1
|
Perotti D, Williams RD, Wegert J, Brzezinski J, Maschietto M, Ciceri S, Gisselsson D, Gadd S, Walz AL, Furtwaengler R, Drost J, Al-Saadi R, Evageliou N, Gooskens SL, Hong AL, Murphy AJ, Ortiz MV, O'Sullivan MJ, Mullen EA, van den Heuvel-Eibrink MM, Fernandez CV, Graf N, Grundy PE, Geller JI, Dome JS, Perlman EJ, Gessler M, Huff V, Pritchard-Jones K. Hallmark discoveries in the biology of Wilms tumour. Nat Rev Urol 2024; 21:158-180. [PMID: 37848532 DOI: 10.1038/s41585-023-00824-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/19/2023]
Abstract
The modern study of Wilms tumour was prompted nearly 50 years ago, when Alfred Knudson proposed the 'two-hit' model of tumour development. Since then, the efforts of researchers worldwide have substantially expanded our knowledge of Wilms tumour biology, including major advances in genetics - from cloning the first Wilms tumour gene to high-throughput studies that have revealed the genetic landscape of this tumour. These discoveries improve understanding of the embryonal origin of Wilms tumour, familial occurrences and associated syndromic conditions. Many efforts have been made to find and clinically apply prognostic biomarkers to Wilms tumour, for which outcomes are generally favourable, but treatment of some affected individuals remains challenging. Challenges are also posed by the intratumoural heterogeneity of biomarkers. Furthermore, preclinical models of Wilms tumour, from cell lines to organoid cultures, have evolved. Despite these many achievements, much still remains to be discovered: further molecular understanding of relapse in Wilms tumour and of the multiple origins of bilateral Wilms tumour are two examples of areas under active investigation. International collaboration, especially when large tumour series are required to obtain robust data, will help to answer some of the remaining unresolved questions.
Collapse
Affiliation(s)
- Daniela Perotti
- Predictive Medicine: Molecular Bases of Genetic Risk, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Richard D Williams
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Section of Genetics and Genomics, Faculty of Medicine, Imperial College London, London, UK
| | - Jenny Wegert
- Theodor-Boveri-Institute/Biocenter, Developmental Biochemistry, Wuerzburg University, Wuerzburg, Germany
| | - Jack Brzezinski
- Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Mariana Maschietto
- Research Center, Boldrini Children's Hospital, Campinas, São Paulo, Brazil
| | - Sara Ciceri
- Predictive Medicine: Molecular Bases of Genetic Risk, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - David Gisselsson
- Cancer Cell Evolution Unit, Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, Lund, Sweden
- Clinical Genetics, Pathology and Molecular Diagnostics, Office of Medical Services, Skåne, Sweden
| | - Samantha Gadd
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Amy L Walz
- Division of Hematology,Oncology, Neuro-Oncology, and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Rhoikos Furtwaengler
- Division of Pediatric Oncology and Hematology, Department of Pediatrics, Inselspital Bern University, Bern, Switzerland
| | - Jarno Drost
- Princess Máxima Center for Paediatric Oncology, Utrecht, Netherlands
- Oncode Institute, Utrecht, Netherlands
| | - Reem Al-Saadi
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
- Department of Histopathology, Great Ormond Street Hospital for Children, London, UK
| | - Nicholas Evageliou
- Divisions of Hematology and Oncology, Children's Hospital of Philadelphia, CHOP Specialty Care Center, Vorhees, NJ, USA
| | - Saskia L Gooskens
- Princess Máxima Center for Paediatric Oncology, Utrecht, Netherlands
| | - Andrew L Hong
- Aflac Cancer and Blood Disorders Center, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Michael V Ortiz
- Department of Paediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maureen J O'Sullivan
- Histology Laboratory, Children's Health Ireland at Crumlin, Dublin, Ireland
- Trinity Translational Medicine Institute, Trinity College, Dublin, Ireland
| | - Elizabeth A Mullen
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | | | - Conrad V Fernandez
- Division of Paediatric Hematology Oncology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Norbert Graf
- Department of Paediatric Oncology and Hematology, Saarland University Hospital, Homburg, Germany
| | - Paul E Grundy
- Department of Paediatrics Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Jeffrey S Dome
- Division of Oncology, Center for Cancer and Blood Disorders, Children's National Hospital and the Department of Paediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Elizabeth J Perlman
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Manfred Gessler
- Theodor-Boveri-Institute/Biocenter, Developmental Biochemistry, Wuerzburg University, Wuerzburg, Germany
- Comprehensive Cancer Center Mainfranken, Wuerzburg, Germany
| | - Vicki Huff
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Kathy Pritchard-Jones
- Developmental Biology and Cancer Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| |
Collapse
|
2
|
Goldstein JA, Renfro LA, Jennings LJ, Mullen EA, Geller J, Vallance K, Fernandez CV, Perlman EJ. BRAF Exon 15 Mutations in the Evaluation of Well-Differentiated Epithelial Nephroblastic Neoplasms in Children: A Report From the Children's Oncology Group Study AREN03B2. Arch Pathol Lab Med 2023:497838. [PMID: 38116848 DOI: 10.5858/arpa.2022-0528-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 12/21/2023]
Abstract
CONTEXT.— The distinction between well-differentiated epithelial favorable-histology Wilms tumor (EFHWT) and metanephric adenoma (MA) in children has historically been determined by the required absence of both a fibrous pseudocapsule and mitotic activity in MA. More recently these features have been allowed in adult MA. Mutations in exon 15 of the BRAF gene are reported in up to 88% of MAs but have not been reported in EFHWTs. OBJECTIVE.— To clarify the pathologic and molecular features used to distinguish between pediatric MA and EFHWT. DESIGN.— Stage I epithelial tumors classified as EFHWT on central review (36 patients) were identified from the Children's Oncology Group AREN03B2 study. Thirteen tumors had morphologic features overlapping those of MA and 23 lacked such features; 35 of 36 had tissue available for sequencing of BRAF. RESULTS.— Patients with EFHWTs with MA features (13) were older (mean, 8.4 versus 1.9 years; P < .001), had smaller tumor diameters (mean, 6.0 versus 9.7 cm; P < .001), and had fewer mitoses (mean, 1 versus 48 mitoses per 10 high-power fields; P < .001) than patients with EFHWT lacking MA features (23). All EFHWTs with MA features contained at least a partial fibrous pseudocapsule; 7 of 12 (58%) had BRAF exon 15 mutation. No BRAF exon 15 mutations were identified in 23 EFHWTs lacking MA features. None of the 13 EFHWT patients with MA features have experienced relapse (median follow-up 5.9 years). CONCLUSIONS.— Pediatric epithelial neoplasms with features of MA that show partial encapsulation and/or modest mitotic activity may be classified as MAs. Although BRAF mutation supports the diagnosis of MA, it is not required for the diagnosis.
Collapse
Affiliation(s)
- Jeffery A Goldstein
- From the Department of Pathology, Northwestern University School of Medicine, Chicago, llinois (Goldstein, Jennings, Perlman)
| | - Lindsay A Renfro
- The Division of Biostatistics, University of Southern California, Los Angeles (Renfro)
- The Statistics and Data Monitoring Center, Children's Oncology Group, Monrovia, California (Renfro)
| | - Lawrence J Jennings
- From the Department of Pathology, Northwestern University School of Medicine, Chicago, llinois (Goldstein, Jennings, Perlman)
| | - Elizabeth A Mullen
- Pediatric Hematology/Oncology, Dana Farber Cancer Institute/Boston Children’s Hospital, Boston, Massachusetts (Mullen)
| | - James Geller
- The Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (Geller)
| | - Kelly Vallance
- The Division of Hematology/Oncology, Cook Children's Medical Center, Fort Worth, Texas (Vallance)
| | - Conrad V Fernandez
- The Departments of Pediatrics and Bioethics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada (Fernandez)
| | - Elizabeth J Perlman
- From the Department of Pathology, Northwestern University School of Medicine, Chicago, llinois (Goldstein, Jennings, Perlman)
| |
Collapse
|
3
|
Modi A, Lopez G, Conkrite KL, Su C, Leung TC, Ramanan S, Manduchi E, Johnson ME, Cheung D, Gadd S, Zhang J, Smith MA, Guidry Auvil JM, Meshinchi S, Perlman EJ, Hunger SP, Maris JM, Wells AD, Grant SF, Diskin SJ. Integrative Genomic Analyses Identify LncRNA Regulatory Networks across Pediatric Leukemias and Solid Tumors. Cancer Res 2023; 83:3462-3477. [PMID: 37584517 PMCID: PMC10787516 DOI: 10.1158/0008-5472.can-22-3186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/07/2023] [Accepted: 08/09/2023] [Indexed: 08/17/2023]
Abstract
Long noncoding RNAs (lncRNA) play an important role in gene regulation and contribute to tumorigenesis. While pan-cancer studies of lncRNA expression have been performed for adult malignancies, the lncRNA landscape across pediatric cancers remains largely uncharted. Here, we curated RNA sequencing data for 1,044 pediatric leukemia and extracranial solid tumors and integrated paired tumor whole genome sequencing and epigenetic data in relevant cell line models to explore lncRNA expression, regulation, and association with cancer. A total of 2,657 lncRNAs were robustly expressed across six pediatric cancers, including 1,142 exhibiting histotype-elevated expression. DNA copy number alterations contributed to lncRNA dysregulation at a proportion comparable to protein coding genes. Application of a multidimensional framework to identify and prioritize lncRNAs impacting gene networks revealed that lncRNAs dysregulated in pediatric cancer are associated with proliferation, metabolism, and DNA damage hallmarks. Analysis of upstream regulation via cell type-specific transcription factors further implicated distinct histotype-elevated and developmental lncRNAs. Integration of these analyses prioritized lncRNAs for experimental validation, and silencing of TBX2-AS1, the top-prioritized neuroblastoma-specific lncRNA, resulted in significant growth inhibition of neuroblastoma cells, confirming the computational predictions. Taken together, these data provide a comprehensive characterization of lncRNA regulation and function in pediatric cancers and pave the way for future mechanistic studies. SIGNIFICANCE Comprehensive characterization of lncRNAs in pediatric cancer leads to the identification of highly expressed lncRNAs across childhood cancers, annotation of lncRNAs showing histotype-specific elevated expression, and prediction of lncRNA gene regulatory networks.
Collapse
Affiliation(s)
- Apexa Modi
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
- Genomics and Computational Biology Graduate Group, Biomedical Graduate Studies, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Gonzalo Lopez
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Karina L. Conkrite
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Chun Su
- Center for Spatial and Functional Genomics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Tsz Ching Leung
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Sathvik Ramanan
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Elisabetta Manduchi
- Center for Spatial and Functional Genomics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Matthew E. Johnson
- Center for Spatial and Functional Genomics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Daphne Cheung
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
| | - Samantha Gadd
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois 60208, USA
| | - Jinghui Zhang
- Department of Computational Biology, St Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Malcolm A. Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland 20892, USA
| | | | - Soheil Meshinchi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA
| | - Elizabeth J. Perlman
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Robert H. Lurie Cancer Center, Northwestern University, Chicago, Illinois 60208, USA
| | - Stephen P. Hunger
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - John M. Maris
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Andrew D Wells
- Center for Spatial and Functional Genomics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | - Struan F.A. Grant
- Center for Spatial and Functional Genomics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Department of Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Divisions of Human Genetics and Endocrinology & Diabetes, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA
| | - Sharon J. Diskin
- Division of Oncology and Center for Childhood Cancer Research, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
- Abramson Family Cancer Research Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| |
Collapse
|
4
|
Oosterom N, Gooskens SL, Renfro LA, Perlman EJ, van den Heuvel-Eibrink MM, Hamilton TE, Green DM, Grundy PE, Daw NC, Geller JI, Dome JS, Fernandez CV, Mullen EA. Severe Hepatopathy in National Wilms Tumor Studies 3-5: Prevalence, Clinical Features, and Outcomes After Reintroduction of Chemotherapy. J Clin Oncol 2023; 41:4247-4256. [PMID: 37343199 PMCID: PMC10852371 DOI: 10.1200/jco.22.02555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/01/2023] [Accepted: 04/26/2023] [Indexed: 06/23/2023] Open
Abstract
PURPOSE The safety of reintroducing chemotherapy in the pediatric renal tumor setting after severe hepatopathy (SH), including sinusoidal obstruction syndrome (SOS), is uncertain. We describe the incidence, severity, outcomes, and impact on subsequent treatment for patients with SH from National Wilms Tumor Study (NWTS) protocols 3-5. PATIENTS AND METHODS Archived charts for patients enrolled on NWTS 3-5 who met study inclusion criteria for SH by using established hepatopathy grading scales and clinical criteria were reviewed for demographics, tumor characteristics, radio- and chemotherapy details, SH-related dose modifications, and oncologic outcomes. Genomic analysis for candidate polymorphisms associated with SH was performed in 14 patients. RESULTS Seventy-one of 8,862 patients (0.8%) met study inclusion criteria. The median time from therapy initiation to SH was 51 days (range, 2-293 days). Sixty percent received radiotherapy, and 56% had right-sided tumors. Grade 1-4 thrombocytopenia was noted in 70% at initial occurrence of SH (median 22,000/microliter). Among 69 of 71 children with SH occurring before the end of therapy (EOT) and post-SH treatment information available, chemotherapy was delayed posthepatopathy for 65% (69% of these at a reduced dose), continued without delay for 20% (57% of these at reduced dose), and stopped completely for 15% (4 of 10 of whom died of SH). Overall, 42% of patients with dose reductions achieved full dose by EOT. The five-year post-SH event-free survival for patients who continued therapy was 89% (95% CI, 81 to 98), with no significant differences by whether delay or dose reduction occurred. We identified no SH-associated pharmacogenomic polymorphism. CONCLUSION The incidence of SH on NWTS 3-5 was low; many had associated severe thrombocytopenia. Careful reintroduction of chemotherapy appeared to be feasible for the majority of patients who developed severe chemotherapy- and/or radiotherapy-induced liver toxicity.
Collapse
Affiliation(s)
- Natanja Oosterom
- Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | | | - Lindsay A. Renfro
- University of Southern California and Children's Oncology Group, Los Angeles, CA
| | - Elizabeth J. Perlman
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | | | - Thomas E. Hamilton
- Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Daniel M. Green
- Department of Epidemiology and Cancer Control Oncology, St Jude Children's Research Hospital, Memphis, TN
| | - Paul E. Grundy
- Department of Pediatric Oncology, University of Alberta Hospital, Edmonton, AB, Canada
| | - Najat C. Daw
- Division of Pediatrics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - James I. Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Jeffrey S. Dome
- Division of Oncology, Children's National Hospital and Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Conrad V. Fernandez
- Division of Pediatric Hematology and Oncology, IWK Health Centre and Dalhouise University, Halifax, NS, Canada
| | - Elizabeth A. Mullen
- Department of Pediatric Hematology/Oncology, Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, MA
| |
Collapse
|
5
|
Gadd S, Huff V, Skol AD, Renfro LA, Fernandez CV, Mullen EA, Jones CD, Hoadley KA, Yap KL, Ramirez NC, Aris S, Phung QH, Perlman EJ. Genetic changes associated with relapse in favorable histology Wilms tumor: A Children's Oncology Group AREN03B2 study. Cell Rep Med 2022; 3:100644. [PMID: 35617957 PMCID: PMC9244995 DOI: 10.1016/j.xcrm.2022.100644] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/23/2022] [Accepted: 05/04/2022] [Indexed: 12/15/2022]
Abstract
Over the last decade, sequencing of primary tumors has clarified the genetic underpinnings of Wilms tumor but has not affected therapy, outcome, or toxicity. We now sharpen our focus on relapse samples from the umbrella AREN03B2 study. We show that over 40% of relapse samples contain mutations in SIX1 or genes of the MYCN network, drivers of progenitor proliferation. Not previously seen in large studies of primary Wilms tumors, DIS3 and TERT are now identified as recurrently mutated. The analysis of primary-relapse tumor pairs suggests that 11p15 loss of heterozygosity (and other copy number changes) and mutations in WT1 and MLLT1 typically occur early, but mutations in SIX1, MYCN, and WTX are late developments in some individuals. Most strikingly, 75% of relapse samples had gain of 1q, providing strong conceptual support for studying circulating tumor DNA in clinical trials to better detect 1q gain earlier and monitor response.
