe
- Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - 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
| | - Kathy Pritchard-Jones
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Christian Vokuhl
- Kiel Paediatric Tumour Registry, Department of Paediatric Pathology, University Hospital of Kiel, Kiel, Germany
| | | | - Norbert Graf
- Department of Paediatric Oncology & Haematology, Saarland University, Homburg, Germany
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Bouty A, Burnand K, Nightingale M, Roberts A, Campbell M, O'Brien M, Heloury Y. What is the risk of local recurrence after laparoscopic transperitoneal radical nephrectomy in children with Wilms tumours? Analysis of a local series and review of the literature. J Pediatr Urol 2018; 14:327.e1-327.e7. [PMID: 29705138 DOI: 10.1016/j.jpurol.2018.03.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/12/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND To reduce long-term morbidity (adhesions-related complications and impaired quality of life due to scars), laparoscopy has been used as an alternative to open surgery in Wilms tumours (WTs). However, concerns have been raised on the risk of local recurrence after this type of resection. OBJECTIVE The aim was to determine the incidence of local recurrence after laparoscopic transperitoneal radical nephrectomy (LTRN). STUDY DESIGN We analysed 18 local cases and conducted a review of the English literature in Pubmed from 2004 to 2017 with the following keywords: (Wilms OR nephroblastoma) AND (laparoscopy OR minimally invasive surgery) AND 2004:3000. The review was conducted according to PRISMA guidelines. Data were collected independently in duplicate in a preformed Excel database. Review articles and duplicated case reports were excluded. Patients with retroperitoneoscopic or nephron-sparing surgery were also excluded. RESULTS One hundred and four LTRNs have been performed for WT with neoadjuvant chemotherapy in 93 cases. Tumour was ruptured preoperatively in three cases but never intraoperatively. The median volume of the tumour was 229.4 mL (3.8-776 mL). Local stage was specified in 86 cases: 49 stage I, 28 stage II, and nine stage III. Lymph nodes were sampled in 48 patients (median 2.3 [0-14] nodes). Histology was reported in 90 cases: 27 favourable and two unfavourable histology (COG); and six low, 50 intermediate, and five high-risk tumours (International Society of Paediatric Oncology). With a median follow-up of 20.5 months (1-114 months), there were four local recurrences (3.8%) at a median of 8.5 (7-9) months after surgery. Three tumours were initial local stage I (2 intermediate and 1 high risk) and one stage III. The results are presented in the Figure. DISCUSSION The incidence of local recurrence after LTRN is 3.8%. This is lower than previously reported after open resection. However, tumours amenable to minimally invasive surgery are smaller, with higher numbers of low stage and standard histology. Additionally, the quality of the reports is suboptimal and follow-up is relatively short. CONCLUSION LTRN does not seem to increase the incidence of local recurrence in WT but inclusion of patients in international protocols with prolonged and systematic follow-up is of utmost importance to carefully evaluate this risk.
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Affiliation(s)
- Aurore Bouty
- Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia.
| | - Kate Burnand
- Paediatric and Neonatal Surgery Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Michael Nightingale
- Paediatric and Neonatal Surgery Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Annie Roberts
- Paediatric and Neonatal Surgery Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Marty Campbell
- Oncology Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Mike O'Brien
- Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Yves Heloury
- Urology Department, Royal Children's Hospital, Parkville, Victoria, Australia
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Dávila Fajardo R, Oldenburger E, Rübe C, López-Yurda M, Pritchard-Jones K, Bergeron C, Graf N, van Grotel M, van Tinteren H, Saunders D, van den Heuvel-Eibrink MM, Janssens GO, Oldenburger F. Evaluation of boost irradiation in patients with intermediate-risk stage III Wilms tumour with positive lymph nodes only: Results from the SIOP-WT-2001 Registry. Pediatr Blood Cancer 2018; 65:e27085. [PMID: 29693799 DOI: 10.1002/pbc.27085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/22/2018] [Accepted: 03/13/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the value of radiotherapy boost omission in patients with intermediate-risk, stage III Wilms tumours (WT) with positive lymph nodes (LN). METHODS AND MATERIALS All patients with intermediate-risk, stage III (LN positive) WT consecutively registered in the SIOP-WT-2001 study were included in this analysis. Endpoints were 5-year event-free survival (EFS), loco-regional control (LRC) and overall survival (OS). RESULTS Between June 2001 and May 2015, 2,569 patients with stage I to III WT after preoperative chemotherapy were registered in the SIOP-WT-2001 study. Five hundred and twenty-three (20%) had stage III disease, of which 113 patients had stage III due to positive LN only. Of those, 101 (89%) received radiotherapy, 36 of which (36%) received, apart from flank irradiation, a boost dose to the LN positive area. Four patients (4%) did not receive any adjuvant radiotherapy. In eight patients information on radiotherapy was not available. With a median follow-up of 71 months, no difference in 5-year EFS (84% vs. 83%, P = 0.77) and LRC (96% vs. 97%, P = 0.91) was observed between patients receiving a radiotherapy boost and those without boost, respectively. Five-year OS, including salvage therapy, was excellent (boost vs. no boost: 97% vs. 95%, P = 0.58). CONCLUSIONS Outcome data demonstrate that omission of the radiotherapy boost to the loco-regional positive lymph nodes in patients with intermediate-risk, stage III WT who receive preoperative chemotherapy and postoperative flank irradiation (14.4 Gy) can be considered a safe approach for future SIOP protocols.
