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Renal tumor in developing countries: 142 cases from a single institution at Shanghai, China
Ci Pan1,2, Jiao-Yang Cai1,2, Min Xu1,3
1, Shanghai, China.
Insights
Pediatric renal tumors managed with National Wilms' Tumor Study Group protocols showed good outcomes. A multidisciplinary team approach is effective and safe in developing countries for treating childhood kidney cancers.
Area of Science:
- Pediatric Oncology
- Nephrology
- Clinical Management
Background:
- Clinical management of pediatric renal tumors (Wilms' tumor, clear cell sarcoma, rhabdoid tumor) at Shanghai Children's Medical Center followed National Wilms' Tumor Study Group protocols.
- Retrospective review of 142 consecutive pediatric renal tumor patients diagnosed between December 1998 and September 2012.
Purpose of the Study:
- To evaluate the feasibility and safety of established pediatric renal tumor management protocols in a developing country setting.
- To assess the outcomes of children with renal tumors treated using a multidisciplinary team approach.
Main Methods:
- Retrospective analysis of 142 pediatric patients with renal tumors.
- Diagnosis and treatment decisions guided by a multidisciplinary team (oncologists, surgeons, pathologists, radiologists).
- Adherence to National Wilms' Tumor Study Group protocols.
Main Results:
- Median age at diagnosis was 27 months.
- Tumor stages: Stage I (24.6%), Stage II (23.2%), Stage III (32.3%), Stage IV (14.1%), Stage V (5.6%).
- Histology: Favorable (80.3%), anaplasia (4.2%), clear cell sarcoma (9.8%), rhabdoid tumor (4.9%).
- 5-year event-free survival: 80%; overall survival: 83%.
- Relapse occurred in 17.6% of patients, with a median relapse time of 6 months.
- Seven relapsed patients received retreatment, achieving second complete remission in four cases.
Conclusions:
- A multidisciplinary team model is effective for managing pediatric renal tumors in developing countries.
- National Wilms' Tumor Study Group protocols are safe and applicable in developing countries for treating childhood kidney cancers.
- The study demonstrates successful implementation of international treatment standards in a resource-limited setting.
Background:
The clinical management of children with renal tumors including Wilms' tumor, clear cell sarcoma, rhabdoid tumor and other renal tumors in our center was designed according to the National Wilms' Tumor Study Group protocols.
Methods:
A total of 142 consecutive patients who had been diagnosed as having renal tumors at Shanghai Children's Medical Center were reviewed retrospectively in the period of December 1998 and September 2012. Diagnosis and treatment were decided by a multidisciplinary team including oncologists, surgeons, pathologists and sub-specialized radiologists.
Results:
The median age of the patients at the time of diagnosis was 27 months. The tumor stages of the patients were as follows: stage I 24.6%, stage II 23.2%, stage III 32.3%, stage IV 14.1%, and stage V 5.6%. Favorable histology was diagnosed in 80.3%, anaplasia in 4.2%, clear cell sarcoma in 9.8%, rhabdoid tumor in 4.9%, and other renal tumors in 0.7% of the patients. The event-free and overall 5-year survival rates were 80% and 83%, respectively. Tumor relapse and progress was seen in 25 patients (17.6%). The median relapse time was 6 months (range: 2-37 months). Seven relapsing patients were retreated and four of them got second complete remission (three in stage II, one in stage I).
Conclusion:
A multi-disciplinary team work model is feasible in developing countries, and the renal tumors protocols basically from developed countries are safe in developing countries.