Collapse
Affiliation(s)
- Samantha Gadd
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Robert H. Lurie Cancer Center, Northwestern University, 225 East Chicago Avenue, Box 17, Chicago, IL 60611, USA
| | - Vicki Huff
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Andrew D Skol
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Robert H. Lurie Cancer Center, Northwestern University, 225 East Chicago Avenue, Box 17, Chicago, IL 60611, USA
| | - Lindsay A Renfro
- Division of Biostatistics, University of Southern California, Los Angeles, CA 90007, USA
| | - Conrad V Fernandez
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NS B3K 6R8, Canada
| | - Elizabeth A Mullen
- Department of Pediatric Oncology, Dana-Farber/Boston Children's Cancer and Blood Disorders Center and Harvard Medical School, Boston, MA 02215, USA
| | - Corbin D Jones
- Department of Biology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Katherine A Hoadley
- Department of Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kai Lee Yap
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Robert H. Lurie Cancer Center, Northwestern University, 225 East Chicago Avenue, Box 17, Chicago, IL 60611, USA
| | - Nilsa C Ramirez
- Institute for Genomic Medicine and Biopathology Center, Nationwide Children's Hospital, Departments of Pathology and Pediatrics, Ohio State University, Columbus, OH 43205, USA
| | - Sheena Aris
- Biospecimen Research Group, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA
| | - Quy H Phung
- Biospecimen Research Group, Frederick National Laboratory for Cancer Research, Frederick, MD 21702, USA
| | - Elizabeth J Perlman
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Robert H. Lurie Cancer Center, Northwestern University, 225 East Chicago Avenue, Box 17, Chicago, IL 60611, USA.
| |
Collapse
|
6
|
Chintagumpala MM, Perlman EJ, Tornwall B, Chi YY, Kim Y, Hoffer FA, Kalapurakal JA, Warwick AB, Shamberger RC, Khanna G, Hamilton TE, Gow KW, Paulino AC, Gratias EJ, Mullen EA, Geller JI, Fernandez CV, Ritchey ML, Grundy PE, Dome JS, Ehrlich PF. Outcomes based on histopathologic response to preoperative chemotherapy in children with bilateral Wilms tumor: A prospective study (COG AREN0534). Cancer 2022; 128:2493-2503. [PMID: 35383900 DOI: 10.1002/cncr.34219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 02/03/2022] [Accepted: 03/10/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND An objective of the Children's Oncology Group AREN0534 Study was to improve the survival of patients with bilateral Wilms tumors (BWT) by using preoperative chemotherapy of limited duration and tailoring postoperative therapy based on histopathologic response. The authors report outcomes based on postoperative histopathologic responses. METHODS Patients with BWT received treatment with vincristine, dactinomycin, and doxorubicin for 6 or 12 weeks followed by surgery. Postoperative therapy was prescribed based on the highest risk tumor according to the International Society of Pediatric Oncology classification and the Children's Oncology Group staging system. RESULTS Analyses were performed on data from 180 evaluable children. The 4-year event-free survival (EFS) and overall survival (OS) rates were 81% (95% CI, 74%-87%) and 95% (95% CI, 91%-99%), respectively. Seven patients who had completely necrotic tumors had a 4-year EFS rate of 100%. Of 118 patients who had tumors with intermediate-risk histopathology, the 4-year EFS and OS rates were 82% (95% CI, 74%-90%) and 97% (95% CI, 94%-100%), respectively. Fourteen patients who had blastemal-type tumors had 4-year EFS and OS rates of 79% (95% CI, 56%-100%) and 93% (95% CI, 79%-100%), respectively. Eighteen patients who had diffuse anaplasia had 4-year EFS and OS rates of 61% (95% CI, 35%-88%) and 72% (95% CI, 47%-97%), respectively; and the 4-year EFS and OS rates of 7 patients who had focal anaplasia were 71% (95% CI, 38%-100%) and 100%, respectively. There was no difference in the outcomes of patients who had different histopathologic subtypes within the intermediate-risk group (P = .54). CONCLUSIONS A risk-adapted treatment approach for BWT results in excellent outcomes. This approach was not successful in improving the outcome of patients who had diffuse anaplasia.
Collapse
Affiliation(s)
| | - Elizabeth J Perlman
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois
| | - Brett Tornwall
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, Florida
| | - Yueh-Yun Chi
- Cancer and Blood Disease Institute, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Yeonil Kim
- Merck Research Laboratories, Merck & Company Inc, Rahway, New Jersey
| | - Fredric A Hoffer
- Department of Radiology, Fred Hutchison Cancer Center, University of Washington, Seattle, Washington
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University, Chicago, Illinois
| | - Anne B Warwick
- Department of Pediatrics, Uniformed Services University, Walter Reed National Military Medical Center, Washington, DC
| | - Robert C Shamberger
- Department of Surgery, Boston Children's Hospital and Dana Farber Cancer Center, Boston, Massachusetts
| | - Geetika Khanna
- School of Medicine, Washington University of St Louis, St Louis, Missouri
| | - Thomas E Hamilton
- Department of Surgery, Boston Children's Hospital and Dana Farber Cancer Center, Boston, Massachusetts
| | - Kenneth W Gow
- Department of Surgery, University of Washington, Seattle, Washington
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | | | - Elizabeth A Mullen
- Department of Surgery, Boston Children's Hospital and Dana Farber Cancer Center, Boston, Massachusetts
| | - James I Geller
- Division of Hematology/Oncology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Conrad V Fernandez
- Pediatrics and Bioethics, IWK Health Center, Halifax, Nova Scotia, Canada
| | - Michael L Ritchey
- Department of Urology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Paul E Grundy
- Department of Pediatrics and Oncology, University of Alberta Children's Hospital, Edmonton, Alberta, Canada
| | - Jeffrey S Dome
- Pediatric Surgery, Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Peter F Ehrlich
- Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
7
|
Dome JS, Mullen EA, Dix DB, Gratias EJ, Ehrlich PF, Daw NC, Geller JI, Chintagumpala M, Khanna G, Kalapurakal JA, Renfro L, Perlman EJ, Grundy PE, Fernandez CV. Authors' Reply to the Letter to the Editor by Daniel M. Green. J Natl Compr Canc Netw 2022; 20:xlvii-xlviii. [PMID: 35276672 DOI: 10.6004/jnccn.2022.7002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jeffrey S Dome
- aCenter for Cancer and Blood Disorders, Children's National Hospital, and George Washington University School of Medicine and Health Sciences, Washington, DC
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Vujanić GM, Parsons LN, D'Hooghe E, Treece AL, Collini P, Perlman EJ. Pathology of Wilms' tumour in International Society of Paediatric Oncology (SIOP) and Children's Oncology Group (COG) renal tumour studies: similarities and differences. Histopathology 2022; 80:1026-1037. [PMID: 35275409 DOI: 10.1111/his.14632] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/09/2022] [Accepted: 02/22/2022] [Indexed: 12/01/2022]
Abstract
Excellent outcomes for patients with Wilms' tumour (WT), over 90% for all stages together, have been achieved through researching WT in multicentre and multinational trials and studies in the last 50 years, led by two major groups - International Society of Paediatric Oncology (SIOP) and Children's Oncology Group (COG, previously National Wilms' Tumor Study Group). Despite having different approaches, the survival outcomes in two groups are remarkably similar. In general, in SIOP, which is followed in Europe and most other countries around the world, patients are first treated with pre-operative chemotherapy, followed by surgery and, if necessary, post-operative chemotherapy and radiotherapy. In COG, which is mainly followed in North America, patients are treated with upfront surgery, followed, if necessary, by post-operative chemotherapy and radiotherapy. In both groups, post-operative treatment primarily depends on tumour histological classification and stage, although in recent studies, other prognostic factors have been included, too (tumour volume, response to preoperative chemotherapy, molecular markers). Due to separate initial treatments, there are differences in histological assessment and subtyping of WT, and, more importantly, in staging criteria. In this review, we discuss the similarities and differences between the two groups in order to help pathologists who are dealing with WT to understand and follow the pathological protocol which is appropriate for a particular case since in many centres both approaches may be followed depending on individual case's / patient's circumstances.
Collapse
Affiliation(s)
- Gordan M Vujanić
- Department of Pathology, Sidra Medicine, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Lauren N Parsons
- Department of Pathology, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Ellen D'Hooghe
- Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Amy L Treece
- Department of Pathology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Paola Collini
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS Istituto Nazionale dei Tumouri, Milano, Italy
| | - Elizabeth J Perlman
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
9
|
Ehrlich PF, Tornwall B, Chintagumpala MM, Chi YY, Hoffer FA, Perlman EJ, Kalapurakal JA, Warwick A, Shamberger RC, Khanna G, Hamilton TE, Gow KW, Paulino AC, Gratias EJ, Mullen EA, Geller JI, Fernandez CV, Dome JS. ASO Video Abstract: Kidney Preservation and Wilms Tumor Development in Children with Diffuse Hyperplastic Perilobar Nephroblastomatosis—A Report from the Children’s Oncology Group Study AREN0534. Ann Surg Oncol 2022; 29:3262-3263. [DOI: 10.1245/s10434-021-11311-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
10
|
Ehrlich PF, Tornwall B, Chintagumpala MM, Chi YY, Hoffer FA, Perlman EJ, Kalapurakal JA, Warwick A, Shamberger RC, Khanna G, Hamilton TE, Gow KW, Paulino AC, Gratias EJ, Mullen EA, Geller JI, Fernandez CV, Dome JS. Kidney Preservation and Wilms Tumor Development in Children with Diffuse Hyperplastic Perilobar Nephroblastomatosis: A Report from the Children’s Oncology Group Study AREN0534. Ann Surg Oncol 2022; 29:3252-3261. [PMID: 35072864 PMCID: PMC9254258 DOI: 10.1245/s10434-021-11266-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/03/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Diffuse hyperplastic perilobar nephroblastomatosis (DHPLN) represents a unique category of nephroblastomatosis. Treatment has ranged from observation to multiple regimens of chemotherapy. Wilms tumors (WTs) develop in 100% of untreated patients and between 32 and 52% of treated patients. Renal preservation rates have not been previously reported. An aim of the Children's Oncology Group (COG) study AREN0534 was to prospectively evaluate the efficacy of chemotherapy in preserving renal units and preventing WT development in children with DHPLN. METHODS Patients were enrolled through the COG protocol AREN03B2 with central radiological review. DHPLN was defined as the cortical surface of the kidney being composed of hyperplastic rests, with the entire nephrogenic zone involved, and with a thick rind capping all of one or both kidneys. Treatment was with vincristine and dactinomycin (regimen EE4A), with cross-sectional imaging at weeks 6 and 12. If the patient's disease was stable or decreasing, treatment was continued for 19 weeks. Renal preservation, WT development rates at 1 year, and overall survival (OS) are reported. RESULTS Nine patients were enrolled (five females and four males), with a median age at enrollment of 10.22 months (range 2.92-29.11). One patient who was enrolled was deemed unevaluable because they did not meet the radiological criteria for DHPLN, resulting in eight evaluable patients. These eight patients had DHPLN confirmed via radiological criteria (all bilateral). Initial chemotherapy was EE4A for all eight patients, with seven of eight patients starting chemotherapy without tissue diagnosis.One patient who had an upfront partial nephrectomy was found to have DHPLN in the specimen and was subsequently treated with EE4A. All patients remained alive, with a median follow-up of 6.6 years (range 4.5-9.1). No patients were anephric; 14 of 16 kidneys were functioning (87.5%). Six of eight patients (75%) did not have WT on therapy, but two of these patients relapsed within 6 months of stopping therapy; both had favorable histology WT. One patient who was diagnosed with WT on therapy relapsed at 12 months (one of eight [12.5%]) and developed anaplastic histology. CONCLUSIONS Chemotherapy for patients with DHPLN was effective in preserving kidney function. Five-year OS is excellent, however the ideal type and duration of chemotherapy to prevent WT development remains elusive.
Collapse
Affiliation(s)
- Peter F Ehrlich
- Section of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
| | - Brett Tornwall
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | | | - Yueh-Yun Chi
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Fredric A Hoffer
- Fred Hutchison Cancer Center, University of Washington, Seattle, WA, USA
| | | | | | - Anne Warwick
- Walter Reed National Military Medical Center, Washington, DC, USA
| | - Robert C Shamberger
- Boston Children's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | | | - Thomas E Hamilton
- Boston Children's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | | | | | | | - Elizabeth A Mullen
- Boston Children's Hospital and Dana Farber Cancer Institute, Boston, MA, USA
| | | | | | - Jeffrey S Dome
- IWK Children's Hospital, Halifax, NS, Canada
- Children National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| |
Collapse
|
11
|
Dome JS, Mullen EA, Dix DB, Gratias EJ, Ehrlich PF, Daw NC, Geller JI, Chintagumpala M, Khanna G, Kalapurakal JA, Renfro LA, Perlman EJ, Grundy PE, Fernandez CV. Impact of the First Generation of Children's Oncology Group Clinical Trials on Clinical Practice for Wilms Tumor. J Natl Compr Canc Netw 2021; 19:978-985. [PMID: 34416705 DOI: 10.6004/jnccn.2021.7070] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/09/2021] [Indexed: 11/17/2022]
Abstract
Refinements in surgery, radiation therapy, and chemotherapy since the mid-20th century have resulted in a survival rate exceeding 90% for patients with Wilms tumor (WT). Although this figure is remarkable, a significant proportion of patients continue to have event-free survival (EFS) estimates of <75%, and nearly 25% of survivors experience severe chronic medical conditions. The first-generation Children's Oncology Group (COG) renal tumor trials (AREN '0'), which opened to enrollment in 2006, focused on augmenting treatment regimens for WT subgroups with predicted EFS <75% to 80%, including those with the adverse prognostic marker of combined loss of heterozygosity (LOH) at chromosomes 1p/16q, pulmonary metastasis with incomplete lung nodule response after 6 weeks of chemotherapy, bilateral disease, and anaplastic histology. Conversely, therapy was reduced for patient subgroups with good outcomes and potential for long-term toxicity, such as those with lung metastasis with complete lung nodule response after 6 weeks of chemotherapy. This article summarizes the key findings of the first-generation COG renal tumor studies and their implications for clinical practice.
Collapse
Affiliation(s)
- Jeffrey S Dome
- Division of Oncology, Center for Cancer and Blood Disorders, Children's National Hospital and the Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Elizabeth A Mullen
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts
| | - David B Dix
- Pediatric Hematology/Oncology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Peter F Ehrlich
- Department of Pediatric Surgery, University of Michigan, CS Mott Children's Hospital, Ann Arbor, Michigan
| | - Najat C Daw
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - James I Geller
- Division of Oncology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Geetika Khanna
- Department of Radiology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern University School of Medicine, Chicago, Illinois
| | - Lindsay A Renfro
- Children's Oncology Group and Division of Biostatistics, University of Southern California, Los Angeles, California
| | - Elizabeth J Perlman
- Department of Pathology, Northwestern University Feinberg School of Medicine, and the Robert H. Lurie Cancer Center, Chicago, Illinois
| | - Paul E Grundy
- Department of Pediatrics, University of Alberta Hospital, Edmonton, Alberta, Canada; and
| | - Conrad V Fernandez
- Division of Pediatric Hematology/Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
| |
Collapse
|
12
|
Tan KT, Kim H, Carrot-Zhang J, Zhang Y, Kim WJ, Kugener G, Wala JA, Howard TP, Chi YY, Beroukhim R, Li H, Ha G, Alper SL, Perlman EJ, Mullen EA, Hahn WC, Meyerson M, Hong AL. Haplotype-resolved germline and somatic alterations in renal medullary carcinomas. Genome Med 2021; 13:114. [PMID: 34261517 PMCID: PMC8281718 DOI: 10.1186/s13073-021-00929-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 06/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Renal medullary carcinomas (RMCs) are rare kidney cancers that occur in adolescents and young adults of African ancestry. Although RMC is associated with the sickle cell trait and somatic loss of the tumor suppressor, SMARCB1, the ancestral origins of RMC remain unknown. Further, characterization of structural variants (SVs) involving SMARCB1 in RMC remains limited. METHODS We used linked-read genome sequencing to reconstruct germline and somatic haplotypes in 15 unrelated patients with RMC registered on the Children's Oncology Group (COG) AREN03B2 study between 2006 and 2017 or from our prior study. We performed fine-mapping of the HBB locus and assessed the germline for cancer predisposition genes. Subsequently, we assessed the tumor samples for mutations outside of SMARCB1 and integrated RNA sequencing to interrogate the structural variants at the SMARCB1 locus. RESULTS We find that the haplotype of the sickle cell mutation in patients with RMC originated from three geographical regions in Africa. In addition, fine-mapping of the HBB locus identified the sickle cell mutation as the sole candidate variant. We further identify that the SMARCB1 structural variants are characterized by blunt or 1-bp homology events. CONCLUSIONS Our findings suggest that RMC does not arise from a single founder population and that the HbS allele is a strong candidate germline allele which confers risk for RMC. Furthermore, we find that the SVs that disrupt SMARCB1 function are likely repaired by non-homologous end-joining. These findings highlight how haplotype-based analyses using linked-read genome sequencing can be applied to identify potential risk variants in small and rare disease cohorts and provide nucleotide resolution to structural variants.
Collapse
Affiliation(s)
- Kar-Tong Tan
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Hyunji Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Jian Carrot-Zhang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Yuxiang Zhang
- Department of Genetics, Harvard Medical School, Boston, MA, USA
| | - Won Jun Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | | | - Jeremiah A Wala
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Thomas P Howard
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Yueh-Yun Chi
- Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | - Rameen Beroukhim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Heng Li
- Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Gavin Ha
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Seth L Alper
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Elizabeth A Mullen
- Department of Hematology and Oncology, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - William C Hahn
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
| | - Matthew Meyerson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.
- Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Department of Genetics, Harvard Medical School, Boston, MA, USA.
| | - Andrew L Hong
- Department of Pediatrics, Emory University, Atlanta, GA, USA.
- Aflac Center for Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA.
| |
Collapse
|
13
|
Modi A, Lopez G, Conkrite KL, Leung TC, Ramanan S, Cheung D, Su C, Johnson ME, Manduchi E, Gadd S, Zhang J, Smith MA, Auvil JMG, Gerhard DS, Meshinchi S, Perlman EJ, Hunger SP, Maris JM, Wells AD, Grant SF, Diskin SJ. Abstract 3028: Integrative genomics reveals lncRNAs associated with pediatric cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-3028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Long non-coding RNAs (lncRNAs) have emerged as key components of transcriptional and post-transcriptional gene regulation. Dysregulation of lncRNA expression has been widely observed in cancer and several lncRNAs are known to influence tumor initiation and progression. Despite this, the lncRNA landscape and regulatory networks across pediatric cancers remain relatively uncharted.
Methods: To characterize the lncRNA landscape of pediatric cancers, we first curated RNA sequencing data for 1,044 pediatric leukemia and solid tumors from the Therapeutically Applicable Research To Generate Effective Treatments (TARGET) project to identify known and novel expressed lncRNAs. This data set included: 280 acute myeloid leukemia (AML), 190 acute B-cell leukemia (B-ALL), 244 acute T-cell leukemia (T-ALL), 121 Wilm's tumor (WT), 48 rhabdoid tumors (RT), and 161 neuroblastoma (NBL). Histotype-specific expression was assessed using the tau score. Whole genome sequencing (WGS) from 826 matched normal-tumor pairs was integrated to identify somatic copy number alterations (SCNAs) disrupting lncRNA expression. To further implicate cancer-relevant drivers of lncRNA expression, we used a unique combination of epigenetic data in pediatric cell lines, including ChIP-sequencing for cancer-specific transcription factors and genome-scale chromatin capture data. A global analysis of lncRNA function was performed using the lncMod method, in which expression data is modelled to identify lncRNA modulators that perturb transcription factor regulation of target genes. Functional prioritization of lncRNAs was obtained through integration of analyses per cancer. Biochemical assays in human-derived cell line models were utilized to validate the function of the top prioritized lncRNA in NBL.
