Cui Kongkong,Yang Shuhan,Tian Xiaomao,et al.Treatments and prognoses of recurrent Wilms’ tumor in children: a retrospective study at a single center[J].Journal of Clinical Pediatric Surgery,,():934-939.[doi:10.3760/cma.j.cn101785-202507009-006]
Treatments and prognoses of recurrent Wilms’ tumor in children: a retrospective study at a single center
- Keywords:
- Wilms Tumor; Recurrence; Risk Factors; Prognosis; China
- Abstract:
- Objective To explore the risk factors associated with recurrence and prognoses of Wilms tumor (WT). Methods A retrospective analysis was conducted for the relevant clinical data of 250 WT children admitted from January 2004 to December 2023.They were assigned into two groups of recurrence (n=32,12.8%) and non-recurrence (n=218,87.2%).Gender,age at presentation,tumor stage,subtype,history of preoperative chemotherapy and metastatic status at diagnosis was recorded.Multivariate Logistic regression analysis was performed to examine the influencing factors of WT recurrence and Kaplan-Meier method to calculate the survival rate. Results Time from surgery to recurrence in recurrence group was 9.3 (5.3,17.6) month.Recurrence was local (n=16),metastatic (n=8) and multiple site (n=8) (local+metastatic).Univariate and multivariate analyses revealed that age >4 year at presentation was an independent risk factor for recurrence after WT surgery.And 22/32 recurrent cases underwent surgery and chemotherapy.Outcome was survival (n=13) and death (n=9).Among 9 cases on chemotherapy,5 survived and 4 died; 1 refused treatment.The causes of death in 14 deceased cases included treatment-related complications (5/14,35.7%),tumor progression (4/14,28.6%),severe infection (3/14,21.4%),electrolyte imbalance (1/14,7.1%) and tumor rupture & hemorrhage (1/14,7.1%). Conclusions WT children aged 4 year or above are more prone to experience recurrence after treatment.There is a high mortality risk among children with recurrent wilms tumor.Thoroughly assessing risk factors for recurrence,early identification and proactive intervention are crucial for improving prognoses and enhancing quality-of-life.
References:
[1] Termuhlen AM,Tersak JM,Liu Q,et al.Twenty-five year follow-up of childhood Wilms tumor:a report from the Childhood Cancer Survivor Study[J].Pediatr Blood Cancer,2011,57(7):1210-1216.DOI:10.1002/pbc.23090.
[2] Brok J,Lopez-Yurda M,Tinteren HV,et al.Relapse of Wilms’ tumour and detection methods:a retrospective analysis of the 2001 renal tumour study group-international society of paediatric oncology Wilms’ tumour protocol database[J].Lancet Oncol,2018,19(8):1072-1081.DOI:10.1016/S1470-2045(18)30293-6.
[3] Libes J,Hol J,de Aguirre Neto JC,et al.Pediatric renal tumor epidemiology:global perspectives,progress,and challenges[J].Pediatr Blood Cancer,2023,70(Suppl 2):e30343.DOI:10.1002/pbc.30343.
[4] Aslam A,Foot AB,Spicer RD.Needle track recurrence after biopsy of non-metastatic Wilms tumour.Pediatr Surg Int.1996;11(5-6):416-417.
[5] Pritchard-Jones K,Kelsey A,Vujanic G,et al.Older age is an adverse prognostic factor in stage I,favorable histology Wilms’ tumor treated with vincristine monochemotherapy: a study by the United Kingdom Children’s Cancer Study Group,Wilm’s Tumor Working Group.Journal of clinical oncology: official journal of the American Society of Clinical Oncology.2003;21(17):3269-3275.
[6] D’Angio GJ,Evans AE,Breslow N,et al.The treatment of Wilms’ tumor:results of the national Wilms’ tumor study[J].Cancer,1976,38(2):633-646.DOI:10.1002/1097-0142(197608)38:2<633::aid-cncr2820380203>3.0.co;2-s.
[7] Hol JA,Lopez-Yurda MI,Van Tinteren H,et al.Prognostic significance of age in 5631 patients with Wilms tumour prospectively registered in International Society of Paediatric Oncology (SIOP) 93-01 and 2001[J].PLoS One,2019,14(8):e0221373.DOI:10.1371/journal.pone.0221373.
[8] Irtan S,Jitlal M,Bate J,et al.Risk factors for local recurrence in Wilms tumour and the potential influence of biopsy-the United Kingdom experience[J].Eur J Cancer,2015,51(2):225-232.DOI:10.1016/j.ejca.2014.10.026.
[9] Dix DB,Fernandez CV,Chi YY,et al.Augmentation of therapy for combined loss of heterozygosity 1p and 16q in favorable histology Wilms tumor:a Children’s Oncology Group AREN0532 and AREN0533 study report[J].J Clin Oncol,2019,37(30):2769-2777.DOI:10.1200/JCO.18.01972.