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Affiliation(s)
- Raquel Dávila Fajardo
- Department of Radiation Oncology, University Medical Center Utrecht and Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Eva Oldenburger
- Radiation Oncology Department, Leuven Cancer Center, Leuven, Belgium
| | - Christian Rübe
- Department of Radio-Oncology, University Hospital of Saarland, Homburg, Germany
| | - Marta López-Yurda
- Department of Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | | | - Norbert Graf
- Department of Paediatric Oncology, University Hospital of Saarland, Homburg, Germany
| | - Martine van Grotel
- Princess Máxima Center for Paediatric Oncology, Utrecht, The Netherlands
| | - Harm van Tinteren
- Department of Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daniel Saunders
- Department of Radiation Oncology. The Christie NHS Foundation Trust, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Geert O Janssens
- Department of Radiation Oncology, University Medical Center Utrecht and Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Foppe Oldenburger
- Department of Radiation Oncology, Academic Medical Center, Amsterdam, The Netherlands
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Doganis D, Panagopoulou P, Tragiannidis A, Vichos T, Moschovi M, Polychronopoulou S, Rigatou E, Papakonstantinou E, Stiakaki E, Dana H, Bouka P, Antunes L, Bastos J, Coza D, Demetriou A, Agius D, Eser S, Ryzhov A, Sekerija M, Trojanowski M, Zagar T, Zborovskaya A, Perisic SZ, Strantzia K, Dessypris N, Psaltopoulou T, Petridou ET. Survival and mortality rates of Wilms tumour in Southern and Eastern European countries: Socioeconomic differentials compared with the United States of America. Eur J Cancer 2018; 101:38-46. [PMID: 30014973 DOI: 10.1016/j.ejca.2018.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/04/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Despite recent therapeutic advancements, Wilms tumour (WT) presents remarkable survival variations. We explored mortality and survival patterns for children (0-14 years) with WT in 12 Southern and Eastern European (SEE) countries in comparison with the United States of America (USA). METHODS A total of 3966 WT cases (0-14 years) were registered by a network of SEE childhood cancer registries (N:1723) during available registration periods circa 1990-2016 and surveillance, epidemiology, and end results program (SEER) (N:2243; 1990-2012); mortality data were provided by the respective national statistical services. Kaplan-Meier curves and Cox proportional hazards models were used to assess the role of age, sex, year of diagnosis, urbanisation and Human Development Index (HDI) on overall survival (OS). RESULTS Persisting regional variations shape an overall 78% 5-year OS in the participating SEE countries, lagging behind the USA figure (92%, p=0.001) and also reflected by higher SEE mortality rates. Worth mentioning is the gradually escalating OS in SEE (hazard ratio [HR]5-year increment:0.67, 95% confidence interval [CI]:0.60, 0.75) vs. a non-significant 10% improvement in the SEER data, which had a high starting value. OS differentials [two-fold less favourable among children aged 10-14 years, boys and those living in rural SEE areas (HR:1.37; CI:1.10-1.71) or countries with inferior HDI (2-3-fold)] were minimal in the USA. CONCLUSIONS Children with WT residing in SEE countries do not equally enjoy the substantial survival gains, especially for those living in rural areas and in lower HDI countries. Noteworthy are steep and sizeable survival gains in SEE along with the newly presented Greek data pointing to achievable survival goals in SEE despite the financial crisis.
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Affiliation(s)
- Dimitrios Doganis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Oncology Department, "P & A Kyriakouˮ Children's Hospital, Athens, Greece
| | - Paraskevi Panagopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Athanasios Tragiannidis
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Hematology-Oncology Unit, 2nd Pediatric Department, Aristotle University of Thessaloniki, AHEPA Hospital, Thessaloniki, Greece
| | - Theodoros Vichos
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Maria Moschovi
- Pediatric Hematology-Oncology Unit, First Department of Pediatrics, University of Athens, "Agia Sofiaˮ Children's Hospital, Athens, Greece
| | - Sofia Polychronopoulou
- Department of Pediatric Hematology-Oncology, "Agia Sofiaˮ Children's Hospital, Athens, Greece
| | - Efthimia Rigatou
- Department of Pediatric Hematology-Oncology, "Agia Sofiaˮ Children's Hospital, Athens, Greece
| | | | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University of Crete, Heraklion, Greece
| | - Helen Dana
- Pediatric Hematology-Oncology Department, "Miteraˮ Children's Hospital, Athens, Greece
| | - Panagiota Bouka
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Luis Antunes
- North Region Cancer Registry of Portugal (RORENO), Portuguese Institute of Oncology, Porto, Portugal
| | - Joana Bastos
- Registo Oncológico Regional Do Centro (ROR-Centro), Instituto Português de Oncologia de Coimbra Francisco Gentil, E.P.E., Coimbra, Portugal
| | - Daniela Coza
- Cluj Regional Cancer Registry, The Oncology Institute "Prof. Dr. Ion Chiricuţăˮ, Cluj-Napoca, Romania
| | - Anna Demetriou
- Health Monitoring Unit, Ministry of Health, Nicosia, Cyprus
| | - Domenic Agius
- Malta National Cancer Registry, Department for Policy in Health - Health Information and Research, Pieta, Malta
| | - Sultan Eser
- Izmir Cancer Registry, Izmir Hub, Izmir and Hacettepe, University Institute of Public Health, Ankara, Turkey
| | - Anton Ryzhov
- National Cancer Registry of Ukraine, National Institute of Cancer, Kiev, Ukraine & Taras Shevchenko National University of Kyiv, Ukraine
| | - Mario Sekerija
- Croatian Institute of Public Health, Croatian National Cancer Registry, Zagreb, Croatia; Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Croatia
| | - Maciej Trojanowski
- Greater Poland Cancer Registry, Greater Poland Cancer Center, Poznan, Poland
| | - Tina Zagar
- Cancer Registry of Slovenia, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Anna Zborovskaya
- Belarusian Research Center for Paediatric Oncology, Haematology and Immunology, Childhood Cancer Subregistry of Belarus, Minsk, Belarus
| | - Snezana Zivkovic Perisic
- Institute of Public Health of Serbia, Central Serbia Cancer Registry, Dr Subotica 5, 11000, Belgrade Serbia
| | - Katerina Strantzia
- Pathology Laboratory, "P & A. Kyriakouˮ Children's Hospital, Athens, Greece
| | - Nick Dessypris
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Theodora Psaltopoulou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - Eleni Th Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, Greece; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institute, Stockholm, Sweden.