Results: We report a total of 2,657 robustly expressed lncRNAs across six pediatric cancers, including 1,142 lncRNAs exhibiting histotype-specific expression. SCNAs contributed to lncRNA dysregulation at a proportion comparable to protein coding genes. There were 207 (28%) lncRNAs in regions with SCNA that had significant expression dysregulation. LncMod analysis across the cancers revealed context-specific transcriptional gene networks per dysregulated lncRNA and enrichment for proliferation, metabolic, and DNA damage hallmarks. We further identified 547 cancer-associated lncRNAs in NBL based on upstream regulation via oncogenic transcription factors. The top-prioritized lncRNA, TBX2-AS1, was predicted to impact proliferation in NBL. Silencing of TBX2-AS1 using siRNAs achieved >90% knockdown in NBL cells and resulted in 46.6% decreased cell growth (p = 8.1 x 10-4).
Conclusion: This study defines the lncRNA landscape across six pediatric cancers and provides a detailed catalog of how lncRNAs impact regulatory gene networks. These data serve as a robust resource for future hypothesis-driven mechanistic studies.
Citation Format: Apexa Modi, Gonzalo Lopez, Karina L. Conkrite, Tsz Ching Leung, Sathvik Ramanan, Daphne Cheung, Chun Su, Matthew E. Johnson, Elisabetta Manduchi, Samantha Gadd, Jinghui Zhang, Malcolm A. Smith, Jaime M. Guidry Auvil, Daniela S. Gerhard, Soheil Meshinchi, Elizabeth J. Perlman, Stephen P. Hunger, John M. Maris, Andrew D. Wells, Struan F. Grant, Sharon J. Diskin. Integrative genomics reveals lncRNAs associated with pediatric cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 3028.
Collapse
Affiliation(s)
- Apexa Modi
- 1University of Pennsylvania, Philadelphia, PA
| | - Gonzalo Lopez
- 2Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | | | | | - Chun Su
- 2Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | - Samantha Gadd
- 3Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | | | | | | | | | | | | | | | - John M. Maris
- 7Children's Hospital of Philadelphia, Philadelphia, PA
| | | | | | | |
Collapse
|
14
|
Apellaniz-Ruiz M, Colón-González G, Perlman EJ, Bouron-Dal Soglio D, Sabbaghian N, Oehl-Huber K, Siebert R, Foulkes WD. A child with neuroblastoma and metachronous anaplastic sarcoma of the kidney: Underlying DICER1 syndrome? Pediatr Blood Cancer 2020; 67:e28488. [PMID: 32568472 DOI: 10.1002/pbc.28488] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/17/2020] [Accepted: 05/22/2020] [Indexed: 01/26/2023]
Affiliation(s)
- Maria Apellaniz-Ruiz
- Department of Human Genetics, McGill University, Montréal, Québec, Canada.,Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Gloria Colón-González
- Department of Pediatric Hematology Oncology, University of Puerto Rico, San Juan, Puerto Rico
| | - Elizabeth J Perlman
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine and Robert H. Lurie Cancer Center, Chicago, Illinois
| | - Dorothée Bouron-Dal Soglio
- Department of Pathology, CHU Sainte Justine, Montréal, Québec, Canada.,Department of Pathology and Cellular Biology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Nelly Sabbaghian
- Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Kathrin Oehl-Huber
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
| | - William D Foulkes
- Department of Human Genetics, McGill University, Montréal, Québec, Canada.,Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, McGill University, Montréal, Québec, Canada.,Program in Cancer Genetics, Department of Oncology and Human Genetics, McGill University, Montréal, Québec, Canada.,Department of Medical Genetics, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| |
Collapse
|
15
|
Geller JI, Cost NG, Chi YY, Tornwall B, Cajaiba M, Perlman EJ, Kim Y, Mullen EA, Glick RD, Khanna G, Daw NC, Ehrlich P, Fernandez CV, Dome JS. A prospective study of pediatric and adolescent renal cell carcinoma: A report from the Children's Oncology Group AREN0321 study. Cancer 2020; 126:5156-5164. [PMID: 32926409 DOI: 10.1002/cncr.33173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/06/2020] [Accepted: 07/17/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND To the authors' knowledge, AREN0321 is the first prospective clinical study of pediatric and adolescent renal cell carcinoma (RCC). Goals of the study included establishing epidemiological, treatment, and outcome data and confirming that patients with completely resected pediatric RCC, including lymph node-positive disease (N1), have a favorable prognosis without adjuvant therapy. METHODS From 2006 to 2012, patients aged <30 years with centrally reviewed pathology of RCC were enrolled prospectively. RESULTS A total of 68 patients were enrolled (39 of whom were male; median age of 13 years [range, 0.17-22.1 years]). Stage was classified according to the American Joint Committee on Cancer TNM stage seventh edition as stage I in 26 patients, stage II in 7 patients, stage III in 26 patients, and stage IV in 8 patients, and was not available in 1 patient. Sixty patients underwent resection of all known sites of disease, including 2 patients with stage IV disease. Surgery included radical nephrectomy (53 patients [81.5%]), partial nephrectomy (12 patients [18.5%]), and unknown (3 patients [4.4%]). Histology was TFE-associated RCC (translocation-type RCC; tRCC) in 40 patients, RCC not otherwise specified and/or other in 13 patients, papillary RCC in 9 patients, and renal medullary carcinoma (RMC) in 6 patients. Lymph node status was N0 in 21 patients, N1 in 21 patients (tRCC in 15 patients, RMC in 3 patients, papillary RCC in 2 patients, and not otherwise specified and/or other in 1 patient), and Nx in 26 patients. The 4-year event-free survival and overall survival rates were 80.2% (95% CI, 69.6%-90.9%) and 84.8% (95% CI, 75.2%-94.5%), respectively, overall and 87.5% (95% CI, 68.3%-100%) and 87.1% (95% CI, 67.6%-100%), respectively, for the 16 patients with N1M0 disease. Among patients presenting with metastases, 2 of 8 patients (2 of 5 patients with RMC) were alive (1 with disease) at the time of last follow-up, including 1 patient who was lost to follow-up (succinate dehydrogenase deficiency). The predominant RCC subtypes associated with mortality were tRCC and RMC. CONCLUSIONS Favorable short-term outcomes can be achieved without adjuvant therapy in children and adolescents with completely resected RCC, independent of lymph node status. A prospective study of patients with tRCC and RMC with M1 or recurrent disease is needed to optimize treatment.
Collapse
Affiliation(s)
- James I Geller
- Division of Pediatric Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Nicholas G Cost
- Division of Urology, Department of Surgery, University of Colorado School of Medicine, the Children's Hospital Colorado, Aurora, Colorado
| | - Yueh-Yun Chi
- Department of Biostatistics, Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, Florida
| | - Brett Tornwall
- Department of Biostatistics, Children's Oncology Group Statistics and Data Center, University of Florida, Gainesville, Florida
| | - Mariana Cajaiba
- Department of Pathology, Anne and Robert H. Lurie Children's Hospital, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Elizabeth J Perlman
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Yeonil Kim
- Biostatistics and Research Decision Sciences, Merck Research Laboratories, Merck & Company Inc, Rahway, New Jersey
| | - Elizabeth A Mullen
- Department of Pediatric Oncology, Dana-Farber Cancer Institute/Boston Children's Hospital, Boston, Massachusetts
| | - Richard D Glick
- Division of Pediatric Surgery, Steven and Alexandra Cohen Medical Center of New York, New York, New York
| | - Geetika Khanna
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Najat C Daw
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Peter Ehrlich
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Conrad V Fernandez
- Division of Pediatric Oncology, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey S Dome
- Division of Pediatric Oncology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | | |
Collapse
|
16
|
Ehrlich PF, Chi YY, Chintagumpala MM, Hoffer FA, Perlman EJ, Kalapurakal JA, Tornwall B, Warwick A, Shamberger RC, Khanna G, Hamilton TE, Gow KW, Paulino AC, Gratias EJ, Mullen EA, Geller JI, Grundy PE, Fernandez CV, Dome JS. Results of Treatment for Patients With Multicentric or Bilaterally Predisposed Unilateral Wilms Tumor (AREN0534): A report from the Children's Oncology Group. Cancer 2020; 126:3516-3525. [PMID: 32459384 DOI: 10.1002/cncr.32958] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/30/2020] [Accepted: 04/18/2020] [Indexed: 01/12/2023]
Abstract
BACKGROUND A primary objective of Children's Oncology Group study AREN0534 (Treatment for Patients With Multicentric or Bilaterally Predisposed, Unilateral Wilms Tumor) was to facilitate partial nephrectomy in 25% of children with bilaterally predisposed unilateral tumors (Wilms tumor/aniridia/genitourinary anomalies/range of developmental delays [WAGR] syndrome; and multifocal and overgrowth syndromes). The purpose of this prospective study was to achieve excellent event-free survival (EFS) and overall survival (OS) while preserving renal tissue through preoperative chemotherapy, completing definitive surgery by 12 weeks from diagnosis, and modifying postoperative chemotherapy based on histologic response. METHODS The treating institution identified whether a predisposition syndrome existed. Patients underwent a central review of imaging studies through the biology and classification study AREN03B2 and then were eligible to enroll on AREN0534. Patients were treated with induction chemotherapy determined by localized or metastatic disease on imaging (and histology if a biopsy had been undertaken). Surgery was based on radiographic response at 6 or 12 weeks. Further chemotherapy was determined by histology. Patients who had stage III or IV disease with favorable histology received radiotherapy as well as those who had stage I through IV anaplasia. RESULTS In total, 34 patients were evaluable, including 13 males and 21 females with a mean age at diagnosis of 2.79 years (range, 0.49-8.78 years). The median follow-up was 4.49 years (range, 1.67-8.01 years). The underlying diagnosis included Beckwith-Wiedemann syndrome in 9 patients, hemihypertrophy in 9 patients, multicentric tumors in 10 patients, WAGR syndrome in 2 patients, a solitary kidney in 2 patients, Denys-Drash syndrome in 1 patient, and Simpson-Golabi-Behmel syndrome in 1 patient. The 4-year EFS and OS rates were 94% (95% CI, 85.2%-100%) and 100%, respectively. Two patients relapsed (1 tumor bed, 1 abdomen), and none had disease progression during induction. According to Response Evaluation Criteria in Solid Tumor 1.1 criteria, radiographic responses included a complete response in 2 patients, a partial response in 21 patients, stable disease in 11 patients, and progressive disease in 0 patients. Posttherapy histologic classification was low-risk in 13 patients (including the 2 complete responders), intermediate-risk in 15 patients, and high-risk in 6 patients (1 focal anaplasia and 5 blastemal subtype). Prenephrectomy chemotherapy facilitated renal preservation in 22 of 34 patients (65%). CONCLUSIONS A standardized approach of preoperative chemotherapy, surgical resection within 12 weeks, and histology-based postoperative chemotherapy results in excellent EFS, OS, and preservation of renal parenchyma.
Collapse
Affiliation(s)
- Peter F Ehrlich
- Section of Pediatric Surgery, CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA
| | - Yueh-Yun Chi
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Murali M Chintagumpala
- Department of Pediatrics and Oncology, Texas Children's Hospital Cancer Center at Baylor College of Medicine, Houston, Texas, USA
| | - Fredric A Hoffer
- Department of Radiology, Fred Hutchison Cancer Center, University of Washington, Seattle, Washington, USA
| | - Elizabeth J Perlman
- Division of Pediatrics and Oncology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois, USA
| | - John A Kalapurakal
- Department of Radiation Oncology, Northwestern Memorial Hospital, Northwestern University, Chicago, Illinois, USA
| | - Brett Tornwall
- Department of Biostatistics, University of Florida, Gainesville, Florida, USA
| | - Anne Warwick
- Department of Oncology, Walter Reed National Military Medical Center, Washington, District of Columbia, USA
| | - Robert C Shamberger
- Department of Pediatric Surgery, Boston Children's Hospital and Dana Farber Cancer Center, Boston, Massachusetts, USA
| | - Geetika Khanna
- Department of Pediatric Radiology, Washington University of St Louis, St Louis, Missouri, USA
| | - Thomas E Hamilton
- Department of Pediatric Surgery, Boston Children's Hospital and Dana Farber Cancer Center, Boston, Massachusetts, USA
| | - Kenneth W Gow
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Eric J Gratias
- Children's Oncology Group, Philadelphia, Pennsylvania, USA
| | - Elizabeth A Mullen
- Department of Pediatric Surgery, Boston Children's Hospital and Dana Farber Cancer Center, Boston, Massachusetts, USA
| | - James I Geller
- Division of Hematology/Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul E Grundy
- Department of Pediatrics, University of Alberta Children's Hospital, Edmonton, Alberta, Canada
| | - Conrad V Fernandez
- Department of Pediatrics, IWK Children's Hospital, Halifax, Nova Scotia, Canada.,Department of Bioethics, IWK Children's Hospital, Halifax, Nova Scotia, Canada
| | - Jeffrey S Dome
- Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| |
Collapse
|
17
|
Parsons LN, Mullen EA, Geller JI, Chi YY, Khanna G, Glick RD, Aldrink JH, Vallance KL, Kim Y, Fernandez CV, Dome JS, Perlman EJ. Outcome analysis of stage I epithelial-predominant favorable-histology Wilms tumors: A report from Children's Oncology Group study AREN03B2. Cancer 2020; 126:2866-2871. [PMID: 32267967 DOI: 10.1002/cncr.32855] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/17/2019] [Accepted: 12/21/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Stage I epithelial-predominant favorable-histology Wilms tumors (EFHWTs) have long been suspected to have an excellent outcome. This study investigates the clinical and pathologic features of patients with stage I EFHWTs to better evaluate the potential for a reduction of chemotherapy and its associated toxicity. METHODS All patients registered in the Children's Oncology Group (COG) AREN03B2 study between 2006 and 2017 with stage I EFHWTs were identified. EFHWTs were defined as tumors with at least 66% epithelial differentiation, regardless of the degree of differentiation. Clinical information was abstracted from COG records. Event-free survival (EFS) and overall survival (OS) were calculated and compared between groups based on age and therapy. RESULTS The 4-year EFS rate was 96.2% (95% confidence interval, 92%-100%), and the OS rate was 100%; EFS and OS did not statistically significantly differ with the age at diagnosis (<48 vs ≥48 months; P = .37) or treatment (EE4A vs observation only; P = .55). Six events were reported. Three patients developed contralateral tumors and did not otherwise relapse; none of these had nephrogenic rests or a recognized predisposition syndrome. Three patients developed metastatic recurrence; all 3 had received EE4A as their primary therapy after nephrectomy. CONCLUSIONS These findings demonstrate an excellent outcome for stage I EFHWTs with >95% EFS and OS. These data support the utility of investigating the treatment of stage I EFHWTs with observation alone after nephrectomy.
Collapse
Affiliation(s)
- Lauren N Parsons
- Department of Pathology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Elizabeth A Mullen
- Pediatric Hematology/Oncology, Dana Farber Cancer Institute/Boston Children's Hospital, Boston, Massachusetts
| | - James I Geller
- Hematology/Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Yueh-Yun Chi
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Geetika Khanna
- Pediatric Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Richard D Glick
- Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Kelly L Vallance
- Hematology/Oncology, Cook Children's Medical Center, Fort Worth, Texas
| | - Yeonil Kim
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Conrad V Fernandez
- Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Bioethics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey S Dome
- Division of Oncology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Elizabeth J Perlman
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
18
|
Daw NC, Chi YY, Kalapurakal JA, Kim Y, Hoffer FA, Geller JI, Perlman EJ, Ehrlich PF, Mullen EA, Warwick AB, Grundy PE, Paulino AC, Gratias E, Ward D, Anderson JR, Khanna G, Tornwall B, Fernandez CV, Dome JS. Activity of Vincristine and Irinotecan in Diffuse Anaplastic Wilms Tumor and Therapy Outcomes of Stage II to IV Disease: Results of the Children's Oncology Group AREN0321 Study. J Clin Oncol 2020; 38:1558-1568. [PMID: 32134700 DOI: 10.1200/jco.19.01265] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE AREN0321 evaluated the activity of vincristine and irinotecan (VI) in patients with newly diagnosed diffuse anaplastic Wilms tumor (DAWT) and whether a regimen containing carboplatin (regimen UH1) in addition to regimen I agents used in the National Wilms Tumor Study 5 (NWTS-5; vincristine, doxorubicin, cyclophosphamide, and etoposide plus radiotherapy) would improve patient outcomes. PATIENTS AND METHODS Patients with stage II to IV DAWT without measurable disease received regimen UH1. Patients with stage IV measurable disease were eligible to receive VI (vincristine, 1.5 mg/m2 per day intravenously on days 1 and 8; irinotecan, 20 mg/m2 per day intravenously on days 1-5 and 8-12 of a 21-day cycle) in an upfront window; those with complete (CR) or partial response (PR) had VI incorporated into regimen UH1 (regimen UH2). The study was designed to detect improvement in outcomes of patients with stage II to IV DAWT compared with historical controls treated with regimen I. RESULTS Sixty-six eligible patients were enrolled. Of 14 patients with stage IV measurable disease who received VI, 11 (79%) achieved CR (n = 1) or PR (n = 10) after 2 cycles. Doses of doxorubicin, cyclophosphamide, and etoposide were reduced midstudy because of nonhematologic toxicity. Four patients (6%) died as a result of toxicity. Four-year event-free survival, relapse-free survival, and overall survival rates were 67.7% (95% CI, 55.9% to 79.4%), 72.9% (95% CI, 61.5% to 84.4%), and 73.7% (95% CI, 62.7% to 84.8%), respectively, compared with 57.5% (95% CI, 47.6% to 67.4%; P = .26), 57.5% (95% CI, 47.6% to 67.4%; P = .048), and 59.2% (95% CI, 49.4% to 69.0%; P = .08), respectively, in NWTS-5. CONCLUSION VI produced a high response rate in patients with metastatic DAWT. AREN0321 treatment seemed to improve outcomes for patients with stage II to IV DAWT compared with NWTS-5, but with increased toxicity. The UH2 regimen warrants further investigation with modifications to reduce toxicity.
