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Evageliou N, Renfro LA, Geller J, Perlman E, Kalapurakal J, Paulino A, Dix D, Eklund MJ, Murphy AJ, Romao RLP, Ehrlich PF, Varela CR, Vallance K, Fernandez Hon CV, Dome JS, Mullen EA. Prognostic impact of lymph node involvement and loss of heterozygosity of 1p or 16q in stage III favorable histology Wilms tumor: A report from Children's Oncology Group Studies AREN03B2 and AREN0532. Cancer 2024; 130:792-802. [PMID: 37902955 PMCID: PMC10993001 DOI: 10.1002/cncr.35084] [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: 07/05/2023] [Revised: 09/14/2023] [Accepted: 09/18/2023] [Indexed: 11/01/2023]
Abstract
INTRODUCTION The prognostic impact of positive lymph nodes (LN+) and/or singular loss of heterozygosity (LOH) of 1p or 16q were assessed in children with stage III favorable histology Wilms tumor (FHWT) enrolled on AREN0532 or AREN03B2 alone. PATIENTS AND METHODS A total of 635 stage III FHWT vincristine/dactinomycin/doxorubicin (DD4A)-treated patients met inclusion criteria. Event-free survival (EFS) and overall survival are reported overall and by LN sampling, LN status, LOH 1p, LOH 16q, and a combination of LN status and singular LOH. Patients with unknown or positive combined LOH of 1p and 16q status and AREN03B2-only patients with unknown outcomes or treatment other than DD4A were excluded. RESULTS EFS did not differ by study, supporting pooling. Lack of LN sampling (hazard ratio [HR], 2.12; p = .0037), LN positivity (HR, 2.78; p = .0002), LOH 1p (HR, 2.18; p = .0067), and LOH 16q (HR, 1.72; p = .042) were associated with worse EFS. Compared with patients with both LN- and LOH-, those with negative nodes but positive LOH 1p or 16q and those with LN+ but LOH- for 1p or 16q had significantly worse EFS (HR, 3.05 and 3.57, respectively). Patients positive for both LN and LOH had the worst EFS (HR, 6.33; overall group factor, p < .0001). CONCLUSION Findings confirm LN+ status as an adverse prognostic factor amplified by presence of singular LOH 1p or 16q, supporting study of intensified therapy for patients with LN+ in combination with singular LOH in a prospective clinical trial.
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Affiliation(s)
- Nicholas Evageliou
- Division of Oncology, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Lindsay A Renfro
- Division of Biostatistics, University of Southern California and Children’s Oncology Group, Monrovia, CA
| | - James Geller
- Division of Oncology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, OH
| | - Elizabeth Perlman
- Department of Pathology and Laboratory Medicine, the Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago IL
| | - John Kalapurakal
- Department of Radiation Oncology, Robert H. Lurie Cancer Center, Northwestern University, Chicago, IL
| | - Arnold Paulino
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - David Dix
- Division of Oncology, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Meryle J Eklund
- Department of Radiology, Medical University of South Carolina, Charleston, SC
| | - Andrew J Murphy
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Rodrigo LP Romao
- Departments of Surgery and Urology, IWK Health, Dalhousie University, Halifax, NS, Canada
| | - Peter F Ehrlich
- Department of Surgery, Section of Pediatric Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Carly R Varela
- Janssen Research and Development, Spring House, PA. (At the time of this work affiliation was Division of Oncology, Children’s National Hospital, Divisions of Pediatric Hematology and Oncology, Inova Fairfax Hospital and Department of Pediatrics, George Washington University School of Medicine, Falls Church, Virginia.)
| | - Kelly Vallance
- Division of Hematology and Oncology, Cook Children’s Hospital, Fort Worth, TX
| | - Conrad V Fernandez Hon
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - 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
| | - Elizabeth A Mullen
- Dana-Farber/Boston Children’s Blood Disorders and Cancer Center, MA, USA
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Naik-Mathuria B, Utria AF, Ehrlich PF, Aldrink JH, Murphy AJ, Lautz T, Dasgupta R, Short SS, Lovvorn HN, Kim ES, Newman E, Lal DR, Rich BS, Piché N, Kastenberg ZJ, Malek MM, Glick RD, Petroze RT, Polites SF, Whitlock R, Alore E, Sutthatarn P, Chen SY, Wong-Michalak S, Romao RLP, Al-Hadidi A, Rubalcava NS, Marquart JP, Gainer H, Johnson M, Boehmer C, Rinehardt H, Seemann NM, Davidson J, Polcz V, Lund SB, McKay KG, Correa H, Rothstein DH. Management and Outcomes of Wilms Tumor With Suprarenal Intravascular Extension: A Pediatric Surgical Oncology Research Collaborative Study. Ann Surg 2024; 279:528-535. [PMID: 37264925 PMCID: PMC10829895 DOI: 10.1097/sla.0000000000005921] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The purpose of this study was to describe management and outcomes from a contemporary cohort of children with Wilms tumor complicated by inferior vena caval thrombus. BACKGROUND The largest series of these patients was published almost 2 decades ago. Since then, neoadjuvant chemotherapy has been commonly used to manage these patients, and outcomes have not been reported. METHODS Retrospective review of 19 North American centers between 2009 and 2019. Patient and disease characteristics, management, and outcomes were investigated and analyzed. RESULTS Of 124 patients, 81% had favorable histology (FH), and 52% were stage IV. IVC thrombus level was infrahepatic in 53 (43%), intrahepatic in 32 (26%), suprahepatic in 14 (11%), and cardiac in 24 (19%). Neoadjuvant chemotherapy using a 3-drug regimen was administered in 82% and postresection radiation in 90%. Thrombus level regression was 45% overall, with suprahepatic level showing the best response (62%). Cardiopulmonary bypass (CPB) was potentially avoided in 67%. The perioperative complication rate was significantly lower after neoadjuvant chemotherapy [(25%) vs upfront surgery (55%); P =0.005]. CPB was not associated with higher complications [CPB (50%) vs no CPB (27%); P =0.08]. Two-year event-free survival was 93% and overall survival was 96%, higher in FH cases (FH 98% vs unfavorable histology/anaplastic 82%; P =0.73). Neither incomplete resection nor viable thrombus cells affected event-free survival or overall survival. CONCLUSIONS Multimodal therapy resulted in excellent outcomes, even with advanced-stage disease and cardiac extension. Neoadjuvant chemotherapy decreased the need for CPB to facilitate resection. Complete thrombectomy may not always be necessary.
