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Pediatric Surgery International

Published in:

01-04-2018 | Original Article

Retrospective analysis to determine outcomes of patients with bilateral Wilms tumor undergoing nephron sparing surgery: 15-year tertiary single-institution experience

Authors: Xiao-Hui Tan, De-Ying Zhang, Xing Liu, Tao Lin, Da-Wei He, Xu-Liang Li, Guang-Hui Wei

Published in: Pediatric Surgery International | Issue 4/2018

Abstract

Purpose

To describe our clinical experience with nephron sparing surgery (NSS) for bilateral Wilms tumor and evaluate the outcomes of patients treated at one of the largest pediatric medical centers in China.

Methods

Medical records of children with bilateral Wilms tumor undergoing NSS in the Children’s Hospital of Chongqing Medical University during a 15-year period were retrospectively analyzed. Data collected were composed of age at surgery, tumor response, tumor rupture during resection, final pathologic margins, use of radiation therapy, pathology reports, renal function, and patient survival.

Results

A total of 18 eligible patients (10 males, 8 females) with bilateral Wilms tumor at a mean age of 2.28 ± 1.12 years were identified. The administration of preoperative chemotherapy did not result in universally successful outcomes. All children underwent successfully unilateral or bilateral NSS, of which one had positive pathologic margins and five received radiation therapy postoperatively. The rates of tumor rupture and positive lymph nodes involvement were 11.1 and 19.4%, respectively. The pathological study showed favorable histology and unfavorable histology in 32 and 4 kidneys, respectively. The 4-year event-free survival and overall survival rates were 68.18 and 85.56%. In univariable analysis, tumor histology (p = 0.0028) and disease stage (p = 0.0303) appeared significantly associated with overall survival. After a median follow-up period of 41.5 months (range 10–89), three of the surviving patients were diagnosed with hypertension and one had renal insufficiency.

Conclusions

Our experience suggests that NSS has become a feasible and effective option with good oncologic outcomes. Further research, ideally in a multicenter randomized manner, is warranted to better assess the role of NSS in this challenging clinical scenario.

Ward E, DeSantis C, Robbins A, Kohler B, Jemal A (2014) Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin 64:83–103. https://doi.org/10.3322/caac.21219 CrossRefPubMed

Dumoucel S, Gauthier-Villars M, Stoppa-Lyonnet D, Parisot P, Brisse H, Philippe-Chomette P et al (2014) Malformations, genetic abnormalities, and wilms tumor. Pediatr Blood Cancer 61:140–144. https://doi.org/10.1002/pbc.24709 CrossRefPubMed

Dome JS, Graf N, Geller JI, Fernandez CV, Mullen EA, Spreafico F et al (2015) Advances in Wilms tumor treatment and biology: progress through international collaboration. J Clin Oncol 33:2999–3007. https://doi.org/10.1200/JCO.2015.62.1888 CrossRefPubMedPubMedCentral

Mir MC, Derweesh I, Porpiglia F, Zargar H, Mottrie A, Autorino R (2017) Partial nephrectomy versus radical nephrectomy for clinical T1b and T2 renal tumors: a systematic review and meta-analysis of comparative studies. Eur Urol 71:606–617. https://doi.org/10.1016/j.eururo.2016.08.060 CrossRefPubMed

Miller DC, Schonlau M, Litwin MS, Lai J, Saigal CS (2008) Renal and cardiovascular morbidity after partial or radical nephrectomy. Cancer 112:511–520. https://doi.org/10.1002/cncr.23218 CrossRefPubMed

Motzer RJ, Jonasch E, Agarwal N, Bhayani S, Bro WP, Chang SS et al (2017) Kidney cancer, version 2.2017, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 15:804–834. https://doi.org/10.6004/jnccn.2017.0100 CrossRefPubMed