Collapse
Affiliation(s)
- Najat C Daw
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yueh-Yun Chi
- Department of Biostatistics, University of Florida, Gainesville, FL
| | - John A Kalapurakal
- Department of Radiation Oncology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern Memorial Hospital, Chicago, IL
| | - Yeonil Kim
- Department of Biostatistics, University of Florida, Gainesville, FL
| | | | - James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Elizabeth J Perlman
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Peter F Ehrlich
- Department of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Elizabeth A Mullen
- Department of Pediatric Hematology/Oncology, Dana-Farber/Harvard Cancer Center, Dana-Farber Cancer Institute, Boston, MA
| | - Anne B Warwick
- Department of Pediatrics, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, MD
| | - Paul E Grundy
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eric Gratias
- University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN
| | - Deborah Ward
- Department of Pharmaceutical Services, St Jude Children's Research Hospital, Memphis, TN
| | | | - Geetika Khanna
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Brett Tornwall
- Department of Biostatistics, University of Florida, Gainesville, FL
| | - Conrad V Fernandez
- Departments of Pediatrics and Bioethics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jeffrey S Dome
- Division of Oncology, Children's National Medical Center, Center for Cancer and Blood Disorders, George Washington University School of Medicine and Health Sciences, Washington, DC
| | | |
Collapse
|
19
|
Chun HJE, Johann PD, Milne K, Zapatka M, Buellesbach A, Ishaque N, Iskar M, Erkek S, Wei L, Tessier-Cloutier B, Lever J, Titmuss E, Topham JT, Bowlby R, Chuah E, Mungall KL, Ma Y, Mungall AJ, Moore RA, Taylor MD, Gerhard DS, Jones SJM, Korshunov A, Gessler M, Kerl K, Hasselblatt M, Frühwald MC, Perlman EJ, Nelson BH, Pfister SM, Marra MA, Kool M. Identification and Analyses of Extra-Cranial and Cranial Rhabdoid Tumor Molecular Subgroups Reveal Tumors with Cytotoxic T Cell Infiltration. Cell Rep 2019; 29:2338-2354.e7. [PMID: 31708418 PMCID: PMC6905433 DOI: 10.1016/j.celrep.2019.10.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 08/20/2019] [Accepted: 10/02/2019] [Indexed: 11/23/2022] Open
Abstract
Extra-cranial malignant rhabdoid tumors (MRTs) and cranial atypical teratoid RTs (ATRTs) are heterogeneous pediatric cancers driven primarily by SMARCB1 loss. To understand the genome-wide molecular relationships between MRTs and ATRTs, we analyze multi-omics data from 140 MRTs and 161 ATRTs. We detect similarities between the MYC subgroup of ATRTs (ATRT-MYC) and extra-cranial MRTs, including global DNA hypomethylation and overexpression of HOX genes and genes involved in mesenchymal development, distinguishing them from other ATRT subgroups that express neural-like features. We identify five DNA methylation subgroups associated with anatomical sites and SMARCB1 mutation patterns. Groups 1, 3, and 4 exhibit cytotoxic T cell infiltration and expression of immune checkpoint regulators, consistent with a potential role for immunotherapy in rhabdoid tumor patients. Chun et al. report similarities between the MYC subgroup of cranial and extracranial rhabdoid tumors (RTs) at genetic, gene-expression, and epigenetic levels. They identify five DNA methylation subgroups of RTs across multiple organ sites, and some subgroups exhibit increased levels of immune cell infiltration and immune checkpoint expression.
Collapse
Affiliation(s)
- Hye-Jung E Chun
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC V7Z 1L3, Canada
| | - Pascal D Johann
- Hopp Children's Cancer Center, Heidelberg 69120, Germany; Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg 69120, Germany; Department of Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - Katy Milne
- Deeley Research Centre, BC Cancer, Victoria, BC V8R 6V5, Canada
| | - Marc Zapatka
- Department of Molecular Genetics, DKFZ, Heidelberg 69120, Germany
| | - Annette Buellesbach
- Hopp Children's Cancer Center, Heidelberg 69120, Germany; Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg 69120, Germany; Department of Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - Naveed Ishaque
- Center for Digital Health, Berlin Institute of Health and Charité-Universitätsmedizin Berlin, Berlin 10117, Germany; Heidelberg Center for Personalized Oncology, DKFZ, Heidelberg 69120, Germany
| | - Murat Iskar
- Department of Molecular Genetics, DKFZ, Heidelberg 69120, Germany
| | - Serap Erkek
- Hopp Children's Cancer Center, Heidelberg 69120, Germany
| | - Lisa Wei
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC V7Z 1L3, Canada
| | - Basile Tessier-Cloutier
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Jake Lever
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC V7Z 1L3, Canada
| | - Emma Titmuss
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC V7Z 1L3, Canada
| | - James T Topham
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC V7Z 1L3, Canada
| | - Reanne Bowlby
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC V7Z 1L3, Canada
| | - Eric Chuah
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC V7Z 1L3, Canada
| | - Karen L Mungall
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC V7Z 1L3, Canada
| | - Yussanne Ma
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC V7Z 1L3, Canada
| | - Andrew J Mungall
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC V7Z 1L3, Canada
| | - Richard A Moore
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC V7Z 1L3, Canada
| | - Michael D Taylor
- Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Daniela S Gerhard
- Office of Cancer Genomics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Steven J M Jones
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC V7Z 1L3, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | | | - Manfred Gessler
- Theodor-Boveri-Institute/Biocenter, Developmental Biochemistry; and Comprehensive Cancer Center Mainfranken, University of Wuerzburg, Wuerzburg 97074, Germany
| | - Kornelius Kerl
- Department of Pediatric Hematology and Oncology, University Children's Hospital Muenster, Muenster 48149, Germany
| | - Martin Hasselblatt
- Institute of Neuropathology, University Hospital Muenster, Muenster 48149, Germany
| | - Michael C Frühwald
- University Children's Hospital Augsburg, Swabian Children's Cancer Center, Augsburg 86156, Germany
| | - Elizabeth J Perlman
- Department of Pathology and Laboratory Medicine, Lurie Children's Hospital, Northwestern University's Feinberg School of Medicine and Robert H. Lurie Cancer Center, Chicago, IL 60611, USA
| | - Brad H Nelson
- Deeley Research Centre, BC Cancer, Victoria, BC V8R 6V5, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada; Department of Biochemistry and Microbiology, University of Victoria, Victoria, BC V8P 3E6, Canada
| | - Stefan M Pfister
- Hopp Children's Cancer Center, Heidelberg 69120, Germany; Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg 69120, Germany; Department of Pediatric Hematology and Oncology, University Hospital Heidelberg, Heidelberg 69120, Germany
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC V7Z 1L3, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada.
| | - Marcel Kool
- Hopp Children's Cancer Center, Heidelberg 69120, Germany; Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), and German Cancer Consortium (DKTK), Core Center Heidelberg, Heidelberg 69120, Germany.
| |
Collapse
|
20
|
Dix DB, Fernandez CV, Chi YY, Mullen EA, Geller JI, Gratias EJ, Khanna G, Kalapurakal JA, Perlman EJ, Seibel NL, Ehrlich PF, Malogolowkin M, Anderson J, Gastier-Foster J, Shamberger RC, Kim Y, Grundy PE, Dome JS. Augmentation of Therapy for Combined Loss of Heterozygosity 1p and 16q in Favorable Histology Wilms Tumor: A Children's Oncology Group AREN0532 and AREN0533 Study Report. J Clin Oncol 2019; 37:2769-2777. [PMID: 31449468 DOI: 10.1200/jco.18.01972] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE In National Wilms Tumor Study 5 (NWTS-5), tumor-specific combined loss of heterozygosity of chromosomes 1p and 16q (LOH1p/16q) was associated with adverse outcomes in patients with favorable histology Wilms tumor. The AREN0533/AREN0532 studies assessed whether augmenting therapy improved event-free survival (EFS) for these patients. Patients with stage I/II disease received regimen DD4A (vincristine, dactinomycin and doxorubicin) but no radiation therapy. Patients with stage III/IV disease received regimen M (vincristine, dactinomycin, and doxorubicin alternating with cyclophosphamide and etoposide) and radiation therapy. METHODS Patients were enrolled through the AREN03B2 Biology study between October 2006 and October 2013; all underwent central review of pathology, surgical reports, and imaging. Tumors were evaluated for LOH1p/16q by microsatellite testing. EFS and overall survival were compared using the log-rank test between NWTS-5 and current studies. RESULTS LOH1p/16q was detected in 49 of 1,147 evaluable patients with stage I/II disease (4.27%) enrolled in AREN03B2; 32 enrolled in AREN0532. LOH1p/16q was detected in 82 of 1,364 evaluable patients with stage III/IV disease (6.01%) in AREN03B2; 51 enrolled in AREN0533. Median follow-up for 83 eligible patients enrolled in AREN0532/0533 was 5.73 years (range, 2.84 to 9.63 years). The 4-year EFS for patients with stage I/II and stage III/IV disease with LOH1p/16 was 87.3% (95% CI, 75.1% to 99.5%) and 90.2% (95% CI, 81.8% to 98.6%), respectively. These results are improved compared with the NWTS-5 updated 4-year EFS of 68.8% for patients with stage I/II disease (P = .042), and 61.3% for patients with stage III/IV disease (P = .001), with trends toward improved 4-year overall survival. The most common grade 3 or higher nonhematologic toxicities with regimen M were febrile neutropenia (39.2%) and infections (21.6%). CONCLUSION Augmentation of therapy improved EFS for patients with favorable histology Wilms tumor and LOH1p/16q compared with the historical NWTS-5 comparison group, with an expected toxicity profile.
Collapse
Affiliation(s)
- David B Dix
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Elizabeth A Mullen
- Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA
| | - James I Geller
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Eric J Gratias
- University of Tennessee College of Medicine Chattanooga, Chattanooga, TN
| | | | - John A Kalapurakal
- Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | | | | | | | - Marcio Malogolowkin
- University of California at Davis Comprehensive Cancer Center, Sacramento, CA
| | | | - Julie Gastier-Foster
- Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH
| | | | | | - Paul E Grundy
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey S Dome
- Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC
| | | |
Collapse
|
21
|
Seibel NL, Chi YY, Perlman EJ, Tian J, Sun J, Anderson JR, Ritchey ML, Thomas PR, Miser J, Kalapurakal JA, Grundy PE, Green DM. Impact of cyclophosphamide and etoposide on outcome of clear cell sarcoma of the kidney treated on the National Wilms Tumor Study-5 (NWTS-5). Pediatr Blood Cancer 2019; 66:e27450. [PMID: 30255545 PMCID: PMC6249042 DOI: 10.1002/pbc.27450] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/10/2018] [Accepted: 08/11/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE To improve the event-free survival (EFS) and overall survival (OS) for patients with clear cell sarcoma of the kidney (CCSK) by incorporating cyclophosphamide and etoposide into treatment on National Wilms Tumor Study (NWTS)-5. PATIENTS AND METHODS Patients less than 16 years of age with a centrally confirmed pathological diagnosis of CCSK were eligible for treatment on this prospective single-arm study conducted between August 1995 and June 2002. Staging consisted of CT scans of chest, abdomen, pelvis, bone scan, skeletal survey, and CT or MRI of the head. Treatment consisted of vincristine/doxorubicin/cyclophosphamide alternating with cyclophosphamide/etoposide for 24 weeks and radiation to sites of disease. RESULTS One hundred eight eligible patients were enrolled on study (69% males, 63% Caucasian), with a median age of 22 months. Stage distribution was as follows: stage I, 12; II, 44; III, 45; IV, 7. Median follow-up was 9.7 years. Five-year EFS and OS were 79% (95% CI: 71%-88%) and 90% (95% CI: 84%-96%). Five-year EFS for stage I-IV was 100%, 88%, 73%, and 29%, respectively. Twenty of the 23 disease-related events occurred within three years of initial treatment. The most common site of recurrence was brain (12/23). CONCLUSION The outcome for patients with CCSK treated on NWTS-5 was similar to NWTS-4 and accomplished over a shorter treatment duration. Stage was highly predictive of outcome. Brain metastases occurred more frequently than on NWTS-4. Regimen I showed more benefit for patients with stage I and II disease as compared with higher stages of disease where new therapies are needed.
Collapse
Affiliation(s)
- Nita L. Seibel
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD; George Washington University School of Medicine and Health Science, Washington, DC
| | - Yueh-Yun Chi
- Department of Biostatistics, University of Florida, Gainesville, FL
| | | | - Jing Tian
- Department of Biostatistics, University of Florida, Gainesville, FL
| | - Junfeng Sun
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD
| | | | | | | | - James Miser
- City of Hope National Medical Center, Duarte, CA
| | - John A Kalapurakal
- Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
| | - Paul E. Grundy
- Department of Pediatrics and Oncology, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel M. Green
- Department of Epidemiology and Cancer Control, St Jude Children’s Research Hospital, Memphis, TN
| |
Collapse
|
22
|
Armstrong AE, Gadd S, Huff V, Gerhard DS, Dome JS, Perlman EJ. A unique subset of low-risk Wilms tumors is characterized by loss of function of TRIM28 (KAP1), a gene critical in early renal development: A Children's Oncology Group study. PLoS One 2018; 13:e0208936. [PMID: 30543698 PMCID: PMC6292605 DOI: 10.1371/journal.pone.0208936] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 11/26/2018] [Indexed: 12/19/2022] Open
Abstract
This study explores the genomic alterations that contribute to the formation of a unique subset of low-risk, epithelial differentiated, favorable histology Wilms tumors (WT), tumors that have been characterized by their expression of post-induction renal developmental genes (Subset 1 WT). We demonstrate copy neutral loss of heterozygosity involving 19q13.32-q13.43, unaccompanied by evidence for imprinting by DNA methylation. We further identified loss-of-function somatic mutations in TRIM28 (also known as KAP1), located at 19q13, in 8/9 Subset 1 tumors analyzed. An additional germline TRIM28 mutation was identified in one patient. Retrospective evaluation of previously analyzed WT outside of Subset 1 identified an additional tumor with anaplasia and both TRIM28 and TP53 mutations. A major function of TRIM28 is the repression of endogenous retroviruses early in development. We depleted TRIM28 in HEK293 cells, which resulted in increased expression of endogenous retroviruses, a finding also demonstrated in TRIM28-mutant WT. TRIM28 has been shown by others to be active during early renal development, and to interact with WTX, another gene recurrently mutated in WT. Our findings suggest that inactivation of TRIM28 early in renal development contributes to the formation of this unique subset of FHWTs, although the precise manner in which TRIM28 impacts both normal renal development and oncogenesis remains elusive.
Collapse
Affiliation(s)
- Amy E. Armstrong
- Division of Hematology-Oncology and Transplantation, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University’s Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Samantha Gadd
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University’s Feinberg School of Medicine and Robert H. Lurie Cancer Center, Chicago, Illinois, United States of America
| | - Vicki Huff
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Daniela S. Gerhard
- Office of Cancer Genomics, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Jeffrey S. Dome
- Division of Pediatric Hematology/Oncology, Children's National Medical Center, Washington, District of Columbia, United States of America
| | - Elizabeth J. Perlman
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University’s Feinberg School of Medicine and Robert H. Lurie Cancer Center, Chicago, Illinois, United States of America
- * E-mail:
| |
Collapse
|
23
|
Cajaiba MM, Dyer LM, Geller JI, Jennings LJ, George D, Kirschmann D, Rohan SM, Cost NG, Khanna G, Mullen EA, Dome JS, Fernandez CV, Perlman EJ. The classification of pediatric and young adult renal cell carcinomas registered on the children's oncology group (COG) protocol AREN03B2 after focused genetic testing. Cancer 2018; 124:3381-3389. [PMID: 29905933 DOI: 10.1002/cncr.31578] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/30/2018] [Accepted: 05/07/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Renal cell carcinomas (RCCs) are rare in young patients. Knowledge of their pathologic and molecular spectrum remains limited, and no prospective studies have been performed to date in this population. This study analyzes patients diagnosed with RCC who were prospectively enrolled in the AREN03B2 Children's Oncology Group (COG). The objective was to classify these tumors with the aid of focused genetic testing and to characterize their features. METHODS All tumors registered as RCC by central review were retrospectively re-reviewed and underwent additional ancillary studies. Tumors were classified according to the 2016 World Health Organization classification system when possible. RESULTS In total, 212 tumors were identified, and these were classified as microphthalmia transcription factor (MiT) translocation RCC (MiT-RCC) (41.5%), papillary RCC (16.5%), renal medullary carcinoma (12.3%), chromophobe RCC (6.6%), clear cell RCC (3.3%), fumarate hydratase-deficient RCC (1.4%), and succinate dehydrogenase-deficient RCC (0.5%). Other subtypes included tuberous sclerosis-associated RCC (4.2%), anaplastic lymphoma kinase (ALK)-rearranged RCC (3.8%), thyroid-like RCC (1.4%), myoepithelial carcinoma (0.9%), and unclassified (7.5%). MiT-RCCs were classified as either transcription factor E3 (TFE3) (93.2%) or EB (TFEB) (6.8%) translocations, and characterization of fusion partners was possible in most tumors. CONCLUSIONS The current study delineates the frequency of distinct RCC subtypes in a large prospective series of young patients and contributes knowledge to the diagnostic, clinical, and genetic features of MiT-RCC, the most common subtype among this age group. The identification of rare subtypes expands the spectrum of RCC in young patients, supporting the need for a thorough diagnostic workup. These studies may aid in the introduction of specific therapies for different RCC subtypes in the future. Cancer 2018. © 2018 American Cancer Society.
