Selection of morphometric features that identify responders and nonresponders in stage IV Wilms' tumors

Wilms' tumor is the most common renal malignancy of childhood. The use of histologic grade and stage has divided those patients into two main groups, responders and nonresponders, based on the absence or presence of extreme cytologic atypia (anaplasia). Patients with Wilms' tumor who have favorable histology experience excellent cure rates with relatively conservative treatment regimens. However, some patients with a favorable histologic diagnosis die of the disease. Destained hematoxylin and eosin-stained tissue sections were restained stoichiometrically with Feulgen stain, and 100 tumor cells per case were measured on a CAS 200 running CMP software. Using multivariant stepwise discriminant analysis on 13 cases of stage IV, favorable-histology Wilms' tumor, we successfully classified 92% of individuals into their correct prognostic groupings using 10 features of the quantitative morphology of tumor cells, including six Markovian textures. This morphometric technique may identify patients who can benefit from reduced therapy and those who must be treated with the more aggressive, classic therapy regimens.