Vanden Berg RNW, Bierman EN, Noord MV, Rice HE, Routh JC (2016) Nephron-sparing surgery for Wilms tumor: a systematic review. Urol Oncol 34:24–32. https://doi.org/10.1016/j.urolonc.2015.07.003 CrossRefPubMed

Harel M, Makari JH, Ferrer FA. Oncology (2013) The role of partial nephrectomy in Wilms tumor. Curr Urol Rep 14:350–358. https://doi.org/10.1007/s11934-013-0330-0 CrossRefPubMed

Wilde JCH, Aronson DC, Sznajder B, Van Tinteren H, Powis M, Okoye B et al (2014) Nephron sparing surgery (NSS) for unilateral wilms tumor (UWT): the SIOP 2001 experience. Pediatr Blood Cancer 61:2175–2179. https://doi.org/10.1002/pbc.25185 CrossRefPubMed

10.

Ehrlich P, Chi YY, Chintagumpala MM, Hoffer FA, Perlman EJ, Kalapurakal JA et al (2017) Results of the first prospective multi-institutional treatment study in children with bilateral wilms tumor (AREN0534). Ann Surg 266:470–478. https://doi.org/10.1097/SLA.0000000000002356 CrossRefPubMedPubMedCentral

11.

Interiano RB, Delos Santos N, Huang S, Srivastava DK, Robison LL, Hudson MM et al (2015) Renal function in survivors of nonsyndromic Wilms tumor treated with unilateral radical nephrectomy. Cancer 121:2449–2456. https://doi.org/10.1002/cncr.29373 CrossRefPubMedPubMedCentral

12.

Wang HS, Abern MR, Cost NG, Chu DI, Ross SS, Wiener JS et al (2014) Use of nephron sparing surgery and impact on survival in children with Wilms tumor: a SEER analysis. J Urol 192:1196–1202. https://doi.org/10.1016/j.juro.2014.04.003 CrossRefPubMedPubMedCentral

13.

Dome JS, Perlman EJ, Graf N (2014) Risk stratification for Wilms tumor: current approach and future directions. Am Soc Clin Oncol Educ Book 34:215–223. https://doi.org/10.14694/EdBook_AM.2014.34.215 CrossRef

14.

Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R et al (2009) New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer 45:228–247. https://doi.org/10.1016/j.ejca.2008.10.026 CrossRefPubMed

15.

Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA et al (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637. https://doi.org/10.1681/ASN.2008030287 CrossRefPubMedPubMedCentral

16.

Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S et al (2006) Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 145:247–254CrossRefPubMed

17.

Chagtai T, Zill C, Dainese L, Wegert J, Savola S, Popov S et al (2016) Gain of 1q As a prognostic biomarker in Wilms tumors (WTs) treated with preoperative chemotherapy in the international society of paediatric oncology (SIOP) WT 2001 trial: a SIOP renal tumours biology consortium study. J Clin Oncol 34:3195–3203. https://doi.org/10.1200/JCO.2015.66.0001 CrossRefPubMedPubMedCentral

18.

Gratias EJ, Dome JS, Jennings LJ, Chi Y, Tian J, Anderson J et al (2016) Association of chromosome 1q gain with inferior survival in favorable-histology Wilms tumor: a report from the children’s oncology group. J Clin Oncol 34:3189–3194. https://doi.org/10.1200/JCO.2015.66.1140 CrossRefPubMedPubMedCentral

19.

Sudour H, Audry G, Schleimacher G, Patte C, Dussart S, Bergeron C (2012) Bilateral Wilms tumors (WT) treated with the SIOP 93 protocol in France: epidemiological survey and patient outcome. Pediatr Blood Cancer 59:57–61. https://doi.org/10.1002/pbc.24059 CrossRefPubMed

20.

Lim I, Honeyman J, Fialkowski E, Murphy J, Price A, Abramson S et al (2015) Experience with retroperitoneal partial nephrectomy in bilateral Wilms tumor. Eur J Pediatr Surg 25:113–117. https://doi.org/10.1055/s-0034-1387944 CrossRefPubMed

21.