Collapse
Affiliation(s)
- Mariana M Cajaiba
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago,`, Chicago, Illinois
| | - Lisa M Dyer
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James I Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lawrence J Jennings
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago,`, Chicago, Illinois
| | - David George
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago,`, Chicago, Illinois
| | - Dawn Kirschmann
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago,`, Chicago, Illinois
| | - Stephen M Rohan
- Department of Pathology, Colorado Pathology Consultants, Denver, Colorado
| | - Nicholas G Cost
- Department of Surgery, University of Colorado, Denver, Colorado
| | - Geetika Khanna
- Department of Radiology, Washington University School of Medicine, St Louis, Missouri
| | - Elizabeth A Mullen
- Department of Pediatric Oncology, Children's Hospital, Boston, Massachusetts
| | - Jeffrey S Dome
- Division of Oncology, Children's National Medical Center, Washington, District of Columbia
| | | | - Elizabeth J Perlman
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago,`, Chicago, Illinois
| |
Collapse
|
24
|
Fernandez CV, Perlman EJ, Gastier-Foster J, Geller JI, Mullen EA, Ehrlich PF, Dome JS. Reply to B. Zhang et al. J Clin Oncol 2018; 36:1454-1455. [PMID: 29613833 DOI: 10.1200/jco.2018.78.0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Conrad V Fernandez
- Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Julie Gastier-Foster, Nationwide Children's Hospital, Columbus, OH; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC
| | - Elizabeth J Perlman
- Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Julie Gastier-Foster, Nationwide Children's Hospital, Columbus, OH; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC
| | - Julie Gastier-Foster
- Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Julie Gastier-Foster, Nationwide Children's Hospital, Columbus, OH; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC
| | - James I Geller
- Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Julie Gastier-Foster, Nationwide Children's Hospital, Columbus, OH; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC
| | - Elizabeth A Mullen
- Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Julie Gastier-Foster, Nationwide Children's Hospital, Columbus, OH; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC
| | - Peter F Ehrlich
- Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Julie Gastier-Foster, Nationwide Children's Hospital, Columbus, OH; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC
| | - Jeffrey S Dome
- Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Julie Gastier-Foster, Nationwide Children's Hospital, Columbus, OH; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC
| |
Collapse
|
25
|
Dix DB, Seibel NL, Chi YY, Khanna G, Gratias E, Anderson JR, Mullen EA, Geller JI, Kalapurakal JA, Paulino AC, Perlman EJ, Ehrlich PF, Malogolowkin M, Gastier-Foster JM, Wagner E, Grundy PE, Fernandez CV, Dome JS. Treatment of Stage IV Favorable Histology Wilms Tumor With Lung Metastases: A Report From the Children's Oncology Group AREN0533 Study. J Clin Oncol 2018; 36:1564-1570. [PMID: 29659330 DOI: 10.1200/jco.2017.77.1931] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose The National Wilms Tumor Study (NWTS) treatment of favorable histology Wilms tumor with lung metastases was vincristine/dactinomycin/doxorubicin (DD4A) and lung radiation therapy (RT). The AREN0533 study applied a new risk stratification and treatment strategy to improve event-free survival (EFS) while reducing exposure to lung RT. Methods Patients with favorable histology Wilms tumor and isolated lung metastases showing complete lung nodule response (CR) after 6 weeks of DD4A continued receiving chemotherapy without lung RT. Patients with incomplete response (IR) or loss of heterozygosity at chromosomes 1p/16q received lung RT and four cycles of cyclophosphamide/etoposide in addition to DD4A drugs (Regimen M). AREN0533 was designed to preserve a 4-year EFS of 85% for lung nodule CR and improve 4-year EFS from 75% to 85% for lung nodule IR. Results Among 292 assessable patients, 133 had CR and 159 had IR. For patients with CR, 4-year EFS and overall survival (OS) estimates were 79.5% (95% CI, 71.2% to 87.8%) and 96.1% (95% CI, 92.1% to 100%), respectively. Expected versus observed event rates were 15% and 20.2% ( P = .052), respectively. For patients with IR, 4-year EFS and OS estimates were 88.5% (95% CI, 81.8% to 95.3%) and 95.4% (95% CI, 90.9% to 99.8%), respectively. Expected versus observed event rates were 25% and 12.2% ( P < .001), respectively. Overall, 4-year EFS and OS were 85.4% (95% CI, 80.5% to 90.2%) and 95.6% (95% CI, 92.8% to 98.4%) compared with 72.5% (95% CI, 66.9% to 78.1%; P < .001) and 84.0% (95% CI, 79.4% to 88.6%; P < .001), respectively, in the predecessor NWTS-5 study. Conclusion Excellent OS was achieved after omission of primary lung RT in patients with lung nodule CR, although there were more events than expected. EFS was significantly improved, with excellent OS, in patients with lung nodule IR using four cycles of cyclophosphamide/etoposide in addition to DD4A drugs. The overall AREN0533 treatment strategy yielded EFS and OS estimates that were superior to previous studies.
Collapse
Affiliation(s)
- David B Dix
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Nita L Seibel
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Yueh-Yun Chi
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Geetika Khanna
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Eric Gratias
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - James R Anderson
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Elizabeth A Mullen
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - James I Geller
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - John A Kalapurakal
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Arnold C Paulino
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Elizabeth J Perlman
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Peter F Ehrlich
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Marcio Malogolowkin
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Julie M Gastier-Foster
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Elizabeth Wagner
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Paul E Grundy
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Conrad V Fernandez
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| | - Jeffrey S Dome
- David B. Dix, British Columbia Children's Hospital, Vancouver, British Columbia; Paul E. Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University, Halifax, Nova Scotia, Canada; Nita L. Seibel, National Cancer Institute, Bethesda, MD; Yueh-Yun Chi, University of Florida, Gainesville, FL; Geetika Khanna, Washington University School of Medicine, St Louis, MO; Eric Gratias, University of Tennessee College of Medicine Chattanooga, Chattanooga, TN; James R. Anderson, Merck Research Laboratories, North Wales, PA; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA; James I. Geller, Cincinnati Children's Hospital Medical Center, Cincinnati; Julie M. Gastier-Foster and Elizabeth Wagner, Nationwide Children's Hospital; Julie M. Gastier-Foster, The Ohio State University College of Medicine, Columbus, OH; John A. Kalapurakal, Lurie Comprehensive Cancer Centre of Northwestern University; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago, IL; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Marcio Malogolowkin, University of California at Davis Comprehensive Cancer Center, Sacramento, CA; Jeffrey S. Dome, George Washington University School of Medicine and Health Sciences, Washington, DC; on behalf of the AREN0533 Study Committee
| |
Collapse
|
26
|
Gooskens SL, Klasson TD, Gremmels H, Logister I, Pieters R, Perlman EJ, Giles RH, van den Heuvel-Eibrink MM. TCF21 hypermethylation regulates renal tumor cell clonogenic proliferation and migration. Mol Oncol 2017; 12:166-179. [PMID: 29080283 PMCID: PMC5792742 DOI: 10.1002/1878-0261.12149] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 09/12/2017] [Accepted: 10/07/2017] [Indexed: 01/06/2023] Open
Abstract
We recently identified hypermethylation at the gene promoter of transcription factor 21 (TCF21) in clear cell sarcoma of the kidney (CCSK), a rare pediatric renal tumor. TCF21 is a transcription factor involved in tubular epithelial development of the kidney and is a candidate tumor suppressor. As there are no in vitro models of CCSK, we employed a well-established clear cell renal cell carcinoma (ccRCC) cell line, 786-O, which also manifests high methylation at the TCF21 promoter, with consequent low TCF21 expression. The tumor suppressor function of TCF21 has not been functionally addressed in ccRCC cells; we aimed to explore the functional potential of TCF21 expression in ccRCC cells in vitro. 786-O clones stably transfected with either pBABE-TCF21-HA construct or pBABE vector alone were functionally analyzed. We found that ectopic expression of TCF21 in 786-O cells results in a trend toward decreased cell proliferation (not significant) and significantly decreased migration compared with mock-transfected 786-O cells. Although the number of colonies established in colony formation assays was not different between 786-O clones, colony size was significantly reduced in 786-O cells expressing TCF21. To investigate whether the changes in migration were due to epithelial-to-mesenchymal transition changes, we interrogated the expression of selected epithelial and mesenchymal markers. Although we observed upregulation of mRNA and protein levels of epithelial marker E-cadherin in clones overexpressing TCF21, this did not result in surface expression of E-cadherin as measured by fluorescence-activated cell sorting and immunofluorescence. Furthermore, mRNA expression of the mesenchymal markers vimentin (VIM) and SNAI1 was not significantly decreased in TCF21-expressing 786-O cells, while protein levels of VIM were markedly decreased. We conclude that re-expression of TCF21 in renal cancer cells that have silenced their endogenous TCF21 locus through hypermethylation results in reduced clonogenic proliferation, reduced migration, and reduced mesenchymal-like characteristics, suggesting a tumor suppressor function for transcription factor 21.
Collapse
Affiliation(s)
- Saskia L Gooskens
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands.,Department of Pediatric Hematology and Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Timothy D Klasson
- Department of Nephrology and Hypertension, University Medical Center Utrecht, University of Utrecht, The Netherlands
| | - Hendrik Gremmels
- Department of Nephrology and Hypertension, University Medical Center Utrecht, University of Utrecht, The Netherlands
| | - Ive Logister
- Department of Nephrology and Hypertension, University Medical Center Utrecht, University of Utrecht, The Netherlands
| | - Robert Pieters
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Elizabeth J Perlman
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine and Robert H. Lurie Cancer Center, IL, USA
| | - Rachel H Giles
- Department of Nephrology and Hypertension, University Medical Center Utrecht, University of Utrecht, The Netherlands
| | | |
Collapse
|
27
|
Fernandez CV, Mullen EA, Chi YY, Ehrlich PF, Perlman EJ, Kalapurakal JA, Khanna G, Paulino AC, Hamilton TE, Gow KW, Tochner Z, Hoffer FA, Withycombe JS, Shamberger RC, Kim Y, Geller JI, Anderson JR, Grundy PE, Dome JS. Outcome and Prognostic Factors in Stage III Favorable-Histology Wilms Tumor: A Report From the Children's Oncology Group Study AREN0532. J Clin Oncol 2017; 36:254-261. [PMID: 29211618 DOI: 10.1200/jco.2017.73.7999] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background The National Wilms Tumor Study (NWTS) approach to treating stage III favorable-histology Wilms tumor (FHWT) is Regimen DD4A (vincristine, dactinomycin, and doxorubicin) and radiation therapy. Further risk stratification is required to improve outcomes and reduce late effects. We evaluated clinical and biologic variables for patients with stage III FHWT without combined loss of heterozygosity (LOH) at chromosomes 1p and 16q treated in the Children's Oncology Group protocol AREN0532. Methods From October 2006 to August 2013, 588 prospectively treated, centrally reviewed patients with stage III FHWT were treated with Regimen DD4A and radiation therapy. Tumor LOH at 1p and 16q was determined by microsatellite analysis. Ineligible patients (n = 5) and those with combined LOH 1p/16q (n = 40) were excluded. Results A total of 535 patients with stage III disease were studied. Median follow-up was 5.2 years (range, 0.2 to 9.5). Four-year event-free survival (EFS) and overall survival estimates were 88% (95% CI, 85% to 91%) and 97% (95% CI, 95% to 99%), respectively. A total of 58 of 66 relapses occurred in the first 2 years, predominantly pulmonary (n = 36). Eighteen patients died, 14 secondary to disease. A better EFS was associated with negative lymph node status ( P < .01) and absence of LOH 1p or 16q ( P < .01), but not with gross residual disease or peritoneal implants. In contrast, the 4-year EFS was only 74% in patients with combined positive lymph node status and LOH 1p or 16q. A total of 123 patients (23%) had delayed nephrectomy. Submitted delayed nephrectomy histology showed anaplasia (n = 8; excluded from survival analysis); low risk/completely necrotic (n = 7; zero relapses), intermediate risk (n = 63; six relapses), and high-risk/blastemal type (n=7; five relapses). Conclusion Most patients with stage III FHWT had good EFS/overall survival with DD4A and radiation therapy. Combined lymph node and LOH status was highly predictive of EFS and should be considered as a potential prognostic marker for future trials.
Collapse
Affiliation(s)
- Conrad V Fernandez
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Elizabeth A Mullen
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Yueh-Yun Chi
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Peter F Ehrlich
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Elizabeth J Perlman
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - John A Kalapurakal
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Geetika Khanna
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Arnold C Paulino
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Thomas E Hamilton
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Kenneth W Gow
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Zelig Tochner
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Fredric A Hoffer
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Janice S Withycombe
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Robert C Shamberger
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Yeonil Kim
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - James I Geller
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - James R Anderson
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Paul E Grundy
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| | - Jeffrey S Dome
- Conrad V. Fernandez, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia; Paul E. Grundy, University of Alberta, Edmonton, Alberta, Canada; Elizabeth A. Mullen, Dana-Farber/Boston Children's Cancer and Blood Disorders Centre, Boston; Thomas E. Hamilton and Robert C. Shamberger, Boston Children's Hospital, Boston, MA; Yueh-Yun Chi and Yeonil Kim, University of Florida, Gainesville, FL; Peter F. Ehrlich, University of Michigan, Ann Arbor, MI; Elizabeth J. Perlman, Ann and Robert H. Lurie Children's Hospital, Chicago; John A. Kalapurakal, Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL; Geetika Khanna, Washington University School of Medicine in St Louis, St Louis, MO; Arnold C. Paulino, MD Anderson Cancer Center, Houston, TX; Kenneth W. Gow, Seattle Children's Hospital, Seattle, WA; Zelig Tochner, University of Pennsylvania, Philadelphia; James R. Anderson, Merck Research Laboratories-Oncology, North Wales, PA; Fredric A. Hoffer, Imaging & Radiation Oncology Core Group in Rhode Island, Lincoln, RI; Janice S. Withycombe, Children's Healthcare of Atlanta, Emory University, Atlanta, GA; James I. Geller, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH; and Jeffrey S. Dome, Children's National Medical Center, Washington, DC, for the Children's Oncology Group AREN0532 Committee
| |
Collapse
|
28
|
Sandberg JK, Mullen EA, Cajaiba MM, Smith EA, Servaes S, Perlman EJ, Geller JI, Ehrlich PF, Cost NG, Dome JS, Fernandez CV, Khanna G. Imaging of renal medullary carcinoma in children and young adults: a report from the Children's Oncology Group. Pediatr Radiol 2017; 47:1615-1621. [PMID: 28689245 PMCID: PMC5768308 DOI: 10.1007/s00247-017-3926-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/25/2017] [Accepted: 06/09/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Renal medullary carcinoma is a rare renal malignancy of childhood. There are no large series describing the imaging appearance of renal medullary carcinoma in children. OBJECTIVE To characterize the clinical and imaging features of pediatric renal medullary carcinoma at initial presentation. MATERIALS AND METHODS We retrospectively analyzed images of 25 pediatric patients with renal medullary carcinoma enrolled in the Children's Oncology Group renal tumors classification, biology and banking study (AREN03B2) from March 2006 to August 2016. Imaging findings of the primary mass, and patterns of locoregional and distant spread were evaluated in correlation with pathological and surgical findings. RESULTS Median age at presentation was 13 years (range: 6-21 years), with a male predominance (3.2:1). The overall stage of disease at initial presentation was stage 1 in 1, stage 2 in 2 and stage 4 in 22. Maximum diameter of the primary renal mass ranged from 1.6 to 10.3 cm (mean: 6.6 cm) with a slight right side predilection (1.5:1). Enlarged (>1 cm short axis) retroperitoneal lymph nodes were identified at initial staging in 20/25 (80%) cases, 10 of which were histologically confirmed while the others did not undergo surgical sampling. Enlarged lymph nodes were also identified in the mediastinum (14/25; 56%) and supraclavicular regions (4/25; 16%). Metastatic disease was present in the lungs in 19/25 (76%) and liver in 6/25 (24%). The pattern of lung metastases was pulmonary lymphangitic carcinomatosis: 10 cases (9 bilateral, 1 unilateral), pulmonary nodules with indistinct margins: 6 cases, pulmonary nodules with distinct margins: 2 cases, while 1 case had pulmonary nodules with both indistinct and distinct margins. Pulmonary lymphangitic carcinomatosis was pathologically confirmed in 4/10 cases. All cases with pulmonary lymphangitic carcinomatosis had associated enlarged mediastinal lymph nodes. CONCLUSION Renal medullary carcinoma in children and young adults presents at an advanced local and distant stage in the majority of patients. The diagnosis of renal medullary carcinoma should be considered when a child or young adult presents with a poorly defined/infiltrative, centrally located renal mass, especially in the setting of known sickle cell hemoglobinopathy. Distant metastases are common at initial presentation in the lungs, distant lymph nodes and liver and often involve multiple sites simultaneously. Pulmonary lymphangitic carcinomatosis, a distinctive and uncommon form of lung metastasis in children, is common in this patient population.
