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Brown EG, Engwall-Gill AJ, Aldrink JH, Ehrlich PF, Fawcett A, Coakley BA, Rothstein DH, Rich BS, Glick RD, Baertschiger RM, Roach JP, Lautz TB. Unwrapping Nephrogenic Rests and Nephroblastomatosis for Pediatric Surgeons: A Systematic Review Utilizing the PICO Model by the APSA Cancer Committee. J Pediatr Surg 2023; 58:2128-2134. [PMID: 37625940 DOI: 10.1016/j.jpedsurg.2023.07.011] [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: 03/28/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Nephrogenic rests (NR) may represent precursor lesions for Wilms tumor (WT), but their clinical course is not fully understood and no guidelines for treatment exist. This study sought to evaluate the outcomes of pediatric patients with NRs related to traditional chemotherapy and surgery. METHODS A PRISMA-P-compliant literature search was conducted in MEDLINE, Embase, CINAHL, Web of Science, COCHRANE, and SCOPUS from inception to June 2021. Clinical questions regarding the treatment of NRs, including chemotherapy and surgery, were developed in the population, intervention, comparison, and outcome format. RESULTS Twenty-five studies including 1445 patients met inclusion criteria for evaluating chemotherapy compared to observation for NRs. Eighteen studies including 1392 patients met inclusion criteria for evaluating the role of surgery for NRs. Patients with isolated NRs who underwent observation progressed to WT 33% of the time; chemotherapy reduced the rate of WT to 3.9%. Observation of multiple NRs and diffuse hyperplastic perilobar nephroblastomatosis (DHPLN) led to progression to WT 50% and 100% of the time, respectively. Chemotherapy reduced the rate of WT to 34% for multiple NRs and 46% for DHPLN. Surgery for isolated NRs reduced the risk of WT development from 23.7% in patients with incomplete excision to 3.3% with complete excision; however, 96% of patients with incompletely excised NRs had bilateral disease. CONCLUSIONS Observation with close surveillance for isolated NRs is safe. Treatment with chemotherapy is recommended for patients with multiple NRs and DHPLN. Surgical management of NRs should focus on renal function preservation. LEVEL OF EVIDENCE Treatment study, Level III.
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Affiliation(s)
- Erin G Brown
- Division of Pediatric Surgery, Department of Surgery, University of California Davis Children's Hospital, Sacramento, CA, USA.
| | | | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Peter F Ehrlich
- Department of Pediatric Surgery, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, MI, USA
| | - Andrea Fawcett
- Health Science Library, Lurie Children's Hospital of Chicago, IL, USA
| | - Brian A Coakley
- Department of Pediatric Surgery, Icahn School of Medicine, Mount Sinai, NY, USA
| | - David H Rothstein
- Department of General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA, 98105, USA
| | - Barrie S Rich
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Richard D Glick
- Division of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA
| | - Reto M Baertschiger
- Division of General and Thoracic Surgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, USA
| | - Jonathan P Roach
- Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Timothy B Lautz
- Department of Pediatric Surgery, Lurie Children's Hospital of Chicago, IL, USA
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Wang X, Li J, Liu P, Tian J, Li M, Sun N, Zhang W, Song H. How does Nephroblastomatosis impact the prognosis of unilateral Wilms tumor? Int Urol Nephrol 2023; 55:803-811. [PMID: 36787088 DOI: 10.1007/s11255-023-03493-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE We aimed to explore whether Nephroblastomatosis (Nbm) has an effect on the prognosis of Wilms tumor (WT), and compare the relapse-free survival (RFS) and overall survival (OS) after surgery of WT patients with or without Nbm. METHODS We retrospectively analyzed the clinical data of children with WT admitted to our department from April 2010 to September 2021. The enrolled patients were divided into two groups according to whether they were combined with Nbm histologically or not, the Nbm group for patients accompany with Nbm and the non-Nbm group for pure WT. All patients underwent a standardized comprehensive treatment according to National Wilms Tumor Study 5. Clinical variables, pathological results, and the prognosis were collected during follow-up. RESULTS A total of 345 patients were finally enrolled in this study, of which 299 patients in the non-Nbm group and 46 patients in the Nbm group. Univariate Cox analysis revealed that Nbm was not the risk factor of either OS or RFS. The difference of postoperative RFS (P = 0.66) and OS (P = 0.68) between two groups was not significant. Subgroup analysis revealed that the RFS and OS between the non-Nbm group and the Nbm group had no statistical difference under the condition of same stage (low grade and high grade), same histology (favorable histology and unfavorable histology), same surgical approach (nephrectomy and nephron-sparing surgery), with or without lymph node metastasis (P > 0.05). CONCLUSION Although Nbm had a strong correlation with the occurrence of WT, a combined Nbm did not increase the risk of metastasis and poor prognosis of WT. After complete surgical resection followed by standardized treatment, the long-term RFS and OS were not different from pure WT. IEC-C-006-A04-V.06 retrospectively registered.