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Percicote AP, Mardegan GL, Gugelmim ES, Ioshii SO, Kuczynski AP, Nagashima S, de Noronha L. Tissue expression of retinoic acid receptor alpha and CRABP2 in metastatic nephroblastomas. Diagn Pathol 2018; 13:9. [PMID: 29378601 PMCID: PMC6389245 DOI: 10.1186/s13000-018-0686-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 01/15/2018] [Indexed: 01/09/2023] Open
Abstract
Background Nephroblastoma or Wilms tumor is the most frequent kidney cancer in children and accounts for 98% of kidney tumors in this age group. Despite favorable prognosis, a subgroup of these patients progresses to recurrence and death. The retinoic acid (RA) pathway plays a role in the chemoprevention and treatment of tumors due to its effects on cell differentiation and its antiproliferative, anti-oxidant, and pro-apoptotic activities. Reports describe abnormal cellular retinoic acid-binding protein 2 (CRABP2) expression in neoplasms and its correlation with prognostic factors and clinical and pathological characteristics. The aim of this study was to evaluate the immunohistochemical expression of retinoic acid receptor alpha (RARA) and CRABP2 in paraffin-embedded samples of nephroblastomas via semiquantitative and quantitative analyses and to correlate this expression with prognostic factors. Methods Seventy-seven cases of nephroblastomas were selected from pediatric oncology services. The respective medical records and surgical specimens were reviewed. Three representative tumor samples and one non-tumor renal tissue sample were selected for the preparation of tissue microarrays (TMA). The Allred scoring system was used for semiquantitative immunohistochemical analyses, whereas a morphometric analysis of the stained area was employed for quantitative evaluation. The nonparametric Mann-Whitney test was used for comparisons between two groups, while the nonparametric Kruskal-Wallis test was used to compare three or more groups. Results Immunopositivity for RARA and CRABP2 was observed in both the nucleus and cytoplasm. All histological components of the nephroblastoma (blastema, epithelium, and stroma) were positive for both markers. RARA, based on semiquantitative analyses, and CRABP2, bases on quantitative analyses, exhibited increased immunohistochemical expression in patients with metastasis, with p values of 0.0247 and 0.0128, respectively. These findings were similar to the results of the quantitative analysis of RARA expression, showing greater immunopositivity in tumor samples of patients subjected to pre-surgical chemotherapy. No significant correlation was found with the other variables studied, such as disease stage, anaplasia, risk group, histological type, nodal involvement, and clinical evolution. Conclusions Semiquantitative and quantitative analyses of the markers RARA and CRABP2 indicate their potential as biomarkers for tumor progression and their participation in nephroblastoma tumorigenesis. Electronic supplementary material The online version of this article (10.1186/s13000-018-0686-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Sergio Ossamu Ioshii
- Department of Medical Pathology, Federal University of Paraná and School of Health of the Pontifical Catholic University of Paraná, Curitiba, Brazil
| | | | - Seigo Nagashima
- School of Health of the Pontifical Catholic University of Paraná, Curitiba, Brazil
| | - Lúcia de Noronha
- Department of Medical Pathology, Federal University of Paraná and School of Health of the Pontifical Catholic University of Paraná, Curitiba, Brazil
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36
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van den Heuvel-Eibrink MM, Hol JA, Pritchard-Jones K, van Tinteren H, Furtwängler R, Verschuur AC, Vujanic GM, Leuschner I, Brok J, Rübe C, Smets AM, Janssens GO, Godzinski J, Ramírez-Villar GL, de Camargo B, Segers H, Collini P, Gessler M, Bergeron C, Spreafico F, Graf N. Position paper: Rationale for the treatment of Wilms tumour in the UMBRELLA SIOP-RTSG 2016 protocol. Nat Rev Urol 2017; 14:743-752. [PMID: 29089605 DOI: 10.1038/nrurol.2017.163] [Citation(s) in RCA: 180] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Renal Tumour Study Group of the International Society of Paediatric Oncology (SIOP-RTSG) has developed a new protocol for the diagnosis and treatment of childhood renal tumours, the UMBRELLA SIOP-RTSG 2016 (the UMBRELLA protocol), to continue international collaboration in the treatment of childhood renal tumours. This protocol will support integrated biomarker and imaging research, focussing on assessing the independent prognostic value of genomic changes within the tumour and the volume of the blastemal component that survives preoperative chemotherapy. Treatment guidelines for Wilms tumours in the UMBRELLA protocol include recommendations for localized, metastatic, and bilateral disease, for all age groups, and for relapsed disease. These recommendations have been established by a multidisciplinary panel of leading experts on renal tumours within the SIOP-RTSG. The UMBRELLA protocol should promote international collaboration and research and serve as the SIOP-RTSG best available treatment standard.
