Impact of Age on Overall Survival Among Children With Wilms Tumor

Abstract

Objectives: International trials have reported conflicting findings on whether the association between age and worse overall survival (OS) among children with Wilms tumor (WT) is due to age as an independent prognostic factor or the observation of more advanced disease at older ages. We sought to further elucidate this relationship using a population-based registry analysis. Methods: The Surveillance, Epidemiology, and End Results database was queried for all patients diagnosed with WT under the age of 20. The association between age and OS was assessed using multivariable Cox proportional hazards regression. Results: In this study, 3463 patients (54% female) were diagnosed with WT between 1975 and 2016. More advanced stage, larger primary tumor size, lymph node involvement, disease requiring radiotherapy, and omission of surgery were associated with worse OS (P<0.05). More advanced stage, larger primary tumor size, and disease requiring radiotherapy were also associated with older age, whereas bilateral disease was associated with younger age (P<0.001). On average, each year of age conferred an incremental hazard ratio (HR) of 1.07 (95% CI, 1.01 to 1.12, P=0.018) independent of relevant covariates. The rise in adjusted OS HR was most pronounced after the transitions in diagnosis age from 2 to 3 (HRage 3–15 vs. 0–2 1.77, 95% CI, 1.11 to 2.82, P=0.016) and from 15 to 16 (HRage 16–19 vs. 3–15 2.58, 95% CI, 1.06 to 6.25, P=0.036). Conclusions: Diagnosis of pediatric WT at an older age was found to be independently associated with worse OS. Although additional prospective studies are warranted to examine tumor biology and other potential correlates, more aggressive treatment of older children based on age, especially as they approach early adulthood, may be considered in the multidisciplinary management of WT.

How to improve initial diagnostic accuracy of kidney tumours in childhood?—A non‐invasive approach

“…[22][23][24] Compared to previous studies, we found a higher risk of distant metastasis for CCSK (13% vs. 4%-7%). 15,17 The association of older age, larger TV and more advanced tumour stage in our series of WT was recently also reported in a large SEER cohort of 3463 patients 25 (Supplemental Consistent with previous work, we identified CMN as the most common kidney tumour up to 3 months of age. 13 Thereafter the frequency decreases significantly as reported by others.…”

“…Compared to previous studies, we found a higher risk of distant metastasis for CCSK (13% vs. 4%–7%) 15,17 . The association of older age, larger TV and more advanced tumour stage in our series of WT was recently also reported in a large SEER cohort of 3463 patients 25 (Supplemental Table 3).…”

The impact of the route to diagnosis in nephroblastoma

“…During the Covid pandemic there was a higher proportion of advanced disease and larger tumor volumes in WT, but the time to the start of treatment was not delayed. 17 In older patients (adolescents and young adults) with WT a higher tumor burden can be found 18 which may be caused by a longer time to diagnosis also resulting in a poorer outcome. preventive medical examination or screening programs for CPSs.…”

“…Welter et al also discussed the importance of early diagnosis in CPS associated with WT 27 being in accordance with our findings that patients with tumor-related symptoms have larger tumor volumes and more metastatic disease. In addition, Qian et al 18 could show that older age in patients diagnosed with WT is independent of other factors associated with worse OS, which further emphasizes the need to ensure early diagnosis, In osteosarcoma, the prognostic impact of diagnostic and treatment delay resulting in higher tumor load was analyzed by Vasquez et al finding that latency to diagnosis did not influence EFS and OS, but outcome was poorer in patients with a longer time to complete treatment. 28 This time-period as a measure for treatment intensity was not analyzed in our study.…”