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Affiliation(s)
- Xinyu Wang
- Department of Urology, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Jiayi Li
- Department of Urology, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Pei Liu
- Department of Urology, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Jun Tian
- Department of Urology, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Minglei Li
- Department of Urology, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Ning Sun
- Department of Urology, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Weiping Zhang
- Department of Urology, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Hongcheng Song
- Department of Urology, National Center for Children's Health (NCCH), Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China.
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de Jesus LE, Fulgencio C, Leve TC, Dekermacher S. Nephroblastomatosis and wilms tumor: dangerous liaisons. Int Braz J Urol 2021; 48:157-164. [PMID: 33650837 PMCID: PMC8691244 DOI: 10.1590/s1677-5538.ibju.2020.0694] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 11/21/2022] Open
Affiliation(s)
- Lisieux Eyer de Jesus
- Departamento de Cirurgia e Urologia Pediátrica, Hospital dos Servidores do Estado, Ministério da Saúde, Rio de Janeiro, RJ, Brasil
| | - Celine Fulgencio
- Departamento de Cirurgia e Urologia Pediátrica, Hospital dos Servidores do Estado, Ministério da Saúde, Rio de Janeiro, RJ, Brasil
| | - Thais Cardoso Leve
- Departamento de Cirurgia e Urologia Pediátrica, Hospital dos Servidores do Estado, Ministério da Saúde, Rio de Janeiro, RJ, Brasil
| | - Samuel Dekermacher
- Departamento de Cirurgia e Urologia Pediátrica, Hospital dos Servidores do Estado, Ministério da Saúde, Rio de Janeiro, RJ, Brasil
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Nerli RB, Sharma M, Ghagane S, Nutalapati S, Hiremath M, Dixit N. Oncological and renal function outcome in children with unilateral wilms' tumors treated with nephron sparing surgery or ablative nephrectomy. JOURNAL OF CANCER RESEARCH AND PRACTICE 2020. [DOI: 10.4103/jcrp.jcrp_12_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cozzi DA, Ceccanti S, Cozzi F. Renal-Sparing Surgery for Multifocal, Bilaterally Predisposed Unilateral Wilms Tumor. Urology 2019; 136:279. [PMID: 31568793 DOI: 10.1016/j.urology.2019.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 08/30/2019] [Accepted: 09/05/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Denis A Cozzi
- Pediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, Italy.
| | - Silvia Ceccanti
- Pediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| | - Francesco Cozzi
- Pediatric Surgery Unit, Sapienza University of Rome, Azienda Policlinico Umberto I, Rome, Italy
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Friesenbichler W, Krizmanich W, Lakatos K, Attarbaschi A, Dworzak M, Amann G, Furtwängler R, Graf N, Kager L. Outcome of two patients with bilateral nephroblastomatosis/Wilms tumour treated with an add-on 13-cis retinoic acid therapy - Case report. Pediatr Hematol Oncol 2018; 35:218-224. [PMID: 30260265 DOI: 10.1080/08880018.2018.1515284] [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] [Indexed: 10/28/2022]
Abstract
Although the fate of nephrogenic rests varies, they are known to be precursors of Wilms tumour. Thus, nephrogenic rests require adequate treatment to prevent malignant transformation. We added 13-cis retinoic acid to the standard chemotherapy with vincristine and actinomycin-D in two patients with bilateral nephrogenic rests/nephroblastomatosis. Patient 1 also had a history of Wilms tumour. 46 (patient 1) and 81 (patient 2) months after end of treatment, both patients show stable conditions with no signs of relapse or progressive disease. Our observation supports further investigation of retinoic acid in patients with nephrogenic rests and nephroblastomatosis.