Fuchs J, Szavay P, Seitz G, Handgretinger R, Schäfer JF, Warmann SW (2011) Nephron sparing surgery for synchronous bilateral nephroblastoma involving the renal hilus. J Urol 186:1430–1436. https://doi.org/10.1016/j.juro.2011.05.068 CrossRefPubMed

22.

Lopes RI, Ming J, Koyle MA, Grant R, Fonseca A, Lorenzo AJ (2017) “Zero-Ischemia” laparoscopic-assisted partial nephrectomy for the management of selected children with Wilms tumor following neoadjuvant chemotherapy. Urology 100:103–110. https://doi.org/10.1016/j.urology.2016.08.051 CrossRefPubMed

23.

Huang WC, Elkin EB, Levey AS, Jang TL, Russo P (2009) Partial nephrectomy versus radical nephrectomy in patients with small renal tumors—is there a difference in mortality and cardiovascular outcomes? J Urol 181:55–62. https://doi.org/10.1016/j.juro.2008.09.017 CrossRefPubMed

24.

Linni K, Urban C, Lackner H, Hollwarth ME (2003) Nephron-sparing procedures in 11 patients with Wilms’ tumor. Pediatr Surg Int 19:457–462. https://doi.org/10.1007/s00383-003-0957-x CrossRefPubMed

25.

Cost NG, Lubahn JD, Granberg CF, Sagalowsky AI, Wickiser JE, Gargollo PC et al (2012) Pathological review of Wilms tumor nephrectomy specimens and potential implications for nephron sparing surgery in Wilms tumor. J Urol 188:1506–1510. https://doi.org/10.1016/j.juro.2012.02.025 CrossRefPubMed

26.

Ferrer FA, Rosen N, Herbst K, Fernandez CV, Khanna G, Dome JS et al (2013) Image based feasibility of renal sparing surgery for very low risk unilateral Wilms tumors: a report from the children’s oncology group. J Urol 190:1846–1851. https://doi.org/10.1016/j.juro.2013.05.060 CrossRefPubMed

27.

Hamilton TE, Ritchey ML, Haase GM, Argani P, Peterson SM, Anderson JR et al (2011) The management of synchronous bilateral Wilms tumor: a report from the national Wilms tumor study group. Ann Surg 253:1004–1010. https://doi.org/10.1097/SLA.0b013e31821266a0 CrossRefPubMedPubMedCentral

28.

Pottel H, Hoste L, Delanaye P (2015) Abnormal glomerular filtration rate in children, adolescents and young adults starts below 75 mL/min/1.73 m². Pediatr Nephrol 30:821–828. https://doi.org/10.1007/s00467-014-3002-5 CrossRefPubMed

29.

Cozzi DA, Ceccanti S, Frediani S, Mele E, Cozzi F (2013) Renal function adaptation up to the fifth decade after treatment of children with unilateral renal tumor: a cross-sectional and longitudinal study. Pediatr Blood Cancer 60:1534–1538. https://doi.org/10.1002/pbc.24545 CrossRefPubMed

30.

Hubertus J, Günther B, Becker K, Graf N, Furtwängler R, Ferrari R et al (2015) Development of hypertension is less frequent after bilateral nephron sparing surgery for bilateral Wilms tumor in a long-term survey. J Urol 193:262–267. https://doi.org/10.1016/j.juro.2014.07.116 CrossRefPubMed

Title: Retrospective analysis to determine outcomes of patients with bilateral Wilms tumor undergoing nephron sparing surgery: 15-year tertiary single-institution experience
Authors: Xiao-Hui Tan
De-Ying Zhang
Xing Liu
Tao Lin
Da-Wei He
Xu-Liang Li
Guang-Hui Wei
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 4/2018
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-018-4232-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Retrospective analysis to determine outcomes of patients with bilateral Wilms tumor undergoing nephron sparing surgery: 15-year tertiary single-institution experience

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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