Collapse
Affiliation(s)
- Jesse K. Sandberg
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO
| | - Elizabeth A. Mullen
- Department of Pediatric Oncology, Children’s Hospital Boston/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Mariana M. Cajaiba
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ethan A. Smith
- Section of Pediatric Radiology, Department of Radiology, C.S. Mott Children’s Hospital, University of Michigan Health System, Ann Arbor, MI
| | - Sabah Servaes
- Department of Radiology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Elizabeth J. Perlman
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James I. Geller
- Division of Pediatric Oncology, Cincinnati, Children’s Hospital Medical Center, University of Cincinnati, Ohio
| | - Peter F. Ehrlich
- Section of Pediatric Surgery, Department of Surgery, CS Mott Children’s Hospital, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Nicholas G. Cost
- Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeffrey S. Dome
- Division of Pediatric Oncology, Children’s National Medical Center, Washington, DC
| | | | - Geetika Khanna
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway, Campus Box 8131, St. Louis, MO, 63110, USA.
| |
Collapse
|
29
|
Gadd S, Huff V, Walz AL, Ooms AHAG, Armstrong AE, Gerhard DS, Smith MA, Auvil JMG, Meerzaman D, Chen QR, Hsu CH, Yan C, Nguyen C, Hu Y, Hermida LC, Davidsen T, Gesuwan P, Ma Y, Zong Z, Mungall AJ, Moore RA, Marra MA, Dome JS, Mullighan CG, Ma J, Wheeler DA, Hampton OA, Ross N, Gastier-Foster JM, Arold ST, Perlman EJ. A Children's Oncology Group and TARGET initiative exploring the genetic landscape of Wilms tumor. Nat Genet 2017; 49:1487-1494. [PMID: 28825729 PMCID: PMC5712232 DOI: 10.1038/ng.3940] [Citation(s) in RCA: 209] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 07/28/2017] [Indexed: 12/12/2022]
Abstract
Genome-wide sequencing, mRNA and miRNA expression, DNA copy number and methylation analyses were performed on 117 Wilms tumors, followed by targeted sequencing of 651 Wilms tumors. In addition to genes previously implicated in Wilms tumors (WT1, CTNNB1, FAM123B, DROSHA, DGCR8, XPO5, DICER1, SIX1, SIX2, MLLT1, MYCN, and TP53), mutations were identified in genes not previously recognized as recurrently involved in Wilms tumors, the most frequent being BCOR, BCORL1, NONO, MAX, COL6A3, ASXL1, MAP3K4, and ARID1A. DNA copy number changes resulted in recurrent 1q gain, MYCN amplification, LIN28B gain, and let-7a loss. Unexpected germline variants involved PALB2 and CHEK2. Integrated analyses support two major classes of genetic changes that preserve the progenitor state and/or interrupt normal development.
Collapse
Affiliation(s)
- Samantha Gadd
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine and Robert H. Lurie Cancer Center, Chicago, Illinois, USA
| | - Vicki Huff
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy L Walz
- Division of Hematology-Oncology and Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ariadne H A G Ooms
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine and Robert H. Lurie Cancer Center, Chicago, Illinois, USA.,Department of Pathology, Princess Maxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Amy E Armstrong
- Division of Hematology-Oncology and Transplantation, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniela S Gerhard
- Office of Cancer Genomics, National Cancer Institute, Bethesda, Maryland, USA
| | - Malcolm A Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Daoud Meerzaman
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland, USA
| | - Qing-Rong Chen
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland, USA
| | - Chih Hao Hsu
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland, USA
| | - Chunhua Yan
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland, USA
| | - Cu Nguyen
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland, USA
| | - Ying Hu
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland, USA
| | - Leandro C Hermida
- Office of Cancer Genomics, National Cancer Institute, Bethesda, Maryland, USA
| | - Tanja Davidsen
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, Maryland, USA
| | - Patee Gesuwan
- Office of Cancer Genomics, National Cancer Institute, Bethesda, Maryland, USA
| | - 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
| | - Jeffrey S Dome
- Division of Pediatric Hematology/Oncology, Children's National Medical Center, Washington DC, USA
| | - Charles G Mullighan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Jing Ma
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - David A Wheeler
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Oliver A Hampton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Nicole Ross
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Julie M Gastier-Foster
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Stefan T Arold
- Computational Bioscience Research Center, Division of Biological and Environmental Sciences and Engineering, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia
| | - Elizabeth J Perlman
- Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine and Robert H. Lurie Cancer Center, Chicago, Illinois, USA
| |
Collapse
|
30
|
Cajaiba MM, North PE, Gong S, Dickman PS, Mroczek-Musulman E, Sauer DA, Perlman EJ. Congenital capillary proliferation of the kidney: a distinctive renal vascular lesion of childhood. Hum Pathol 2017; 66:59-66. [DOI: 10.1016/j.humpath.2017.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/03/2017] [Accepted: 05/10/2017] [Indexed: 11/30/2022]
|
31
|
Marsden L, Jennings LJ, Gadd S, Yu M, Perlman EJ, Cajaiba MM. BRAF exon 15 mutations in pediatric renal stromal tumors: prevalence in metanephric stromal tumors. Hum Pathol 2017; 60:32-36. [DOI: 10.1016/j.humpath.2016.09.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 08/16/2016] [Accepted: 09/14/2016] [Indexed: 11/28/2022]
|
32
|
Ehrlich PF, Hamilton TE, Gow K, Barnhart D, Ferrer F, Kandel J, Glick R, Dasgupta R, Naranjo A, He Y, Perlman EJ, Kalapurakal JA, Khanna G, Dome JS, Geller J, Mullen E. Surgical protocol violations in children with renal tumors provides an opportunity to improve pediatric cancer care: a report from the Children's Oncology Group. Pediatr Blood Cancer 2016; 63:1905-10. [PMID: 27229358 PMCID: PMC5030129 DOI: 10.1002/pbc.26083] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 03/31/2016] [Accepted: 04/26/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the frequency and characteristics of surgical protocol violations (SPVs) among children undergoing surgery for renal tumors who were enrolled on the Children's Oncology Group (COG) renal tumor biology and classification study AREN03B2. METHODS AREN03B2 was opened in February 2006, and as on March 31, 2013, there were 3,664 eligible patients. The surgical review forms for 3,536 patients with unilateral disease were centrally reviewed for SPVs. The frequency, type, number of violations, institutional prevalence, and quartiles for SPVs were assessed. RESULTS Of the 3,536 patients, there were a total of 505 with at least one SPV (564 total SPVs reported), for an overall incidence of 14.28%. The types of SPVs included a lack of lymph node sampling in 365 (64.7%), avoidable spill in 61 (10.8%), biopsy immediately before nephrectomy in 89 (15.8%), an incorrect abdominal incision in 32 (5.7%), and unnecessary resection of organs in 17 (3.0%). The SPVs occurred in 163 of 215 participating institutions (75.8%). For centers with at least one SPV, the mean number of SPVs reported was 3.10 ± 2.39 (mean ± standard deviation). The incidence of protocol violation per institution ranged from 0 to 67%. Centers with an average of ≤1 case/year had an incidence of SPVs of 12.2 ± 3.8%, those with an average of >1 to <4 cases/year had an incidence of SPVs of 16.4 ± 3.6%, and those with an average of ≥4 cases/year had an incidence of SPVs of 12.6 ± 5.5% (P > 0.05). CONCLUSIONS SPVs that potentially result in additional exposure to chemotherapy and radiation therapy are not uncommon in children undergoing resection of renal malignancies.
Collapse
Affiliation(s)
| | - Thomas E. Hamilton
- Dana Farber Cancer Institute, Boston Children's Hospital, Boston, MA, USA
| | - Kenneth Gow
- Seattle Children's Hospital, Seattle, WA, USA
| | | | | | - Jessica Kandel
- Comer Children's Hospital University of Chicago, Chicago IL, USA
| | - Richard Glick
- Steven and Alexandra Cohen Medical Center of New York, New York, NY, USA
| | | | - Arlene Naranjo
- Children's Oncology Group (COG) Statistics and Data Center (SDC), University of Florida, Gainesville, FL, USA
| | - Ying He
- Clarkson University, Potsdam NY, USA
| | - Elizabeth J. Perlman
- Luire Children's Hospital Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - John A. Kalapurakal
- Luire Children's Hospital Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | - James Geller
- Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Elizabeth Mullen
- Dana Farber Cancer Institute, Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|
33
|
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 DOI: 10.1158/1078-0432.ccr-16-0985] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [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.
Collapse
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.
| |
Collapse
|
34
|
Gratias EJ, Dome JS, Jennings LJ, Chi YY, Tian J, Anderson J, Grundy P, Mullen EA, Geller JI, Fernandez CV, Perlman EJ. Association of Chromosome 1q Gain With Inferior Survival in Favorable-Histology Wilms Tumor: A Report From the Children's Oncology Group. J Clin Oncol 2016; 34:3189-94. [PMID: 27400937 PMCID: PMC5012705 DOI: 10.1200/jco.2015.66.1140] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The goal of this study was to analyze the association of copy number gain of 1q in favorable-histology Wilms tumors (FHWTs) with event-free survival (EFS) and overall survival (OS) within each tumor stage and with 1p and 16q copy number loss and/or loss of heterozygosity. METHODS Unilateral FHWTs from 1,114 patients enrolled in National Wilms Tumor Study-5 that were informative for 1p and 16q microsatellite markers (previously determined) and informative for 1q gain, 1p loss, and 16q loss using multiplex ligation-dependent probe amplification were analyzed. RESULTS Eight-year EFS was 86% (95% CI, 84% to 88%) for the entire cohort. Of 1,114 patients, 317 tumors (28%) displayed 1q gain. Eight-year EFS was 77% for those with 1q gain and 90% for those lacking 1q gain (P < .001). Eight-year OS was 88% for those with 1q gain and 96% for those lacking 1q gain (P < .001). Within each disease stage, 1q gain was associated with inferior EFS (stage I, 85% v 95%; P = .0052; stage II, 81% v 87%; P = .0775; stage III, 79% v 89%; P = .01; stage IV, 64% v 91%; P = .001). OS was significantly inferior in patients with stage I (P < .0015) and stage IV disease (P = .011). With multivariable analysis, 1q gain was associated with an increased relative risk of relapse of 2.4 (P < .001), whereas 1p loss was not, despite significance on univariable analysis. CONCLUSION Gain of 1q is associated with inferior survival in unilateral FHWTs and may be used to guide risk stratification in future studies.
Collapse
Affiliation(s)
- Eric J Gratias
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Jeffrey S Dome
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Lawrence J Jennings
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Yueh-Yun Chi
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Jing Tian
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - James Anderson
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Paul Grundy
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Elizabeth A Mullen
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - James I Geller
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Conrad V Fernandez
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH
| | - Elizabeth J Perlman
- Eric J. Gratias, University of Tennessee College of Medicine-Chattanooga, Chattanooga, TN; Jeffrey S. Dome, Children's National Health System, Washington, DC; Lawrence J. Jennings and Elizabeth J. Perlman, Northwestern University, Chicago, IL; Yueh-Yun Chi and Jing Tian, University of Florida, Gainesville, FL; James Anderson, University of Nebraska Medical Center, Omaha, NE; Paul Grundy, University of Alberta, Edmonton, Alberta; Conrad V. Fernandez, Dalhousie University and the IWK Health Centre, Halifax, Nova Scotia, Canada; Elizabeth A. Mullen, Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, MA; and James I. Geller, University of Cincinnati, Cincinnati, OH.
| |
Collapse
|
35
|
Scelo G, Hofmann JN, Banks RE, Bigot P, Bhatt RS, Cancel-Tassin G, Chew SK, Creighton CJ, Cussenot O, Davis IJ, Escudier B, Frayling TM, Häggström C, Hildebrandt MAT, Holcatova I, Johansson M, Linehan WM, McDermott DF, Nathanson KL, Ogawa S, Perlman EJ, Purdue MP, Stattin P, Swanton C, Vasudev NS, Wu X, Znaor A, Brennan P, Chanock SJ. International cancer seminars: a focus on kidney cancer. Ann Oncol 2016; 27:1382-5. [PMID: 27130845 PMCID: PMC4959923 DOI: 10.1093/annonc/mdw186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/20/2016] [Indexed: 01/05/2023] Open
Abstract
Recent years have seen important advances in our understanding of the etiology, biology and genetics of kidney cancer. To summarize important achievements and identify prominent research questions that remain, a workshop was organized by IARC and the US NCI. A series of 'difficult questions' were formulated, which should be given future priority in the areas of population, genomic and clinical research.
Collapse
Affiliation(s)
- G Scelo
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - J N Hofmann
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Service, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - R E Banks
- Clinical and Biomedical Proteomics Group, Cancer Research UK Centre, Leeds Institute for Cancer Studies and Pathology, St James' University Hospital, Leeds, UK
| | - P Bigot
- Department of Urology, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - R S Bhatt
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Kidney Cancer Program, Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - G Cancel-Tassin
- Groupe de Recherche GRC-UPMC n°5, Centre de Recherche sur les Pathologies Prostatiques et Urologiques (CeRePP), Paris, France
| | - S K Chew
- Translational Cancer Therapeutics Laboratory, UCL Cancer Institute, University College London, London, UK
| | - C J Creighton
- Duncan Cancer Center-Biostatistics, Baylor College of Medicine, Houston
| | - O Cussenot
- Groupe de Recherche GRC-UPMC n°5, Centre de Recherche sur les Pathologies Prostatiques et Urologiques (CeRePP), Paris, France
| | - I J Davis
- Department of Genetics, UNC School of Medicine, Chapel Hill, USA
| | - B Escudier
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | | | - C Häggström
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå Department of Biobank Research, Umeå University, Umeå, Sweden
| | - M A T Hildebrandt
- Department of Epidemiology, Division of OVP, Cancer Prevention and Population Sciences, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - I Holcatova
- Institute of Public Health and Preventive Medicine, Charles University, 2nd Faculty of Medicine, Prague, Czech Republic
| | - M Johansson
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - W M Linehan
- Urologic Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda
| | - D F McDermott
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Kidney Cancer Program, Dana-Farber/Harvard Cancer Center, Boston, MA, USA
| | - K L Nathanson
- Department of Medicine, University of Pennsylvania, Philadelphia, USA
| | - S Ogawa
- Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - E J Perlman
- Department of Pathology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center, Chicago, USA
| | - M P Purdue
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Service, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - P Stattin
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå
| | - C Swanton
- University College London Hospitals and Cancer Institute, London, UK
| | - N S Vasudev
- Clinical and Biomedical Proteomics Group, Cancer Research UK Centre, Leeds Institute for Cancer Studies and Pathology, St James' University Hospital, Leeds, UK
| | - X Wu
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Znaor
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - P Brennan
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - S J Chanock
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Service, National Cancer Institute, National Institutes of Health, Bethesda, USA
| |
Collapse
|
36
|
Gadd SL, Walz AL, Ooms AHAG, Huff V, Gerhard DS, Smith MA, Guidry Auvil JM, Hermida L, Davidsen T, Gesuwan P, Meerzaman D, Ma Y, Marra MA, Dome JS, Mullighan CG, Wheeler DA, Hampton OA, Gastier-Foster JM, Ross N, Perlman EJ. Abstract LB-180: The genetic landscape of Wilms tumor. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-lb-180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The National Cancer Institute's Therapeutically Applicable Research to Generate Effective Treatments (TARGET) initiative seeks to characterize the genomes of high-risk pediatric tumors to identify therapeutic targets. The High-Risk Renal Tumor TARGET initiative includes the analysis of pre-therapy favorable histology Wilms Tumors (FHWT) that relapsed and tumors with diffuse anaplasia (unfavorable histology; DAWT). These two tumor subsets have survival rates of approximately 50% and 60%, respectively.
Experimental procedures: Genomic sequencing (whole genome [WGS] or exome [WXS]), global copy number analysis, and global gene expression analysis were performed on a discovery set of 117 (78 FHWT, 39 DAWT) pre-therapy high-risk WTs treated on National Wilms Tumor Study-5 (NWTS-5). To determine the frequency of recurrent variants, targeted sequencing (Illumina HiSeq2500) was performed on a validation set of pre-therapy tumor DNA from a case-cohort of all FHWT treated on NWTS-5 (531 FHWT) and all available 118 DAWT treated on NWTS-5 (these groups include tumors from the discovery set).
Results: WGS and WXS revealed an average of 21.74 ± 22.6 high-quality variants per DAWT (range, 3-131) and 13.8 ± 10.9 per FHWT (range 2-58). Genes previously reported to be recurrently mutated in WT were mutated at the following frequencies in the validation set: WTX (6%), CTNNB1 (15%), WT1 (7.5%), DROSHA (11%), DGCR8 (4.5%), XPO5 (2%), SIX1/2 (7%), and MLLT1 (3%). In addition, mutations were identified in three genes that impact the NMYC pathway, which is known to be involved in renal development. These include MYCN P44L/H (4%), MAX R60Q (2%), and novel mutations in NONO (2%); these mutations were mutually exclusive. Novel mutations in BCOR, a transcriptional corepressor that regulates both gene expression during development and chromatin modification, were found in 3% of validation set tumors. Analysis of global gene expression revealed significant up-regulation of genes associated with kidney development, extracellular matrix organization, and epithelial tube development in BCOR-mutant tumors compared with precursor lesions (5 hyperplastic perilobar nephrogenic rests). TP53 mutations were identified in 48% of DAWTs and 1% of FHWTs. The above data do not include copy number changes, which were recurrently detected in WT1, WTX, NMYC, and TP53.
Conclusions: Through the TARGET initiative, we have identified several novel, potential driver mutations that occur in WT and have not been reported in other pediatric tumors. The majority of these genes are known to function in processes critical to early development and/or specifically in renal development. Many of these mutations are accompanied by Wnt activating mutations or 11p15 biallelic expression. However, approximately 50% of WTs lack clear driver mutations. Future studies will need to focus on elucidating epigenetic alterations in these tumors as well as genetic changes outside of protein-coding regions.
Citation Format: Samantha L. Gadd, Amy L. Walz, Ariadne HAG Ooms, Vicki Huff, Daniela S. Gerhard, Malcolm A. Smith, Jaime M. Guidry Auvil, Leandro Hermida, Tanja Davidsen, Patee Gesuwan, Daoud Meerzaman, Yussanne Ma, Marco A. Marra, Jeffrey S. Dome, Charles G. Mullighan, David A. Wheeler, Oliver A. Hampton, Julie M. Gastier-Foster, Nicole Ross, Elizabeth J. Perlman. The genetic landscape of Wilms tumor. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr LB-180.