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Affiliation(s)
- Waltraud Friesenbichler
- a Department of Pediatric Hematology and Oncology , St. Anna Children's Hospital, Medical University of Vienna , Vienna , Austria
| | - Wolfgang Krizmanich
- b Department of Radiology , St. Anna Children's Hospital, Medical University of Vienna , Vienna , Austria
| | - Karoly Lakatos
- b Department of Radiology , St. Anna Children's Hospital, Medical University of Vienna , Vienna , Austria
| | - Andishe Attarbaschi
- a Department of Pediatric Hematology and Oncology , St. Anna Children's Hospital, Medical University of Vienna , Vienna , Austria
| | - Michael Dworzak
- a Department of Pediatric Hematology and Oncology , St. Anna Children's Hospital, Medical University of Vienna , Vienna , Austria.,c Children's Cancer Research Institute (CCRI) , Vienna , Austria
| | - Gabriele Amann
- d Institute of Pathology , Medical University of Vienna , Vienna , Austria
| | - Rhoikos Furtwängler
- e Department for Pediatric Hematology and Oncology , Saarland University , Homburg , Germany
| | - Norbert Graf
- e Department for Pediatric Hematology and Oncology , Saarland University , Homburg , Germany
| | - Leo Kager
- a Department of Pediatric Hematology and Oncology , St. Anna Children's Hospital, Medical University of Vienna , Vienna , Austria
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Niu HC, Zhang WP, Sun N, He LJ, Peng Y. Prognostic Factors of Wilms' Tumor Complicated with Nephroblastomatosis. Chin Med J (Engl) 2015; 128:2539-41. [PMID: 26365976 PMCID: PMC4725562 DOI: 10.4103/0366-6999.164985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
| | | | - Ning Sun
- Department of Pediatric Urology, Beijing Children's Hospital, Capital Medical University, Beijing 100045, China
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Perilobar nephroblastomatosis: natural history and management. Case Rep Pediatr 2014; 2014:756819. [PMID: 25114825 PMCID: PMC4120796 DOI: 10.1155/2014/756819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 06/25/2014] [Indexed: 11/18/2022] Open
Abstract
Nephroblastomatosis (NB) has been considered as a precursor of Wilms tumor (WT). The natural history of NB seems to present significant variation as some lesions may regress spontaneously, while others may grow and expand or relapse and develop into WT later in childhood. Although, most investigators suggest adjutant chemotherapy, the effect and duration of treatment are not well established. Children with diffuse perilobar NB, Beckwith-Wiedemann syndrome, and hemihypertrophy seem to particularly benefit from treatment. We discuss our experience on two cases of NB and we review the literature for the management of this rare condition.
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Cozzi DA, Ceccanti S, Frediani S, Schiavetti A, Cozzi F. Chronic kidney disease in children with unilateral renal tumor. J Urol 2012; 187:1800-5. [PMID: 22424685 DOI: 10.1016/j.juro.2011.12.109] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Indexed: 10/28/2022]
Abstract
PURPOSE In patients who have undergone nephrectomy lower stage chronic kidney disease may develop, which is an independent risk factor for cardiovascular disease and overall mortality. We investigated whether the prevalence of lower stage chronic kidney disease is related to the amount of renal parenchyma excised in children with unilateral renal tumor. MATERIALS AND METHODS A total of 15 patients treated with nephrectomy and 10 treated with nephron sparing surgery were enrolled at a single academic center. The Kidney Disease Outcomes Quality Initiative guidelines were used to classify patients by chronic kidney disease stage based on estimated glomerular filtration rate values. The Modification of Diet in Renal Disease study equation and Schwartz equation were used in patients older and younger than 17 years, respectively. RESULTS At a mean followup of more than 12 years 8 patients who had undergone nephrectomy and 1 treated with bilateral nephron sparing surgery presented with stage II chronic kidney disease (estimated glomerular filtration rate 60 to 89 ml/min/1.73 m(2)). Sequential measurements from diagnosis to 12 to 17 years postoperatively showed that stage II chronic kidney disease in patients who had undergone nephrectomy manifested as a negligible postoperative increase in mean ± SD estimated glomerular filtration rate (75.7 ± 25.5 vs 79.4 ± 3.9 ml/min/1.73 m(2), p = 0.6). Five of the 8 patients presented with stage II chronic kidney disease even before nephrectomy. The other 7 patients who had undergone nephrectomy and those treated with nephron sparing surgery presented with a significant postoperative increase in mean ± SD estimated glomerular filtration rate (81.1 ± 24 vs 102.3 ± 3 ml/min/1.73 m(2), p = 0.02, and 88.7 ± 2 vs 107.4 ± 14 ml/min/1.73 m(2), p = 0.005, respectively). CONCLUSIONS A subset of children with unilateral renal tumor presents before and/or after nephrectomy, and not after nephron sparing surgery, with stage II chronic kidney disease, probably due to a reduced renal reserve capacity. Whether patients with preoperative renal dysfunction may benefit from nephron sparing surgery should be studied in a cooperative clinical trial setting.
