Improved survival with lymph node sampling in Wilms tumor

Abstract

Objective: We sought to determine the impact of number of lymph nodes examined on survival for Wilms tumor (WT). Methods: Data from the Surveillance, Epidemiology, and End Results and Florida Cancer Data System were queried for patients < 20 years of age with WT. Results: Of 1805 WT patients, 1340 had lymph node (LN) data available following surgery. The mean age for the cohort was 3.3 ± 2.8 y. Most patients were White (78%), and non-Hispanic (78%). A total of 297 patients (22%) had 0 LN sampled, while 697 (52%) had 1-5 LN, 210 (16%) had 6-10 LN, and 136 (10%) had > 10 LN. Overall 5-y survival was 91%. By univariate analysis, 5-y survival was significantly lower for patients with 0 LN sampled (87% versus 91% 1-5 LN; 93% 6-10 LN; 95% > 10 LN, P = 0.005). Multivariate analysis confirmed a survival advantage for patients having 1-5 LN (HR 0.600, P = 0.016), 6-10 LN (HR 0.521, P = 0.048), and > 10 LN (HR 0.403, P = 0.039) compared with patients with 0 LN examined. Conclusion: Failure to biopsy lymph nodes for WT patients not only increases the risk of local recurrence due to understaging and inadequate adjuvant therapy, but is also an independent prognostic indicator of lower survival.

Pediatric genitourinary tumors

“…The importance of adequate lymph node biopsy is stressed by Zhuge et al [11], who demonstrated that failure to biopsy lymph nodes increased risk of local recurrence, and was an independent prognostic indicator of survival. Data from Associazione Italiana Ematologia Oncologia Pediatrica suggest that it may be useful to separate stage III patients into those with positive and negative lymph nodes, as this was prognostic of outcome in their patient population [10 & ].…”

Minimally invasive surgery in management of renal tumours in children

“…There has been a controversy if the number of lymph nodes resected is associated with 5-year survival rate, as two large studies have had different conclusions. Zhuge et al reviewed available lymph node data in 1,340 patients, and reported a significantly lower 5-year overall survival for patients with absent lymph node sampling (87%) versus patients with more than ten lymph node sampled (95%) (43). Kieran et al concluded however that number of lymph node sampled did not change 5-year survival variation in their review of 3,409 patients, and found that only patients with anaplastic tumours had greater effect on lymph node positivity.…”

The Role of Hispanic Ethnicity in Pediatric Wilms’ Tumor Survival

“…Between 1973 and 2009, over 7,000,000 cancer cases were reported to SEER, which is one of the largest population-based datasets on adult and pediatric cancers currently available [15,17]. For this analysis, the study population was restricted to individuals diagnosed between 1990 and 2009 both because of changes in WT diagnostic criteria and standard of care over time [18,3] and because detailed Hispanic ethnicity data were not collected on all SEER cases prior to the late 1980s [17].…”

“…WT patients usually have a good prognosis, with an overall survival of over 90% [12], due partially to advances in treatment stemming from recommendations by the National Wilms Tumor Study Group (NWTS) and the International Society of Paediatric Oncology (SIOP) [3,[13][14][15][16]. However, few, if any, studies have specifically focused on elucidating the association between Hispanic ethnicity and WT prognosis.…”