Collapse
Affiliation(s)
- Samantha L. Gadd
- 1Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Amy L. Walz
- 1Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | | | - Vicki Huff
- 3The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | | | | | - Yussanne Ma
- 5British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | - Marco A. Marra
- 5British Columbia Cancer Agency, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Nicole Ross
- 9Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH
| | | |
Collapse
|
37
|
Cajaiba MM, Jennings LJ, George D, Perlman EJ. Expanding the spectrum of ALK-rearranged renal cell carcinomas in children: Identification of a novel HOOK1-ALK fusion transcript. Genes Chromosomes Cancer 2016; 55:814-7. [PMID: 27225638 DOI: 10.1002/gcc.22382] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 12/15/2022] Open
Affiliation(s)
- Mariana M Cajaiba
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lawrence J Jennings
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David George
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth J Perlman
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
38
|
Gooskens SL, Gadd S, Guidry Auvil JM, Gerhard DS, Khan J, Patidar R, Meerzaman D, Chen QR, Hsu CH, Yan C, Nguyen C, Hu Y, Mullighan CG, Ma J, Jennings LJ, de Krijger RR, van den Heuvel-Eibrink MM, Smith MA, Ross N, Gastier-Foster JM, Perlman EJ. TCF21 hypermethylation in genetically quiescent clear cell sarcoma of the kidney. Oncotarget 2016; 6:15828-41. [PMID: 26158413 PMCID: PMC4599240 DOI: 10.18632/oncotarget.4682] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 06/07/2015] [Indexed: 01/31/2023] Open
Abstract
Clear Cell Sarcoma of the Kidney (CCSK) is a rare childhood tumor whose molecular pathogenesis remains poorly understood. We analyzed a discovery set of 13 CCSKs for changes in chromosome copy number, mutations, rearrangements, global gene expression and global DNA methylation. No recurrent segmental chromosomal copy number changes or somatic variants (single nucleotide or small insertion/deletion) were identified. One tumor with t(10;17)(q22;p13) involving fusion of YHWAE with NUTM2B was identified. Integrated analysis of expression and methylation data identified promoter hypermethylation and low expression of the tumor suppressor gene TCF21 (Pod-1/capsulin/epicardin) in all CCSKs except the case with t(10;17)(q22;p13). TARID, the long noncoding RNA responsible for demethylating TCF21, was virtually undetectable in most CCSKs. TCF21 hypermethylation and decreased TARID expression were validated in an independent set of CCSK tumor samples. The presence of significant hypermethylation of TCF21, a transcription factor known to be active early in renal development, supports the hypothesis that hypermethylation of TCF21 and/or decreased TARID expression lies within the pathogenic pathway of most CCSKs. Future studies are needed to functionally verify a tumorigenic role of TCF21 down-regulation and to tie this to the unique gene expression pattern of CCSK.
Collapse
Affiliation(s)
- Saskia L Gooskens
- Department of Pediatric Hematology and Oncology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Pediatric Oncology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - Samantha Gadd
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine and Robert H. Lurie Cancer Center, Chicago, IL, USA
| | | | - Daniela S Gerhard
- Office of Cancer Genomics, National Cancer Institute, Bethesda, MD, USA
| | - Javed Khan
- Genetics Branch, Oncogenomics section, National Cancer Institute, Bethesda, MD, USA
| | - Rajesh Patidar
- Genetics Branch, Oncogenomics section, National Cancer Institute, Bethesda, MD, USA
| | - Daoud Meerzaman
- Computational Genomics Research Group, Center for Biomedical Informatics and Information Technology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Qing-Rong Chen
- Computational Genomics Research Group, Center for Biomedical Informatics and Information Technology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Chih Hao Hsu
- Computational Genomics Research Group, Center for Biomedical Informatics and Information Technology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Chunhua Yan
- Computational Genomics Research Group, Center for Biomedical Informatics and Information Technology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Cu Nguyen
- Computational Genomics Research Group, Center for Biomedical Informatics and Information Technology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ying Hu
- Computational Genomics Research Group, Center for Biomedical Informatics and Information Technology, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Charles G Mullighan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jing Ma
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Lawrence J Jennings
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine and Robert H. Lurie Cancer Center, Chicago, IL, USA
| | - Ronald R de Krijger
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC, Rotterdam, The Netherlands.,Department of Pathology, Reinier de Graaf Hospital, Delft, The Netherlands
| | | | - Malcolm A Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA
| | - Nicole Ross
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA
| | - Julie M Gastier-Foster
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH, USA
| | - Elizabeth J Perlman
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine and Robert H. Lurie Cancer Center, Chicago, IL, USA
| |
Collapse
|
39
|
Gooskens SL, Gadd S, van den Heuvel-Eibrink MM, Perlman EJ. BCORinternal tandem duplications in clear cell sarcoma of the kidney. Genes Chromosomes Cancer 2016; 55:549-50. [DOI: 10.1002/gcc.22353] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 02/10/2016] [Accepted: 02/10/2016] [Indexed: 11/07/2022] Open
Affiliation(s)
- Saskia L. Gooskens
- Department of Pediatric Hematology and Oncology; Erasmus MC-Sophia Children's Hospital; Rotterdam the Netherlands
- Department of Pediatric Oncology; Princess Máxima Center for Pediatric Oncology; Utrecht the Netherlands
| | - Samantha Gadd
- Department of Pathology; Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine and Robert H. Lurie Cancer Center; Chicago IL
| | | | - Elizabeth J. Perlman
- Department of Pathology; Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University's Feinberg School of Medicine and Robert H. Lurie Cancer Center; Chicago IL
| |
Collapse
|
40
|
Chun HJE, Lim EL, Heravi-Moussavi A, Saberi S, Mungall KL, Bilenky M, Carles A, Tse K, Shlafman I, Zhu K, Qian JQ, Palmquist DL, He A, Long W, Goya R, Ng M, LeBlanc VG, Pleasance E, Thiessen N, Wong T, Chuah E, Zhao YJ, Schein JE, Gerhard DS, Taylor MD, Mungall AJ, Moore RA, Ma Y, Jones SJM, Perlman EJ, Hirst M, Marra MA. Genome-Wide Profiles of Extra-cranial Malignant Rhabdoid Tumors Reveal Heterogeneity and Dysregulated Developmental Pathways. Cancer Cell 2016; 29:394-406. [PMID: 26977886 PMCID: PMC5094835 DOI: 10.1016/j.ccell.2016.02.009] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 01/05/2016] [Accepted: 02/16/2016] [Indexed: 12/18/2022]
Abstract
Malignant rhabdoid tumors (MRTs) are rare lethal tumors of childhood that most commonly occur in the kidney and brain. MRTs are driven by SMARCB1 loss, but the molecular consequences of SMARCB1 loss in extra-cranial tumors have not been comprehensively described and genomic resources for analyses of extra-cranial MRT are limited. To provide such data, we used whole-genome sequencing, whole-genome bisulfite sequencing, whole transcriptome (RNA-seq) and microRNA sequencing (miRNA-seq), and histone modification profiling to characterize extra-cranial MRTs. Our analyses revealed gene expression and methylation subgroups and focused on dysregulated pathways, including those involved in neural crest development.
Collapse
Affiliation(s)
- Hye-Jung E Chun
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Emilia L Lim
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Alireza Heravi-Moussavi
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Saeed Saberi
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Karen L Mungall
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Mikhail Bilenky
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Annaick Carles
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Kane Tse
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Inna Shlafman
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Kelsey Zhu
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Jenny Q Qian
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Diana L Palmquist
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - An He
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - William Long
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Rodrigo Goya
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Michelle Ng
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Veronique G LeBlanc
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Erin Pleasance
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Nina Thiessen
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Tina Wong
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Eric Chuah
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Yong-Jun Zhao
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Jacquie E Schein
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Daniela S Gerhard
- Office of Cancer Genomics, National Cancer Institute, US National Institutes of Health, Bethesda, MD 20892, USA
| | - Michael D Taylor
- The Arthur and Sonia Labatt Brain Tumour Research Centre, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Andrew J Mungall
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Richard A Moore
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Yussanne Ma
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada
| | - Steven J M Jones
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada; Department of Molecular Biology and Biochemistry, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Elizabeth J Perlman
- Department of Pathology and Laboratory Medicine, Lurie Children's Hospital, Northwestern University's Feinberg School of Medicine and Robert H. Lurie Cancer Center, Chicago, IL 60611, USA
| | - Martin Hirst
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada; Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 1L3, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada.
| |
Collapse
|
41
|
Cajaiba MM, Jennings LJ, Rohan SM, Perez-Atayde AR, Marino-Enriquez A, Fletcher JA, Geller JI, Leuer KMC, Bridge JA, Perlman EJ. ALK-rearranged renal cell carcinomas in children. Genes Chromosomes Cancer 2016; 55:442-51. [DOI: 10.1002/gcc.22346] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/06/2016] [Accepted: 01/07/2016] [Indexed: 12/19/2022] Open
Affiliation(s)
- Mariana M. Cajaiba
- Department of Pathology and Laboratory Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine; Chicago IL
| | - Lawrence J. Jennings
- Department of Pathology and Laboratory Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine; Chicago IL
| | - Stephen M. Rohan
- Department of Pathology; Colorado Pathology Consultants and Saint Joseph Hospital; Denver CO
| | | | | | - Jonathan A. Fletcher
- Department of Pathology; Brigham Women's Hospital and Harvard Medical School; Boston MA
| | - James I. Geller
- Division of Pediatric Oncology; Cincinnati Children's Hospital Medical Center, University of Cincinnati; Cincinnati Ohio
| | - Katrin M. C. Leuer
- Department of Pathology and Laboratory Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine; Chicago IL
| | - Julia A. Bridge
- Department of Pathology and Microbiology; University of Nebraska Medical Center; Omaha NE
| | - Elizabeth J. Perlman
- Department of Pathology and Laboratory Medicine; Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine; Chicago IL
| |
Collapse
|
42
|
Abstract
Wilms tumor, or nephroblastoma, has provided a paradigm for progressive improvement in clinical outcomes achieved through serial cooperative group studies. With modern surgery, chemotherapy, and radiation therapy approaches, the overall survival rate for patients with Wilms tumor has reached 90%. Remarkably, the increase in survival has been achieved with a reduction in therapy for most patient subgroups, leading not only to more survivors, but also to healthier survivors. A key contributor to improved outcomes has been the development of clinical and biologic prognostic markers that have enabled risk-directed therapy. Whereas the early cooperative group studies used only tumor stage for risk stratification, current Children's Oncology Group (COG) and International Society of Pediatric Oncology (SIOP) protocols employ a multitude of prognostic factors to guide therapy. Prognostic factors used in the current generation of COG studies include stage, histology, patient age, tumor weight, completeness of lung nodule response, and loss of heterozygosity at chromosomes 1p and 16q. Future COG studies seek to incorporate gain of chromosome 1q and methylation pattern of chromosome 11p15 into the risk classification schema. Prognostic factors used in the current SIOP studies include stage, histology, tumor volume, and responsiveness to therapy. Future SIOP studies seek to incorporate absolute blastemal volume and novel molecular markers for resistant blastema into the risk stratification approach.
Collapse
Affiliation(s)
- Jeffrey S Dome
- From the Division of Oncology, Children's National Medical Center, Washington DC; Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatric Oncology and Hematology, Saarland University, Homburg, Germany
| | - Elizabeth J Perlman
- From the Division of Oncology, Children's National Medical Center, Washington DC; Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatric Oncology and Hematology, Saarland University, Homburg, Germany
| | - Norbert Graf
- From the Division of Oncology, Children's National Medical Center, Washington DC; Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatric Oncology and Hematology, Saarland University, Homburg, Germany
| |
Collapse
|
43
|
Cajaiba MM, Khanna G, Smith EA, Gellert L, Chi YY, Mullen EA, Hill DA, Geller JI, Dome JS, Perlman EJ. Pediatric cystic nephromas: distinctive features and frequent DICER1 mutations. Hum Pathol 2015; 48:81-7. [PMID: 26772403 DOI: 10.1016/j.humpath.2015.08.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/24/2015] [Indexed: 12/21/2022]
Abstract
Cystic nephromas (CNs) are uncommon benign renal neoplasms that present with a bimodal age distribution, affecting either infants/young children or adult females. Although differences between these age groups have been suggested, large studies of pediatric CN have not been conducted. As a result, the nomenclature and diagnostic criteria for these lesions remain controversial. In addition, the morphological overlap seen between CN and cystic partially differentiated nephroblastoma (CPDN) can result in diagnostic dilemmas. This study reviews the morphologic and radiographic features of 44 pediatric CN prospectively enrolled on a Children's Oncology Group protocol from 2007 to 2013. Although the typical multicystic architecture with thin septa described in adult CN was present in all of our pediatric cases, differences were also identified. We report distinctive features that add to the morphological spectrum of CN in children. Of the 44 cases, 16 had been previously analyzed and reported for DICER1 mutation, and either loss of function or missense mutations or both were identified in 15 of 16. In contrast, we analyzed 10 cases of adult CN, and all were negative for DICER1 mutations; similarly, 6 CPDNs previously analyzed and reported were negative for DICER1 mutations. Therefore, the clinical, morphological, and genetic differences between pediatric and adult CN, as well as between CN and CPDN, suggest that these 3 lesions represent distinct entities.
Collapse
Affiliation(s)
- Mariana M Cajaiba
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL 60611.
| | - Geetika Khanna
- Department of Radiology, Washington University School of Medicine, St Louis, MO 63110
| | - Ethan A Smith
- Departrment of Radiology, University of Michigan Health System, Ann Arbor, MI 48109
| | - Lan Gellert
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN 37232
| | - Yueh-Yun Chi
- Department of Biostatistics, University of Florida, Gainesville, FL 32611
| | - Elizabeth A Mullen
- Department of Pediatric Oncology, Children's Hospital Boston/Dana-Farber Cancer Institute, Boston, MA 02115
| | - Dana A Hill
- Department of Pathology, Children's National Medical Center, Washington, DC 20010
| | - James I Geller
- Division of Pediatric Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH 45229
| | - Jeffrey S Dome
- Division of Pediatric Oncology, Children's National Medical Center, Washington, DC 20010
| | - Elizabeth J Perlman
- Department of Pathology and Laboratory Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL 60611
| |
Collapse
|
44
|
Geller JI, Ehrlich PF, Cost NG, Khanna G, Mullen EA, Gratias EJ, Naranjo A, Dome JS, Perlman EJ. Characterization of adolescent and pediatric renal cell carcinoma: A report from the Children's Oncology Group study AREN03B2. Cancer 2015; 121:2457-64. [PMID: 25845370 DOI: 10.1002/cncr.29368] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/16/2015] [Accepted: 02/19/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND The current study was conducted to characterize the epidemiology, histology, and radiographic features of as well as the surgical approach to pediatric and adolescent renal cell carcinoma (pRCC). METHODS pRCC cases prospectively enrolled on the Children's Oncology Group study AREN03B2 underwent central pathology, radiology, surgery, and oncology review. RESULTS As of June 2012, 120 of a total of 3250 patients enrolled on AREN03B2 (3.7%) were found to have unilateral RCC (median age, 12.9 years [range, 1.9-22.1 years]; 52.5% were female). Central review classified these as translocation morphology (56 patients), papillary (20 patients), renal medullary carcinoma (13 patients), chromophobe (4 patients), oncocytoma (1 patient), conventional clear cell (1 patient), and RCC not otherwise specified (25 patients). Lymph node (LN) involvement (N+) was found in 35 of 73 cases (47.9%) for which LNs were sampled, including 19 of 40 cases with primary tumors measuring <7 cm (47.5%). Using a size cutoff of 1 cm, imaging detection of LN involvement had a sensitivity of 57.14% (20 of 35 cases; 95% CI, 39.35%-73.68%) and a specificity of 94.59% (35 of 37 cases; 95% CI, 81.81%-99.34%). Distant metastases were present in 23 cases (19.2%). Initial surgery was radical nephrectomy in 88 patients (73.3%), nephron-sparing surgery in 18 patients (15.0%), and biopsy in 14 patients (11.7%). Compared with patients undergoing radical nephrectomy, those treated with nephron-sparing surgery were less likely to have LNs sampled (6 of 18 patients [33.3%] vs 65 of 88 patients [73.9%]; P = .002). CONCLUSIONS Translocation RCC is the most common form of pediatric and adolescent RCC. Lymph node disease is common and observed among patients with small primary tumors. Imaging has a high specificity but relatively low sensitivity for the detection of such lymph node disease. Failure to sample LNs results in incomplete staging and potentially inadequate disease control for younger patients with RCC.