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Affiliation(s)
- Marry M van den Heuvel-Eibrink
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584EA Utrecht, The Netherlands
| | - Janna A Hol
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584EA Utrecht, The Netherlands
| | - Kathy Pritchard-Jones
- Great Ormond Street Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, United Kingdom
| | - Harm van Tinteren
- Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Rhoikos Furtwängler
- Department of Paediatric Oncology & Haematology, Saarland University, Kirrberger Str. 100, 66421, Homburg, Germany
| | - Arnauld C Verschuur
- Department of Paediatric Oncology & Haematology, La Timone Children's Hospital, 264 Rue Saint-Pierre, 13385, Marseille, France
| | - Gordan M Vujanic
- Department of Cellular Pathology, University Hospital of Wales, Cardiff University School of Medicine, Heath Park, Eastern Ave, Cardiff, CF14 4XW, United Kingdom
| | - Ivo Leuschner
- Kiel Paediatric Tumour Registry, Department of Paediatric Pathology, University Hospital of Kiel, Christian-Albrechts-Platz 4, 24118, Kiel, Germany
| | - Jesper Brok
- Great Ormond Street Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, United Kingdom
| | - Christian Rübe
- Department of Radiotherapy, University Hospital of the Saarland, Kirrberger Str. 100, 66421, Homburg, Germany
| | - Anne M Smets
- Department of Radiology, Academic Medical Center Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Geert O Janssens
- Department of Paediatric Oncology, Princess Máxima Center for Paediatric Oncology, Lundlaan 6, 3584EA Utrecht, The Netherlands
- Department of Radiation Oncology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jan Godzinski
- Department of Paediatric Surgery, Marciniak Hospital, Fieldorfa 2, 54-049, Wroclaw, Poland
- Department of Paediatric Traumatology and Emergency Medicine, Medical University, Wybrzeze Ludwika Pasteura 1, 50-367, Wroclaw, Poland
| | - Gema L Ramírez-Villar
- Department of Paediatric Oncology, Hospital Universitario Virgen del Rocío, Av. Manuel Siurot, S/N, 41013 Seville, Spain
| | - Beatriz de Camargo
- Paediatric Haematology-Oncology Program, Instituto Nacional de Cancer (INCA), Praça Cruz Vermelha, 23, Rio de Janeiro, 20230-130, Brazil
| | - Heidi Segers
- Department of Paediatric Oncology, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Paola Collini
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Manfred Gessler
- Biocenter of the University of Wuerzburg, Developmental Biochemistry, and Comprehensive Cancer Center Mainfranken, Josef-Schneider-Straße 6, 97080, Wuerzburg, Germany
| | - Christophe Bergeron
- Institut d'Hématologie et d'Oncologie Pédiatrique, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Filippo Spreafico
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Norbert Graf
- Department of Paediatric Oncology & Haematology, Saarland University, Kirrberger Str. 100, 66421, Homburg, Germany
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Offor UT, Basta NO, James PW, McNally RJQ. Is there a socioeconomic variation in survival from renal tumours in children and young people resident in northern England (1968-2012)? Cancer Epidemiol 2017; 50:92-98. [PMID: 28843177 DOI: 10.1016/j.canep.2017.08.010] [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: 05/12/2017] [Revised: 08/11/2017] [Accepted: 08/16/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Despite strong evidence of a social gradient in cancer survival among UK adults, studies in children and young people remain inconclusive and have not included renal tumours. This study investigated the relationship between socioeconomic status and survival from renal tumours among children and young people. PROCEDURE Kaplan-Meier estimation and Cox regression were used to analyse survival for all 209 renal tumours in children and young people (0-24 years) diagnosed 1968-2012 and registered by a specialist population-based registry. Sociodemographic and clinicopathologic variables, including paternal occupation at birth, were also analysed. RESULTS No significant disparity in overall renal tumour and Wilms tumour (WT) survival was observed according to paternal social class [p=0.988 and 0.808, respectively]. The strongest predictor of survival was stage, with late stage (III-IV) disease having a 4-fold higher risk of death compared to early stage (I-II) disease [p<0.001]. Similarly, high mortality-risk was seen for late stage WT in children aged 0-14 years (Hazard Ratio=6.37; 95% CI=2.60-15.59). CONCLUSIONS This study did not detect a significant social gradient in renal tumour survival. The identification of tumour stage as a strong predictor of survival irrespective of age, necessitates the development of appropriate public health interventions that target early diagnosis and treatment.