[10] Gratias EJ,Dome JS,Jennings LJ,et al.Association of chromosome 1q gain with inferior survival in favorable-histology Wilms tumor:a report from the children’s oncology group[J].J Clin Oncol,2016,34(26):3189-3194.DOI:10.1200/JCO.2015.66.1140.
[11] Sutow WW,Breslow NE,Palmer NF,et al.Prognosis in children with Wilms’ tumor metastases prior to or following primary treatment:results from the first National Wilms’ Tumor Study (NWTS-1)[J].Am J Clin Oncol,1982,5(4):339-347.DOI:10.1097/00000421-198208000-00001.
[12] Green DM,Cotton CA,Malogolowkin M,et al.Treatment of Wilms tumor relapsing after initial treatment with vincristine and actinomycin D:a report from the national Wilms tumor study group[J].Pediatr Blood Cancer,2007,48(5):493-499.DOI:10.1002/pbc.20822.
[13] D’Angio GJ,Evans AE,Breslow N,et al.The treatment of Wilms’ tumor: Results of the national Wilms’ tumor study.Cancer.1976;38(2):633-646.
[14] Honeyman JN,Rich BS,McEvoy MP,et al.Factors associated with relapse and survival in Wilms tumor:a multivariate analysis[J].J Pediatr Surg,2012,47(6):1228-1233.DOI:10.1016/j.jpedsurg.2012.03.030.
[15] Schiavetti A,Bonci E,Varrasso G,et al.Evaluation of nephron-sparing surgery as potential risk factor for relapse in unilateral Wilms tumor[J].J Surg Res,2020,247:21-27.DOI:10.1016/j.jss.2019.11.001.
[16] Huang JT,Zhang Y,Zhen ZJ,et al.The prognosis of prechemotherapy blastemal predominant histology subtype in Wilms tumor:a retrospective study in China[J].Pediatr Blood Cancer,2020,67(11):e28567.DOI:10.1002/pbc.28567.
[17] Shamberger RC,Guthrie KA,Ritchey ML,et al.Surgery-related factors and local recurrence of Wilms tumor in National Wilms Tumor Study 4[J].Ann Surg,1999,229(2):292-297.DOI:10.1097/00000658-199902000-00019.
[18] 解鲁璐,刘百慧,董瑞,等.肾母细胞瘤复发危险因素分析[J].中华小儿外科杂志,2023,44(11):986-992.DOI:10.3760/cma.j.cn421158-20230919-00350. Xie LL,Liu BH,Dong R,et al.Relapsing risk factors for Wilms tumor[J].Chin J Pediatr Surg,2023,44(11):986-992.DOI:10.3760/cma.j.cn421158-20230919-00350.
[19] Meier CM,Furtw?ngler R,Mergen M,et al.Impact of time to surgery on outcome in Wilms tumor treated with preoperative chemotherapy[J].Cancers (Basel),2023,15(5):1494.DOI:10.3390/cancers15051494.
[20] 谢晨捷,顾松,田瑞成,等.儿童复发肾母细胞瘤的治疗及预后相关因素分析[J].临床小儿外科杂志,2021,20(5):430-436.DOI:10.12260/lcxewkzz.2021.05.007. Xie CJ,Gu S,Tian RC,et al.Treatment and prognostic factors of recurrent Wilm’s tumor in children[J].J Clin Ped Sur,2021,20(5):430-436.DOI:10.12260/lcxewkzz.2021.05.007.
[21] Yagasaki H,Katsumi Y,Nozaki M,et al.Long-term survey of Japanese children with recurrent nephroblastoma:a report from Japan Children’s Cancer Group[J].Pediatr Hematol Oncol,2025,42(1):14-26.DOI:10.1080/08880018.2024.2423207.
[22] Bordbar S,Shahriari M,Zekavat OR,et al.The outcomes of children with primary malignant renal tumors:a 14-year single-center experience[J].BMC Cancer,2024,24(1):1388.DOI:10.1186/s12885-024-13150-4.
[23] 王天怡,潘慈,高怡瑾,等.儿童肾母细胞瘤复发后再治疗长期随访研究[J].中华儿科杂志,2017,55(10):743-747.DOI:10.3760/cma.j.issn.0578-1310.2017.10.006. Wang TY,Pan C,Gao YJ,et al.A long-term follow-up report of pediatric relapsed Wilms tumor after retreatment[J].Chin J Pediatr,2017,55(10):743-747.DOI:10.3760/cma.j.issn.0578-1310.2017.10.006.
Memo
收稿日期:2025-7-4。
基金项目:国家科学自然基金(82302948)
通讯作者:石秦林,Email:485141@hospital.cqmu.edu.cn