Available online 15 December 2022, 101896

Author links open overlay panelAbstractBackground

To identify prognostic factors for overall survival through the analysis of 132 patients with Wilms tumor followed at a single center, with emphasis on the inferior vena cava/right atrium extension.

Methods

Retrospective analysis of overall survival using logistic regression models and including age, sex, clinical features, associated syndromes, comorbidities, tumor size before chemotherapy, stage, presence of metastatic disease and its site, invasion of adjacent structures, inferior vena cava/right atrium extension, laterality, tumor histology, chemotherapy protocol, and radiotherapy as potential risk factors.

Results

From January 2000 through November 2021, 132 patients met the inclusion criteria, 64 females and 68 males; 15 (11.4%) patients presented with tumoral extension to inferior vena cava/right atrium and 44 had metastatic disease (33.3%). Based on logistic regression, the factors correlating to a fatal outcome were male sex (p = 0.046), high risk histology (p = 0.036), and the presence of metastatic disease (p = 0.003). None of the patients presenting inferior vena cava/right atrium extension died (p = 0.992). In a specific analysis of metastatic sites, hepatic metastasis alone showed correlation with a fatal outcome (p = 0.001).

Conclusion

These results underline the importance of identifying and treating metastatic disease and high-risk tumors. The female gender as a potential driver for a less aggressive disease is a new finding that deserves further investigation. The accurate identification of inferior vena cava/right atrium extension, subsequent preoperative chemotherapy, and resection with a skilled team promoted survival rates of all patients.

Section snippetsData collection

We conducted a retrospective review of our database searching for all patients with Wilms tumor seen at our service from January 2000 through November 2021. The institutional Ethics Committee approved the study, and informed consent was obtained from the parents of all patients. The informed consent was obtained for experimentation with human subjects and the privacy rights of human subjects was always observed. We identified 132 patients with electronic medical records from where we collected

Data analysis

Our study population included 64 female and 68 male patients. The median age at diagnosis was 3 years old (mean 2.22 years old, range 2 months–12 years old). Symptoms at admission, other subsequent symptoms and the associated genetic syndromes are shown in Table 1. Patients with tumor imaging measurements recorded presented a mean tumor size of 10.7 cm, ranging from 1.8 to 24 cm. Invasion of adjacent structures and distant metastatic disease are shown in Table 2. Other tumor and patients’

Discussion

The survival rates of children with WT have increased in recent years, even in cases with serious vascular tumor extension. After a thorough data collection, we obtained information from 132 patients and sought to identify prognostic factors for overall survival. Previous studies of the same kind have usually been conducted in a collaborative setting, gathering databases from different centers. Nevertheless, we decided to conduct this retrospective analysis exclusively on our database,

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declaration of competing interest

None.

References (23)R.J. Duarte et al.Wilms tumor: a retrospective study of 32 patients using videolaparoscopic and open approaches

Urology

(2014)

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© 2022 Published by Elsevier Ltd.