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Affiliation(s)
- Ugonna T Offor
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - Nermine O Basta
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - Peter W James
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK
| | - Richard J Q McNally
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, NE1 4LP, UK.
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Pan Z, He H, Tang L, Bu Q, Cheng H, Wang A, Lyu J, You H. Loss of heterozygosity on chromosome 16q increases relapse risk in Wilms' tumor: a meta-analysis. Oncotarget 2017; 8:66467-66475. [PMID: 29029528 PMCID: PMC5630428 DOI: 10.18632/oncotarget.20191] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/06/2017] [Indexed: 02/05/2023] Open
Abstract
Wilms’ tumor (WT) is the most frequent malignant renal tumor in children. The survival rate is lower in patients with recurrence, and the factors that influence relapse in WT are not fully understood. Loss of heterozygosity on chromosome 16q (LOH 16q) has been reported to be associated with the relapse in WT, but this remains controversial. We performed a meta-analysis to clarify this. PUBMED, EMBASE, and the Cochrane Library were searched up to March 17, 2017. Ten studies involving 3385 patients were ultimately included in the meta-analysis. The meta-analysis showed that LOH 16q was significantly associated with the relapse in WT (relative risk [RR] = 1.74, 95% confidence interval [CI] = 1.43–2.13, P < 0.00001; hazard ratio [HR] = 1.76, 95% CI = 1.38–2.24, P < 0.00001). No significant heterogeneity among studies or publication bias was found. Sensitivity analysis showed omitting one study in each turn could not change the results. Subgroup analysis based on two studies indicated LOH 16q was more effective on elevated replase risk in patients with favorable-histology WT (RR = 2.52, 95% CI = 1.68–3.78, P < 0.00001; HR = 2.99, 95% CI = 1.84–4.88, P < 0.0001) but further work are needed to confirm this. These findings confirm that LOH 16q increased the relapse risk in WT, but more studies are required to further assess the association between LOH 16q and WT relapse among different subgroups.
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Affiliation(s)
- Zhenyu Pan
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China.,Department of Pharmacy, Xi'an Jiaotong University Affiliated Children's Hospital, Xi'an, Shaanxi, 710003, China
| | - Hairong He
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Lina Tang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Qingting Bu
- Department of Genetics, Northwest Women's and Children's Hospital, Xi'an, Shaanxi, 710061, China
| | - Hua Cheng
- Department of Pharmacy, Xi'an Jiaotong University Affiliated Children's Hospital, Xi'an, Shaanxi, 710003, China
| | - Anmin Wang
- Department of Pharmacy, Xi'an Jiaotong University Affiliated Children's Hospital, Xi'an, Shaanxi, 710003, China
| | - Jun Lyu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Haisheng You
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
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Liu GC, Zhuo ZJ, Zhu SB, Zhu J, Jia W, Zhao Z, Hu JH, He J, Wang FH, Fu W. Associations between LMO1 gene polymorphisms and Wilms' tumor susceptibility. Oncotarget 2017; 8:50665-50672. [PMID: 28881592 PMCID: PMC5584185 DOI: 10.18632/oncotarget.16926] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/22/2017] [Indexed: 02/07/2023] Open
Abstract
Wilms' tumor is the most common childhood renal malignancy. A genome-wide association study identified LIM domain only 1 (LMO1) as having oncogenic potential. We examined the associations between LMO1 gene polymorphisms and susceptibility to Wilms' tumor. In this hospital-based, case-control study, we recruited 145 children with Wilms' tumor and 531 cancer-free children. Four polymorphisms (rs110419 A>G, rs4758051 G>A, rs10840002 A>G and rs204938 A>G) were genotyped using Taqman methodology. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to measure the associations between selected polymorphisms and Wilms' tumor susceptibility. Only rs110419 AG was found to be protective against Wilms' tumor (adjusted OR = 0.62, 95% CI = 0.41-0.94, P = 0.024) when compared to rs110419 AA. Wilms' tumor risk was markedly greater in children with 1-4 risk genotypes (nucleotide alterations) than in those with no risk genotypes (adjusted OR = 1.84, 95% CI = 1.25-2.69, P = 0.002). In a stratified analysis, the protective effect of rs110419 AG/GG was predominant in males. The association of 1-4 risk genotypes with Wilms' tumor risk was limited to subgroups of children who were >18 months old, female, and in clinical stages III+IV. Thus, LMO1 gene polymorphisms may contribute to Wilms' tumor risk, but this conclusion should be validated in other populations and larger studies.