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Affiliation(s)
- Denis A Cozzi
- Pediatric Surgery Unit and Pediatric Oncology Unit (AS), Sapienza University of Rome, Rome, Italy.
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11
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Ko EY, Ritchey ML. Current management of Wilms' tumor in children. J Pediatr Urol 2009; 5:56-65. [PMID: 18845484 DOI: 10.1016/j.jpurol.2008.08.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2008] [Accepted: 08/18/2008] [Indexed: 11/28/2022]
Abstract
PURPOSE Wilms' tumor is the most common renal tumor in children. Outcomes have improved dramatically over the past few decades, but important treatment questions remain. These include the role of molecular biologic markers in stratifying patients for therapy or targeting tumors for treatment. We present a summary of these advances and outline the current treatment of Wilm's tumor. MATERIALS AND METHODS The medical literature and results of all cooperative group studies reporting treatment of children with Wilms' tumor were reviewed. RESULTS Overall survival exceeds 90% for most patients with nephroblastoma. However, outcomes for patients with rhabdoid tumors and diffuse anaplasia remain poor. The role of renal sparing surgery in patients with bilateral tumors is clear, but for children with unilateral tumors it continues to be defined. CONCLUSIONS Current protocols conducted by pediatric oncology groups are beginning to incorporate biologic features to stratify patients for therapy. Treatment strategies continue to focus on limiting late effects of treatment while maintaining an excellent survival. New therapies are needed to treat the high-risk patients who continue to have high relapse and mortality rates.
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Affiliation(s)
- Edmund Y Ko
- Mayo Clinic College of Medicine, Phoenix, AZ, USA
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12
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Abstract
The role of the pathologist has been fundamental in the progress of the treatment of paediatric renal tumours. There are different philosophies in the treatment of these tumours, and there have been many recent advances in the areas of chemotherapy, identification of new entities, prognostic histological criteria following treatment and molecular prognostic and diagnostic features. This review discusses the different approaches of the different treatment protocols from Europe and North America, and reviews staging criteria, prognostic criteria and also the different tumour entities.
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Affiliation(s)
- Gordan M Vujanic
- Paediatric Pathology, School of Medicine, Cardiff University, United Kingdom
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13
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Wilms tumour: prognostic factors, staging, therapy and late effects. Pediatr Radiol 2008; 38:2-17. [PMID: 18026723 DOI: 10.1007/s00247-007-0687-7] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Revised: 10/15/2007] [Accepted: 10/24/2007] [Indexed: 10/22/2022]
Abstract
Wilms tumour is the most common malignant renal tumour in children. Dramatic improvements in survival have occurred as the result of advances in anaesthetic and surgical management, irradiation and chemotherapy. Current therapies are based on trials and studies primarily conducted by large multi-institutional cooperatives including the Société Internationale d'Oncologie Pédiatrique (SIOP) and the Children's Oncology Group (COG). The primary goals are to treat patients according to well-defined risk groups in order to achieve the highest cure rates, to decrease the frequency and intensity of acute and late toxicity and to minimize the cost of therapy. The SIOP trials and studies largely focus on the issue of preoperative therapy, whereas the COG trials and studies start with primary surgery. This paper reviews prognostic factors and staging systems for Wilms tumour and its current treatment with surgery and chemotherapy. Surgery remains a crucial part of treatment for nephroblastoma, providing local primary tumour control and adequate staging and possibly controlling the metastatic spread and central vascular extension of the disease. Partial nephrectomy, when technically feasible, seems reasonable not only in those with bilateral disease but also in those with unilateral disease where the patient has urological disorders or syndromes predisposing to malignancy. Partial nephrectomy, however, is frequently not sufficient for an anaplastic variant of tumour. The late effects for Wilms tumour and its treatment are also reviewed. The treatment of Wilms tumour has been a success story, and currently in excess of 80% of children diagnosed with Wilms tumour can look forward to long-term survival, with less than 20% experiencing serious morbidity at 20 years from diagnosis. The late complications are a consequence of the type and intensity of treatment required, which in turn reflects the nature and extent of the original tumour. Continual international trial development and participation will improve matching of treatment needs with prognosis, reducing long-term complications in the majority. The advent of molecular markers of disease severity and improved functional imaging might help.
