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Can Lymph Node Involvement in Unilateral Wilms Tumor be Predicted by Preoperatively known Data in Combination with
Clemens-Magnus Meier1, Rhoikos Furtwängler2,3, Nils Welter3
1Department of General Surgery, Visceral, Vascular and Paediatric Surgery, Saarland University, Homburg, Germany.
This study identified key factors like age, tumor volume, and metastasis at diagnosis to predict lymph node (LN) infiltration in Wilms tumor (WT). These findings aid surgeons in determining the extent of surgery, potentially improving outcomes for WT patients.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Tumor Biology
Background:
- Complete tumor resection with regional lymph node (LN) removal is crucial for Wilms tumor (WT) treatment.
- Positive LNs necessitate local irradiation, impacting outcomes, especially after nephron-sparing surgery (NSS).
- Estimating LN status during surgery is vital for treatment planning.
Purpose of the Study:
- To identify predictive parameters for tumor-infiltrated lymph nodes (LN) in unilateral Wilms tumor (WT) after neoadjuvant therapy.
- To develop tools for estimating LN status to guide surgical decisions.
Main Methods:
- Prospective enrollment of 2115 patients with unilateral WT over 30 years (SIOP-93-01 / GPOH and SIOP-2001 / GPOH).
- Logistic regression models were used to analyze the correlation between LN infiltration and factors including age, sex, metastasis, tumor volume (TV), TV shrinkage, and intraoperative findings (IAF).
Main Results:
- Age (≥48 months), TV at diagnosis (≥300), metastasis at diagnosis, and IAF (>1) were significantly correlated with positive LNs.
- Tumor volume shrinkage was not a significant predictor of LN infiltration.
- Three risk-stratification flowcharts were developed, estimating LN infiltration risk from 0% to 41.5% based on key clinical and intraoperative parameters.
Conclusions:
- A combination of patient age, tumor volume at diagnosis, metastasis status, and intraoperative findings effectively estimates the likelihood of lymph node involvement in Wilms tumor.
- These predictive parameters and developed flowcharts can assist surgeons in making informed decisions regarding nephron-sparing surgery (NSS).
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