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Association of Systemic Inflammatory Markers and Clinical Outcomes Among Children With Wilms Tumor
Shannon N Acker1,2,3, Ioannis A Ziogas1, Nicholas Cost2,3,4
1Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA.
Insights
Elevated inflammatory markers like NLR, PLR, and LMR in children with Wilms tumor correlate with advanced disease stages and poorer outcomes, indicating their prognostic value.
Area of Science:
- Pediatric Oncology
- Tumor Microenvironment
- Biomarkers
Background:
- Elevated inflammatory markers (NLR, PLR, LMR) predict outcomes in adult renal tumors.
- This study investigates their role in pediatric Wilms tumor.
Purpose of the Study:
- To determine if elevated inflammatory markers at diagnosis predict higher disease stages and adverse outcomes in children with Wilms tumor.
Main Methods:
- Retrospective review of 235 children with Wilms tumor (2002-2022).
- Compared demographics and lab parameters by disease stage.
- Analyzed tumor characteristics and outcomes based on elevated LMR, NLR, and PLR using statistical tests.
Main Results:
- Preoperative LMR, NLR, and PLR increased with Wilms tumor stage.
- Elevated NLR, PLR, and LMR were associated with higher odds of stage 3 or 4 disease.
- These associations remained significant after controlling for age, histology, and genetic markers.
Conclusions:
- Serum inflammatory markers (LMR, NLR, PLR) at diagnosis are linked to advanced Wilms tumor stage.
- Elevated markers predict cancer recurrence and unfavorable histology in pediatric Wilms tumor.
Background:
Elevated pre-treatment inflammatory markers predict disease progression and overall survival among adults with renal tumors, including elevated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR). We hypothesized that elevated inflammatory markers at diagnosis predict higher disease stages and adverse outcomes for children with Wilms tumor.
Procedure:
We performed a retrospective review of children with Wilms tumor who underwent surgical resection at two centers from 2002 to 2022. Differences in patient demographics and laboratory parameters were compared between the overall disease stages. Differences in tumor characteristics and patient outcomes were compared by elevated LMR, NLR, and PLR at diagnosis using Wilcoxon tests and chi-squared or Fisher's exact tests. For LMR, NLR, and PLR, optimal cut points for predicting disease ≥ stage 3 were determined using the Youden index for optimization.
Results:
Data were collected from 235 children with Wilms tumor. The median age was 39.8 months and 50.2% of patients were female; 40 had stage 1 disease, 50 had stage 2 disease, 61 had stage 3 disease, 54 had stage 4 disease, and 26 had stage 5 disease. Preoperative inflammatory markers varied with the overall stage. LMR, NLR, and PLR increased as the stage increased. After controlling for age, final histology, and any abnormal genetic marker, elevated NLR, PLR, and LMR at presentation were each associated with significantly higher odds of stage 3 or 4 disease.
Conclusion:
Elevation in serum inflammatory markers at diagnosis among children with Wilms tumors is associated with higher disease stage, cancer recurrence, and unfavorable histology.
