Wilms' tumor: long-term results from a single institution

Area of Science:

• Pediatric Oncology
• Surgical Pathology
• Clinical Outcomes Research

Background:

• Wilms tumor is a common pediatric kidney cancer.
• Accurate staging and understanding prognostic factors are crucial for effective treatment.
• The National Wilms Tumor Study (NWTS) staging system is widely used.

Purpose of the Study:

• To analyze the impact of staging, histopathology, and surgical factors on the outcomes of children with Wilms tumor.
• To evaluate the 10-year actuarial survival rates based on different prognostic indicators.

Main Methods:

• Retrospective analysis of 112 children diagnosed with Wilms tumor between 1979-1989.
• Utilized the National Wilms Tumor Study (NWTS) staging system for classification.
• Treatment included nephrectomy, radiotherapy, and/or chemotherapy based on stage and pathology.
• Univariate analyses were performed to assess the significance of various factors on survival.

Main Results:

• Favorable histology showed significantly better 10-year survival rates compared to unfavorable histology.
• NWTS stage impacted disease-free survival but not overall survival.
• Massive tumor rupture and surgical residuum increased local recurrence but not distant metastasis.
• Retroperitoneal lymph node involvement increased local relapse and decreased overall survival.

Conclusions:

• Histopathology is a critical determinant of both disease-free and overall survival in Wilms tumor.
• Surgical complications like tumor rupture and residuum, along with lymph node involvement, significantly affect local recurrence and overall survival.
• Age at diagnosis had a borderline effect on disease-free survival but not overall survival.