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Cozzi DA, Zani A. Nephron-sparing surgery in children with primary renal tumor: indications and results. Semin Pediatr Surg 2006; 15:3-9. [PMID: 16458840 DOI: 10.1053/j.sempedsurg.2005.11.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Nephron-sparing surgery (NSS) is the treatment of choice for children with bilateral Wilms' tumor (WT), or with WT on a single kidney, or with WT and a disease of the contralateral kidney, or with benign kidney tumor. NSS is a reasonable alternative to nephrectomy in children at risk of metachronous WT, including children with genetic syndromes, children younger than 1 year of age, and children with hyperplastic nephroblastomatosis. The use of NSS in selected children with "low-risk" or stage I "intermediate-risk" WT and a normal contralateral kidney is still controversial. Available data suggest that, in children with WT, NSS does not impair the outcome and has a renal function advantage over nephrectomy.
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Affiliation(s)
- Denis Andrew Cozzi
- Pediatric Surgery Unit, Policlinico Umberto I, University of Rome "La Sapienza", Rome, Italy.
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17
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Abstract
Nephroblastoma, or Wilms tumor, is a malignant embryonal neoplasm that is derived from nephrogenic blastemal cells, with variable recapitulation of renal embryogenesis. The pathogenesis of nephroblastoma is complex and has been linked to alterations of several genomic loci, including WT1, WT2, FWT1, and FWT2. Generally, nephroblastoma is composed of variable proportions of blastema, epithelium, and stroma, each of which may exhibit a wide spectrum of morphologic variations. Distinguishing nephroblastoma with favorable histology from tumors that exhibit anaplasia is an integral component of histologic assessment because of its prognostic and therapeutic implications. Nephrogenic rests and a special variant of nephroblastoma, cystic partially differentiated nephroblastoma, also are discussed.
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Affiliation(s)
- Joseph D Khoury
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Zani A, Schiavetti A, Gambino M, Cozzi DA, Conforti A, Cozzi F. LONG-TERM OUTCOME OF NEPHRON SPARING SURGERY AND SIMPLE NEPHRECTOMY FOR UNILATERAL LOCALIZED WILMS TUMOR. J Urol 2005; 173:946-8; discussion 948. [PMID: 15711346 DOI: 10.1097/01.ju.0000152580.90861.d3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE We retrospectively assessed survival and local recurrence rates in children with unilateral localized Wilms tumor (WT) treated with nephron sparing surgery (NSS) or simple nephrectomy with removal only of the perirenal fat adherent to the tumor surface. MATERIALS AND METHODS The records of 70 children with renal tumor, operated on by the same surgeon between January 1968 and December 2003, were reviewed. Of 64 children with WT 52 with localized nonanaplastic WT were enrolled. Treatment was administered according to International Society of Pediatric Oncology protocols 1 to 2001 in all patients but 7, who were operated on between 1968 and 1971. Patients were stratified as having stage I (27), stage II (23) or stage III (2) disease. Surgical treatment included 40 simple nephrectomies, 10 NSSs (only stage I cases ascertained by frozen section) and 2 radical nephrectomies. Mean patient age at operation was 39.5 months (range 1 to 126). Followup ranged from 27 to 431 months (mean 188.4). RESULTS Event-free survival rate in all localized stages was 88.5% (stage I 92.6%, stage II 87%, stage III 50%). Two infants with stage I disease died after surgery for reasons not related to malignancy. Only 1 patient with stage II lymph node negative WT had local relapse. CONCLUSIONS Our results are similar to those achieved by radical nephrectomy in previous studies. Leaving Gerota's fascia in situ does not seem to confer a higher risk of local recurrence in patients with low stage nonanaplastic WT. After NSS Gerota's fascia may be used to cover the defect and to maintain tissue plains, thus, facilitating reintervention if necessary.
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Affiliation(s)
- Augusto Zani
- Pediatric Surgery Unit, Department of Pediatrics, University of Rome La Sapienza, Rome, Italy
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