Collapse
Affiliation(s)
- James I Geller
- Division of Pediatric Oncology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | - Peter F Ehrlich
- Section of Pediatric Surgery, Department of Surgery, CS Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Nicholas G Cost
- Division of Urology, Department of Surgery, University of Colorado School of Medicine and the Children's Hospital Colorado, Aurora, Colorado
| | - Geetika Khanna
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Elizabeth A Mullen
- Department of Pediatric Oncology, Children's Hospital Boston/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Eric J Gratias
- Division of Pediatric Hematology/Oncology, T.C. Thompson Children's Hospital, University of Tennessee College of Medicine-Chattanooga, Chattanooga, Tennessee
| | - Arlene Naranjo
- Department of Biostatistics, University of Florida, Children's Oncology Group Statistics and Data Center, Gainesville, Florida
| | - Jeffrey S Dome
- Division of Pediatric Oncology, Children's National Medical Center, Washington, DC
| | - Elizabeth J Perlman
- Department of Pathology, Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| |
Collapse
|
45
|
Walz AL, Ooms A, Gadd S, Gerhard DS, Smith MA, Guidry Auvil JM, Meerzaman D, Chen QR, Hsu CH, Yan C, Nguyen C, Hu Y, Bowlby R, Brooks D, Ma Y, Mungall AJ, Moore RA, Schein J, Marra MA, Huff V, Dome JS, Chi YY, Mullighan CG, Ma J, Wheeler DA, Hampton OA, Jafari N, Ross N, Gastier-Foster JM, Perlman EJ. Recurrent DGCR8, DROSHA, and SIX homeodomain mutations in favorable histology Wilms tumors. Cancer Cell 2015; 27:286-97. [PMID: 25670082 PMCID: PMC4800737 DOI: 10.1016/j.ccell.2015.01.003] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/28/2014] [Accepted: 01/12/2015] [Indexed: 12/21/2022]
Abstract
We report the most common single-nucleotide substitution/deletion mutations in favorable histology Wilms tumors (FHWTs) to occur within SIX1/2 (7% of 534 tumors) and microRNA processing genes (miRNAPGs) DGCR8 and DROSHA (15% of 534 tumors). Comprehensive analysis of 77 FHWTs indicates that tumors with SIX1/2 and/or miRNAPG mutations show a pre-induction metanephric mesenchyme gene expression pattern and are significantly associated with both perilobar nephrogenic rests and 11p15 imprinting aberrations. Significantly decreased expression of mature Let-7a and the miR-200 family (responsible for mesenchymal-to-epithelial transition) in miRNAPG mutant tumors is associated with an undifferentiated blastemal histology. The combination of SIX and miRNAPG mutations in the same tumor is associated with evidence of RAS activation and a higher rate of relapse and death.
Collapse
Affiliation(s)
- 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, IL 60611, USA
| | - Ariadne Ooms
- Department of Pathology, Josephine Nefkens Institute, Erasmus Medical Center, Rotterdam CA 3000, the Netherlands
| | - Samantha Gadd
- Department of Pathology and Laboratory Medicine, Lurie Children's Hospital, Northwestern University's Feinberg School of Medicine and Robert H. Lurie Cancer Center, Chicago, IL 60611, USA
| | - Daniela S Gerhard
- Office of Cancer Genomics, National Cancer Institute, Bethesda, MD 20892, USA
| | - Malcolm A Smith
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD 20892, USA
| | | | - Daoud Meerzaman
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, MD 20892, USA
| | - Qing-Rong Chen
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, MD 20892, USA
| | - Chih Hao Hsu
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, MD 20892, USA
| | - Chunhua Yan
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, MD 20892, USA
| | - Cu Nguyen
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, MD 20892, USA
| | - Ying Hu
- Center for Biomedical Informatics and Information Technology, National Cancer Institute, Bethesda, MD 20892, USA
| | - Reanne Bowlby
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 4S6, Canada
| | - Denise Brooks
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 4S6, Canada
| | - Yussanne Ma
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 4S6, Canada
| | - Andrew J Mungall
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 4S6, Canada
| | - Richard A Moore
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 4S6, Canada
| | - Jacqueline Schein
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 4S6, Canada
| | - Marco A Marra
- Canada's Michael Smith Genome Sciences Centre, British Columbia Cancer Agency, Vancouver, BC V5Z 4S6, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC V6H 3N1, Canada
| | - Vicki Huff
- Department of Genetics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jeffrey S Dome
- Division of Pediatric Hematology/Oncology, Children's National Medical Center, Washington, DC 20010, USA
| | - Yueh-Yun Chi
- Department of Biostatistics, University of Florida, Gainesville, FL 32610, USA
| | - Charles G Mullighan
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - Jing Ma
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA
| | - David A Wheeler
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Oliver A Hampton
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Nadereh Jafari
- Center for Genetic Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Nicole Ross
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH 43205, USA
| | - Julie M Gastier-Foster
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH 43205, USA
| | - Elizabeth J Perlman
- Department of Pathology and Laboratory Medicine, Lurie Children's Hospital, Northwestern University's Feinberg School of Medicine and Robert H. Lurie Cancer Center, Chicago, IL 60611, USA.
| |
Collapse
|
46
|
Servaes S, Khanna G, Naranjo A, Geller JI, Ehrlich PF, Gow KW, Perlman EJ, Dome JS, Gratias E, Mullen EA. Comparison of diagnostic performance of CT and MRI for abdominal staging of pediatric renal tumors: a report from the Children's Oncology Group. Pediatr Radiol 2015; 45:166-72. [PMID: 25135711 PMCID: PMC4337797 DOI: 10.1007/s00247-014-3138-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Revised: 05/12/2014] [Accepted: 07/18/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND CT and MRI are both used for abdominal staging of pediatric renal tumors. The diagnostic performance of the two modalities for local and regional staging of renal tumors has not been systematically evaluated. OBJECTIVE To compare the diagnostic performance of CT and MRI for local staging of pediatric renal tumors. MATERIALS AND METHODS The study population was derived from the AREN03B2 study of the Children's Oncology Group. Baseline abdominal imaging performed with both CT and MRI within 30 days of nephrectomy was available for retrospective review in 82 renal tumor cases. Each case was evaluated for capsular penetration, lymph node metastasis, tumor thrombus, preoperative tumor rupture, and synchronous contralateral lesions. The surgical and pathological findings at central review were the reference standard. RESULTS The sensitivity of CT and MRI for detecting capsular penetration was 68.6% and 62.9%, respectively (P = 0.73), while specificity was 86.5% and 83.8% (P = 1.0). The sensitivity of CT and MRI for detecting lymph node metastasis was 76.5% and 52.9% (P = 0.22), and specificity was 90.4% and 92.3% (P = 1.0). Synchronous contralateral lesions were identified by CT in 4/9 cases and by MRI in 7/9 cases. CONCLUSION CT and MRI have similar diagnostic performance for detection of lymph node metastasis and capsular penetration. MR detected more contralateral synchronous lesions; however these were present in a very small number of cases. Either modality can be used for initial loco-regional staging of pediatric renal tumors.
Collapse
Affiliation(s)
- Sabah Servaes
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Geetika Khanna
- Pediatric Radiology, St. Louis Children's Hospital, Mallinckrodt Institute for Radiology, Washington University School of Medicine, 510 S. Kingshighway, Campus Box 8131-MIR, St. Louis, MO 63110, USA
| | - Arlene Naranjo
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - James I. Geller
- Division of Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Peter F. Ehrlich
- Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth W. Gow
- Pediatric Surgery, Seattle Children's Hospital, Seattle, WA, USA
| | - Elizabeth J. Perlman
- Department of Pathology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jeffrey S. Dome
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA
| | - Eric Gratias
- Dana Farber Cancer Institute and Boston Children's Hospital, Harvard University, Boston, MA, USA
| | - Elizabeth A. Mullen
- Dana Farber Cancer Institute and Boston Children's Hospital, Harvard University, Boston, MA, USA
| |
Collapse
|
47
|
Chun HJE, Zhu K, Qian JQ, Mungall KL, Ma Y, Zhao YJ, Mungall AJ, Moore RA, Schein JE, Gerhard DS, Perlman EJ, Marra MA. Abstract 3087: Whole genome sequencing of rhabdoid tumors of the kidney. Cancer Res 2014. [DOI: 10.1158/1538-7445.am2014-3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Rhabdoid tumors (RT) of the kidney (RTK) are aggressive pediatric solid tumors that predominantly affect infants. There is no effective chemotherapy and the overall 4-year survival rate is 23%. RT has a characteristic loss of SMARCB1 function, found in >90% of the patients. SMARCB1 is a conserved core subunit of the SWI/SNF chromatin-remodeling complex, which in turn is responsible for proper chromatin assembly and dynamic regulation of gene expression. Previous studies showed a remarkable paucity of mutations in coding regions of genomes and a highly penetrant cancer susceptibility in a conditional knockout mouse model. These findings support the interpretation that SMARCB1 is a tumor suppressor whose inactivation is the primary driver in RT and that RT follows a tumorigenesis model in which cancer is driven by aberrant epigenetic regulation and gene expression instead of accumulation of somatic mutations. Characterizing interplays of mutations, gene expression and epigenetic regulation will be important in understanding RT development and biology.
To achieve this goal, we will comprehensively characterize genetic and epigenetic aberrations in RT using HiSeq sequencing technology. Our research efforts include profiling whole genome, whole transcriptome, promoter methylation and histone modification in 40 primary RTK samples. Here, we report preliminary results from whole genome analyses.
Using an amplification-free library construction method, we sequenced whole genomes of 40 RTK and matched normal cases to an average haploid coverage of 39.4X. The RTK genomes were mostly diploid, but we found 35 loci that are either recurrently focally amplified or deleted using GISTIC 2.0 at FDR ≤0.05. Using the Trans-ABySS de novo short-read assembler, we assembled the RT cases’ whole genomes and identified a total of 19 genes that were recurrently rearranged in 8 out of 40 cases. Eleven of the genes were either known tumor suppressors (e.g. CABIN1, BCR) or associated with developmental or neurodegenerative diseases (e.g. UPB1, SPECC1L). The genome-wide single nucleotide variant and indel analysis showed an average somatic mutation rate at 0.37 per Mb in RTK, comparable to the previous finding of 0.19 per Mb in AT/RT. Approximately 99% of the somatic mutations occurred in non-genic regions. SMARCB1 had homozygous loss of function in 83% of cases by somatic homozygous deletion, or heterozygous deletion or truncating point mutations followed by loss of heterozygosity. The remaining cases appeared to have at least 1 copy of the gene unaffected and analyses are ongoing to investigate the inactivation mechanism in these cases.
Citation Format: Hye-Jung E. Chun, Kelsey Zhu, Jenny Q. Qian, Karen L. Mungall, Yussanne Ma, Yong-Jun Zhao, Andrew J. Mungall, Richard A. Moore, Jacquie E. Schein, Daniela S. Gerhard, Elizabeth J. Perlman, Marco A. Marra. Whole genome sequencing of rhabdoid tumors of the kidney. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3087. doi:10.1158/1538-7445.AM2014-3087
Collapse
Affiliation(s)
- Hye-Jung E. Chun
- 1University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelsey Zhu
- 2Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Jenny Q. Qian
- 2Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Karen L. Mungall
- 2Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Yussanne Ma
- 2Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Yong-Jun Zhao
- 2Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Andrew J. Mungall
- 2Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Richard A. Moore
- 2Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Jacquie E. Schein
- 2Canada's Michael Smith Genome Sciences Centre, BC Cancer Agency, Vancouver, British Columbia, Canada
| | - Daniela S. Gerhard
- 3Office of Cancer Genomics, National Cancer Institute, US National Institutes of Health, Bethesda, MD
| | | | - Marco A. Marra
- 1University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
48
|
Reindel R, Bischof J, Kim KYA, Orenstein JM, Soares MB, Baker SC, Shulman ST, Perlman EJ, Lingen MW, Pink AJ, Trevenen C, Rowley AH. CD84 is markedly up-regulated in Kawasaki disease arteriopathy. Clin Exp Immunol 2014; 177:203-11. [PMID: 24635044 DOI: 10.1111/cei.12327] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2014] [Indexed: 11/28/2022] Open
Abstract
The major goals of Kawasaki disease (KD) therapy are to reduce inflammation and prevent thrombosis in the coronary arteries (CA), but some children do not respond to currently available non-specific therapies. New treatments have been difficult to develop because the molecular pathogenesis is unknown. In order to identify dysregulated gene expression in KD CA, we performed high-throughput RNA sequencing on KD and control CA, validated potentially dysregulated genes by real-time reverse transcription-polymerase chain reaction (RT-PCR) and localized protein expression by immunohistochemistry. Signalling lymphocyte activation molecule CD84 was up-regulated 16-fold (P < 0·01) in acute KD CA (within 2 months of onset) and 32-fold (P < 0·01) in chronic CA (5 months to years after onset). CD84 was localized to inflammatory cells in KD tissues. Genes associated with cellular proliferation, motility and survival were also up-regulated in KD CA, and immune activation molecules MX2 and SP140 were up-regulated in chronic KD. CD84, which facilitates immune responses and stabilizes platelet aggregates, is markedly up-regulated in KD CA in patients with acute and chronic arterial disease. We provide the first molecular evidence of dysregulated inflammatory responses persisting for months to years in CA significantly damaged by KD.
Collapse
Affiliation(s)
- R Reindel
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Stricker TP, Morales La Madrid A, Chlenski A, Guerrero L, Salwen HR, Gosiengfiao Y, Perlman EJ, Furman W, Bahrami A, Shohet JM, Zage PE, Hicks MJ, Shimada H, Suganuma R, Park JR, So S, London WB, Pytel P, Maclean KH, Cohn SL. Validation of a prognostic multi-gene signature in high-risk neuroblastoma using the high throughput digital NanoString nCounter™ system. Mol Oncol 2014; 8:669-78. [PMID: 24560446 DOI: 10.1016/j.molonc.2014.01.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 12/24/2013] [Accepted: 01/21/2014] [Indexed: 10/25/2022] Open
Abstract
Microarray-based molecular signatures have not been widely integrated into neuroblastoma diagnostic classification systems due to the complexities of the assay and requirement for high-quality RNA. New digital technologies that accurately quantify gene expression using RNA isolated from formalin-fixed paraffin embedded (FFPE) tissues are now available. In this study, we describe the first use of a high-throughput digital system to assay the expression of genes in an "ultra-high risk" microarray classifier in FFPE high-risk neuroblastoma tumors. Customized probes corresponding to the 42 genes in a published multi-gene neuroblastoma signature were hybridized to RNA isolated from 107 FFPE high-risk neuroblastoma samples using the NanoString nCounter™ Analysis System. For classification of each patient, the Pearson's correlation coefficient was calculated between the standardized nCounter™ data and the molecular signature from the microarray data. We demonstrate that the nCounter™ 42-gene panel sub-stratified the high-risk cohort into two subsets with statistically significantly different overall survival (p = 0.0027) and event-free survival (p = 0.028). In contrast, none of the established prognostic risk markers (age, stage, tumor histology, MYCN status, and ploidy) were significantly associated with survival. We conclude that the nCounter™ System can reproducibly quantify expression levels of signature genes in FFPE tumor samples. Validation of this microarray signature in our high-risk patient cohort using a completely different technology emphasizes the prognostic relevance of this classifier. Prospective studies testing the prognostic value of molecular signatures in high-risk neuroblastoma patients using FFPE tumor samples and the nCounter™ System are warranted.
Collapse
Affiliation(s)
- Thomas P Stricker
- Department of Pathology, Microbiology and Immunology, Vanderbilt University, Nashville, TN, USA
| | | | - Alexandre Chlenski
- Department of Pediatrics, Comer Children's Hospital, University of Chicago, Chicago, IL, USA
| | - Lisa Guerrero
- Department of Pediatrics, Comer Children's Hospital, University of Chicago, Chicago, IL, USA
| | - Helen R Salwen
- Department of Pediatrics, Comer Children's Hospital, University of Chicago, Chicago, IL, USA
| | - Yasmin Gosiengfiao
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elizabeth J Perlman
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Wayne Furman
- Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Armita Bahrami
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Jason M Shohet
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Peter E Zage
- Department of Pediatrics, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - M John Hicks
- Department of Pathology, Texas Children's Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Hiroyuki Shimada
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Rie Suganuma
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Julie R Park
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Sara So
- Department of Pediatrics, Seattle Children's Hospital, University of Washington, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Wendy B London
- Children's Oncology Group Statistics and Data Center, Boston, MA, USA; Boston Children's Hospital/Dana-Farber Cancer Institute, Boston, MA, USA
| | - Peter Pytel
- Department of Pathology, Comer Children's Hospital, University of Chicago, Chicago, IL, USA
| | | | - Susan L Cohn
- Department of Pediatrics, Comer Children's Hospital, University of Chicago, Chicago, IL, USA.
| |
Collapse
|
50
|
Green DM, Breslow NE, D’Angio GJ, Malogolowkin MH, Ritchey ML, Evans AE, Beckwith JB, Perlman EJ, Shamberger RC, Peterson S, Grundy PE, Dome JS, Thomas PR, Kalapurakal JA. Outcome of patients with Stage II/favorable histology Wilms tumor with and without local tumor spill: a report from the National Wilms Tumor Study Group. Pediatr Blood Cancer 2014; 61:134-9. [PMID: 24038736 PMCID: PMC3933291 DOI: 10.1002/pbc.24658] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 05/20/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Intra-operative tumor spill increases the risk of local recurrence of Wilms tumor, and adversely impacts relapse-free (RFS) and overall survival (OS) rates. METHODS Surgical checklists, operative notes, institutional pathology reports, central pathology review and flow sheets of 602 patients registered between August 1986 and September 1994 on National Wilms Tumor Study-4 as randomized, followed or switched and coded as Final Stage II, favorable histology (FH) were reviewed. RFS and OS were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were estimated using the Cox model and tested for statistical significance by the log-rank test. RESULTS Four hundred ninety-nine patients were found after review to have Stage II, FH Wilms tumor. The 8-year RFS percentages were 85.0% (95% confidence interval (CI): 81.1%, 88.1%) for those with no spill compared to 75.7% (65.8%, 83.2%) for those with spill. The 8-year OS percentages were 95.6% (93.1%, 97.3%) for those with no spill compared to 90.3% (82.2%, 94.9%) for those with spill. The HR for relapse among those with spill was 1.55 ((95%CI: 0.97,2.51), P = 0.067) and the HR for death was 1.94 ((0.92,4.09), P = 0.077). CONCLUSIONS RFS and OS were lower for patients who had intra-operative tumor spill. The majority of NWTS Stage II, FH patients with intra-operative tumor spill have an overall excellent outcome when treated with two drug chemotherapy (vincristine and actinomycin D) and no abdominal irradiation.
Collapse
Affiliation(s)
- Daniel M. Green
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, TN
| | | | - Giulio J. D’Angio
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Audrey E. Evans
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Elizabeth J. Perlman
- Department of Pathology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | - Susan Peterson
- Department of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Paul E. Grundy
- Cancer Care, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jeffrey S. Dome
- Division of Oncology, Children’s National Medical Center, Washington, District of Columbia
| | | | - John A. Kalapurakal
- Department of Radiation Oncology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| |
Collapse
|