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Affiliation(s)
- Guo-Chang Liu
- 1 Department of Pediatric Urology, Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Zhen-Jian Zhuo
- 2 School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| | - Shi-Bo Zhu
- 1 Department of Pediatric Urology, Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Jinhong Zhu
- 3 Molecular Epidemiology Laboratory and Department of Laboratory Medicine, Harbin Medical University Cancer Hospital, Harbin 150040, Heilongjiang, China
| | - Wei Jia
- 1 Department of Pediatric Urology, Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Zhang Zhao
- 1 Department of Pediatric Urology, Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Jin-Hua Hu
- 1 Department of Pediatric Urology, Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Jing He
- 1 Department of Pediatric Urology, Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Feng-Hua Wang
- 1 Department of Pediatric Urology, Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
| | - Wen Fu
- 1 Department of Pediatric Urology, Department of Pediatric Surgery, Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou 510623, Guangdong, China
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Results of the Third AIEOP Cooperative Protocol on Wilms Tumor (TW2003) and Related Considerations. J Urol 2017; 198:1138-1145. [PMID: 28655531 DOI: 10.1016/j.juro.2017.06.081] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE TW2003, the third Italian prospective study on Wilms tumor, aimed to improve survival in patients with stage III-IV tumors, de-escalate therapy for stage I-II nonanaplastic tumors, refine the risk stratification of therapy, and develop a national infrastructure for biobanking and central pathology review. MATERIALS AND METHODS TW2003 recruited children 18 years old or younger with primary intrarenal tumors. Local physicians chose nephrectomy with or without preoperative chemotherapy as the initial treatment based on the risk of unsafe and/or incomplete immediate surgery. The main drivers for adjuvant therapy were tumor stage and diffuse anaplasia. A new risk stratification schema was investigated, incorporating patient age, reason for stage III designation and completeness of lung nodule response in stage IV disease. RESULTS We report on 453 patients with unilateral Wilms tumor. Preoperative chemotherapy was administered to 42% of patients. The 5-year event-free survival and overall survival rates were 89.1% (95% CI 83.6-94.9) and 97.0% (93.7-100) for stage I; 85.1% (79.6-91.1) and 94.0% (90.1-98.1) for stage II (160); 82.7% (75.3-90.8) and 90.9% (85.0-97.1) for stage III (101); and 72.1% (61.9-84.0) and 82.5% (73.1-93.1) for stage IV (69), respectively. On multivariable analysis only anaplasia was significant for event-free survival (HR 2.68, 95% CI 1.48-4.86, p=0.001; bias corrected c-index 0.580) and overall survival (HR 5.29, 95% CI 2.52-11.12, p <0.001; bias corrected c-index 0.697). CONCLUSIONS The survival rates achieved and the proposed risk stratification schema provide a basis for future comparisons of Wilms tumor treatment burden and patient outcome.
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Abstract
Wilms tumor (WT) is the most prevalent pediatric renal tumor and most commonly occurs between ages 1 and 5 years. Data are lacking on children younger than 12 months with renal tumors. The cancer registry at the authors' institution was queried to identify patients 12 months and younger with renal masses. Demographics, clinical presentation, histopathology, stage, and survival outcomes were reviewed. The most common presenting symptoms included an asymptomatic abdominal mass (73%) and hematuria (9%). Histopathology revealed WT in 73% of patients, mesoblastic nephroma in 20%. Of those infants younger than 1 month of age, mesoblastic nephroma was the most common histopathology (68%). The 5-year overall survival (OS) was 93%, and 5-year event-free survival (EFS) was 93% for the entire group. For patients with WT, 5-year OS was 88% and 5-year EFS was 83%. Outcomes for congenital mesoblastic nephroma were excellent with 5-year OS and EFS of 100%. Reasons for good prognosis may be multifactorial and may include frequent well child checks in the first year of life and favorable histology. Patients in this age group are more likely to be classified as very low risk and may be treated with surgical resection alone.
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42
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Njuguna F, Martijn HA, Kuremu RT, Saula P, Kirtika P, Olbara G, Langat S, Martin S, Skiles J, Vik T, Kaspers GJL, Mostert S. Wilms Tumor Treatment Outcomes: Perspectives From a Low-Income Setting. J Glob Oncol 2016; 3:555-562. [PMID: 29094095 PMCID: PMC5646879 DOI: 10.1200/jgo.2016.005389] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Purpose Wilms tumor is the commonest renal malignancy in childhood. Survival in high-income countries is approximately 90%, whereas in low-income countries, it is less than 50%. This study assessed treatment outcomes of patients with Wilms tumor at a Kenyan academic hospital. Patients and Methods We conducted a retrospective medical record review of all children diagnosed with Wilms tumor between 2010 and 2012. Data on treatment outcomes and various sociodemographic and clinical characteristics were collected. Results Of the 39 patients with Wilms tumor, 41% had event-free survival, 31% abandoned treatment, 23% died, and 5% had progressive or relapsed disease. Most patients presented at an advanced stage: stage I (0%), II (7%), III (43%), IV (40%), or V (10%). The most likely treatment outcome in patients with low-stage (I to III) disease was event-free survival (67%), whereas in those with high-stage (IV to V) disease, it was death (40%). No deaths or instances of progressive or relapsed disease were recorded among patients with low-stage disease; their only reason for treatment failure was abandonment of treatment. Stage of disease significantly affected treatment outcomes (P = .014) and event-free survival estimates (P < .001). Age at diagnosis, sex, duration of symptoms, distance to hospital, and health insurance status did not statistically significantly influence treatment outcomes or event-free survival estimates. Conclusion Survival of patients with Wilms tumor in Kenya is lower compared with that in high-income countries. Treatment abandonment is the most common cause of treatment failure. Stage of disease at diagnosis statistically significantly affects treatment outcomes and survival.
