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Outcome of patients with stage II/favorable histology wilms tumor with and without local tumor spill: A report from the National Wilms Tumor Study Group
Author(s) -
Green Daniel M.,
Breslow Norman E.,
D'Angio Giulio J.,
Malogolowkin Marcio H.,
Ritchey Michael L.,
Evans Audrey E.,
Beckwith J. Bruce,
Perlman Elizabeth J.,
Shamberger Robert C.,
Peterson Susan,
Grundy Paul E.,
Dome Jeffrey S.,
Thomas Patrick R.M.,
Kalapurakal John A.
Publication year - 2014
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.24658
Subject(s) - medicine , wilms' tumor , hazard ratio , stage (stratigraphy) , confidence interval , vincristine , histology , statistical significance , chemotherapy , proportional hazards model , oncology , cyclophosphamide , paleontology , biology
Background Intra‐operative tumor spill increases the risk of local recurrence of Wilms tumor, and adversely impacts relapse‐free (RFS) and overall survival (OS) rates. Methods Surgical checklists, operative notes, institutional pathology reports, central pathology review and flow sheets of 602 patients registered between August 1986 and September 1994 on National Wilms Tumor Study—4 as randomized, followed or switched and coded as Final Stage II, favorable histology (FH) were reviewed. RFS and OS were estimated using the Kaplan–Meier method. Hazard ratios (HRs) were estimated using the Cox model and tested for statistical significance by the log‐rank test. Results Four hundred ninety‐nine patients were found after review to have Stage II, FH Wilms tumor. The 8‐year RFS percentages were 85.0% (95% confidence interval (CI): 81.1%, 88.1%) for those with no spill compared to 75.7% (65.8%, 83.2%) for those with spill. The 8‐year OS percentages were 95.6% (93.1%, 97.3%) for those with no spill compared to 90.3% (82.2%, 94.9%) for those with spill. The HR for relapse among those with spill was 1.55 ((95%CI: 0.97,2.51), P = 0.067) and the HR for death was 1.94 ((0.92,4.09), P = 0.077). Conclusions RFS and OS were lower for patients who had intra‐operative tumor spill. The majority of NWTS Stage II, FH patients with intra‐operative tumor spill have an overall excellent outcome when treated with two drug chemotherapy (vincristine and actinomycin D) and no abdominal irradiation. Pediatr Blood Cancer 2014;61:134–139. © 2013 Wiley Periodicals, Inc.