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Affiliation(s)
- Bindi Naik-Mathuria
- Department of Surgery, Division of Pediatric Surgery, University of Texas Medical Branch, Galveston, TX
| | - Alan F. Utria
- Department of Surgery, Division of General and Thoracic Surgery, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA
| | - Peter F. Ehrlich
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children’s Hospital, The University of Michigan, Ann Arbor, MI
| | - Jennifer H. Aldrink
- Department of Surgery, Division of Pediatric Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Andrew J. Murphy
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN
| | - Timothy Lautz
- Department of Surgery, Division of Pediatric Surgery, Lurie Children’s Hospital, Northwestern School of Medicine, Chicago, IL
| | - Roshni Dasgupta
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children’s Medical Center, Cincinnati, OH
| | - Scott S. Short
- Department of Surgery, Division of Pediatric Surgery, University of Utah, Primary Children’s Hospital, Salt Lake City, UT
| | - Harold N. Lovvorn
- Department of Pediatric Pathology, Vanderbilt University Medical Center, Nashville, TN
| | - Eugene S. Kim
- Division of Pediatric Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Erica Newman
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children’s Hospital, The University of Michigan, Ann Arbor, MI
| | - Dave R. Lal
- Division of Pediatric Surgery, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI
| | - Barrie S. Rich
- Division of Pediatric Surgery, Zucker School of Medicine at Hofstra/
| | - Nelson Piché
- Division of Pediatric Surgery, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Zachary J. Kastenberg
- Department of Surgery, Division of Pediatric Surgery, University of Utah, Primary Children’s Hospital, Salt Lake City, UT
| | - Marcus M. Malek
- Division of Pediatric General and Thoracic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Richard D. Glick
- Division of Pediatric Surgery, Zucker School of Medicine at Hofstra/
| | - Robin T. Petroze
- Division of Pediatric Surgery, University of Florida, Gainesville, FL
| | | | - Richard Whitlock
- Department of Surgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - Elizabeth Alore
- Department of Surgery, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | | | - Stephanie Y. Chen
- Division of Pediatric Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Shannon Wong-Michalak
- Department of Surgery, Division of Pediatric Surgery, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Rodrigo LP Romao
- Division of Pediatric Surgery and Pediatric Urology, IWK Health, Dalhousie University, Halifax, NS, Canada
| | - Ameer Al-Hadidi
- Department of Surgery, Division of Pediatric Surgery, Nationwide Children’s Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Nathan S. Rubalcava
- Section of Pediatric Surgery, Department of Surgery, C.S. Mott Children’s Hospital, The University of Michigan, Ann Arbor, MI
| | - John P. Marquart
- Division of Pediatric Surgery, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI
| | - Hailey Gainer
- Division of Pediatric Surgery, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI
| | - Mike Johnson
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children’s Medical Center, Cincinnati, OH
| | - Chloe Boehmer
- Department of Pediatric General and Thoracic Surgery, Cincinnati Children’s Medical Center, Cincinnati, OH
| | - Hannah Rinehardt
- Division of Pediatric General and Thoracic Surgery, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA
| | - Natashia M. Seemann
- Department of Surgery, Division of Pediatric Surgery, Western University, London, ON, Canada
| | - Jacob Davidson
- Department of Surgery, Division of Pediatric Surgery, Western University, London, ON, Canada
| | - Valerie Polcz
- Division of Pediatric Surgery, University of Florida, Gainesville, FL
| | | | - Katlyn G. McKay
- Department of Pediatric Pathology, Vanderbilt University Medical Center, Nashville, TN
| | - Hernan Correa
- Department of Pediatric Pathology, Vanderbilt University Medical Center, Nashville, TN
| | - David H. Rothstein
- Department of Surgery, Division of General and Thoracic Surgery, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA
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