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Affiliation(s)
- Festus Njuguna
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Hugo A Martijn
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Robert Tenge Kuremu
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Peter Saula
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Patel Kirtika
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Gilbert Olbara
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Sandra Langat
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Steve Martin
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Jodi Skiles
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Terry Vik
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Gertjan J L Kaspers
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
| | - Saskia Mostert
- , , , , , and Moi University, Eldoret, Kenya; , , and , Vrije Universiteit Medical Center, Amsterdam, the Netherlands; and , , and , Indiana University School of Medicine, Indianapolis, IN
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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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Clinicoepidemiological Profile and Outcome of Children With Wilms Tumor in a Developing Country. J Pediatr Hematol Oncol 2016; 38:e213-6. [PMID: 27299590 DOI: 10.1097/mph.0000000000000603] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Outcome of children with Wilms tumor (WT) has improved remarkably because of the advancements in Pediatric Oncology. However, in most developing countries survival rates are still poor. There is a paucity of data regarding the clinical profile and outcome of children with WT in India. METHODS Children with WT who were treated at our center between 2005 and 2014 were retrospectively analyzed. RESULTS Over the 10-year study period, 108 children with WT were treated in our unit. The median age at presentation was 30 months (male:female ratio of 4:1). Abdominal mass was the most common presenting feature (91%). The majority of children had stage 2 (30%) or stage 3 (35%) disease. Fifty-nine children had large or bilateral tumors requiring preoperative chemotherapy. Of the total 108 children, 11 died during primary treatment and 14 relapsed after completion of treatment. The projected 5-year overall survival is 74%, whereas the event-free survival is 73%. CONCLUSIONS Children with WT in our setting present late with advanced disease and large tumors, which are technically difficult to deliver at surgery. With a multidisciplinary approach, reasonably good survival rates were achieved even in the resource-limited Indian scenario.
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Abstract
Despite an impressive increase in survival rate over the past decades, there is still a need to improve the survival of specific subgroups of Wilms tumor (anaplastic, metastatic, and bilateral) and to decrease the late effects of treatment in terms of renal function and heart toxicity. We aim to explore new areas of improvement, from diagnosis to treatment: in the field of radiology the increased use of MRI and exploration of its diffusion-weighted imaging capabilities to predict WT histology at diagnosis and for preoperative assessment; in biology the emergence of new biomarkers that could be integrated into the decision-making process; and surgical techniques with more accurate indication of nephron-sparing surgery that is no longer reserved for bilateral WT and the minimally invasive approach. The long-term outcome of patients with WT should thus be a strong indicator of the improvement in adapting and personalizing the treatment to each individual.
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Affiliation(s)
- Sabine Irtan
- Department of Pediatric Surgery, APHP Hôpital Armand Trousseau, Research Unit St Antoine Inserm UMRS.938, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Peter F Ehrlich
- Pediatric Surgery Department, C.S. Mott Children׳s Hospital, University of Michigan, Ann Arbor, Michigan
| | - Kathy Pritchard-Jones
- Cancer Section, Developmental Biology & Cancer Programme, Institute of Child Health, University College London, 30 Guilford St, London WC1N 1EH, UK.
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Fawzy M, Bahanassy A, Samir A, Hafez H. Profiling Loss of Heterozygosity Patterns in a Cohort of Favorable Histology Nephroblastoma Egyptian Patients: What is Consistent With the Rest of the World. Pediatr Hematol Oncol 2016; 32:548-56. [PMID: 26390800 DOI: 10.3109/08880018.2015.1071902] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
According to the Fifth National Wilms Tumor Study (NWTS-5), tumor-specific loss of heterozygosity (LOH) for chromosomes 1p and 16q identifies a subset of patients with Wilms tumor (WT) who despite having favorable histology (FH) have a significantly increased risk of relapse and death. We aimed to find out 1p and 16q LOH frequencies in patients with FH-WT as well as its correlation to survival outcome and epidemiologic and clinical characteristics. Data of patients with FH-WT presenting to the National Cancer Institute, Egypt, were retrospectively analyzed. Paraffin blocks were tested for 1p and 16q LOH using polymorphic loci that span the minimal regions of LOH at this area. The study included 100 patients with a median age of 5 years. Thirty-nine patients (39%) showed LOH at 1p (n = 14), 16q (n = 13), or both (n = 12). LOH was most frequently encountered in patients above 10 years (5/5), advanced stages disease (80% of stage V and 50% of stages IV and III each). The 3-year overall survival (OS) and event-free survival (EFS) were significantly lower in patients with double LOH (75% and 50%, respectively), followed by 16q (92% and 54%), in comparison with 1p (93% each) and negative LOH (97% and 100%) cases, respectively (p = 0.001). Combined LOH (1p+16q), followed by 16q LOH alone, was predictive of poorer outcome and was associated with lower OS and EFS in patients with FH-WT. Our results showed a higher-risk disease that would suggest the need for an intensified upfront therapy in this group of patients.
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Affiliation(s)
- Mohamed Fawzy
- a Department of Pediatric Oncology , National Cancer Institute , Cairo , Egypt
| | - Abeer Bahanassy
- b Department of Pathology , National Cancer Institute , Cairo , Egypt
| | - Amr Samir
- c Department of Pediatrics , Armed Forces Hospitals , Egypt
| | - Hanafy Hafez
- a Department of Pediatric Oncology , National Cancer Institute , Cairo , Egypt
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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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Rais F, Benhmidou N, Rais G, Loughlimi H, Kouhen F, Maghous A, Aarab J, Bellahammou K, Moukinebillah M, Khattab M, Chala S, Elmejjaoui S, Kebdani T, Elkacemi H, Benjaafar N. Wilms tumor in childhood: Single centre retrospective study from the National Institute of Oncology of Rabat and literature review. PEDIATRIC HEMATOLOGY ONCOLOGY JOURNAL 2016. [DOI: 10.1016/j.phoj.2016.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
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Wong KF, Reulen RC, Winter DL, Guha J, Fidler MM, Kelly J, Lancashire ER, Pritchard-Jones K, Jenkinson HC, Sugden E, Levitt G, Frobisher C, Hawkins MM. Risk of Adverse Health and Social Outcomes Up to 50 Years After Wilms Tumor: The British Childhood Cancer Survivor Study. J Clin Oncol 2016; 34:1772-9. [DOI: 10.1200/jco.2015.64.4344] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose Survivors of Wilms tumor (WT) are at risk for adverse health and social outcomes but risks beyond 30 years from diagnosis remain uncertain. We investigated the risks of adverse outcomes among 5-year survivors of WT, in particular, those between 30 and 50 years from diagnosis. Patients and Methods The British Childhood Cancer Survivor Study includes 1,441 5-year survivors of WT. We investigated cause-specific mortality, risk of subsequent primary neoplasms (SPNs), and, for those who completed a questionnaire, the extent of smoking and drinking, educational achievement, health status, and health service use compared with the general population. Results Cumulative risk of death from all causes, excluding recurrence, increased substantially from 5.4% to 22.7% at 30 years and 50 years, respectively, after WT diagnosis—75% of excess deaths beyond 30 years from diagnosis were attributable to SPNs (50%) and cardiac diseases (25%). Digestive cancer, most frequently bowel, accounted for 41% of excess cancers beyond 30 years. Conclusion Between 30 and 50 years from diagnosis, survivors of WT are at a substantially increased risk of premature mortality, and 75% of excess deaths were accounted for by SPNs and cardiac diseases. Radiotherapy exposure was a risk factor for both outcomes. The proportion of patients with WT who are exposed to radiotherapy has reduced substantially in recent decades because of initiatives such as the SIOP WT 2001 clinical trial, which sought to reduce late effects; however, the majority of current survivors, who are at least 30 years from diagnosis, received radiotherapy. Surveillance of this group should focus on SPNs, in particular, bowel and breast cancers, and cardiac conditions.
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Affiliation(s)
- Kwok F. Wong
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Raoul C. Reulen
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - David L. Winter
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Joyeeta Guha
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Miranda M. Fidler
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Julie Kelly
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Emma R. Lancashire
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Kathryn Pritchard-Jones
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Helen C. Jenkinson
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Elaine Sugden
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Gill Levitt
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Clare Frobisher
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
| | - Michael M. Hawkins
- Kwok F. Wong, Raoul C. Reulen, David L. Winter, Joyeeta Guha, Miranda M. Fidler, Julie Kelly, Emma R. Lancashire, Elaine Sugden, Gill Levitt, Clare Frobisher, and Michael M. Hawkins, University of Birmingham; Helen C. Jenkinson, Birmingham Children’s Hospital NHS Foundation Trust, Birmingham; and Kathryn Pritchard-Jones, University College London and Great Ormond Street Hospital for Children, London, United Kingdom
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Pritchard-Jones K, Graf N, van Tinteren H, Craft A. Evidence for a delay in diagnosis of Wilms' tumour in the UK compared with Germany: implications for primary care for children. Arch Dis Child 2016; 101:417-20. [PMID: 26948824 PMCID: PMC4862069 DOI: 10.1136/archdischild-2015-309212] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 12/31/2015] [Indexed: 12/24/2022]
Abstract
The UK has a longstanding system of general practice which provides the vast majority of primary care, including that for children. It acts as a 'gatekeeper' to more specialist care. Parents may also use accident and emergency departments as their first point of medical contact for their children. Outcomes in the UK for many conditions in children appear to be worse than in comparable European countries where there is direct access to care by paediatricians. We have therefore looked at pathways to diagnosis and compared outcomes in the childhood kidney cancer, Wilms' tumour, which has been treated in the UK and Germany within the same clinical trial for over a decade. We find that Wilms' tumours are significantly larger in volume and have a more advanced tumour stage at diagnosis in the UK compared to Germany. There is a small (∼3%) difference in event free and overall survival between the two countries. Our data suggest that the system of primary care for children in the UK is less likely to result in the incidental finding of an abdominal mass in a child with no or vague symptoms. This may be a reason for the poorer outcome.
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Affiliation(s)
| | - Norbert Graf
- Department of Paediatric Oncology/Hematology, Saarland University Hospital Homburg, Homburg, Germany
| | - Harm van Tinteren
- Head Biometrics Department, Netherlands Cancer Institute—Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Alan Craft
- Department of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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