Quality assessment for Wilms' tumor: a report from the National Wilms' Tumor Study-5

Ehrlich, Peter F.; Ritchey, Michael L.; Hamilton, Tomas E.; Haase, Gerald M.; Ou, San San; Breslow, Norman E.; Grundy, Paul E.; Green, Daniel; Norkool, Patricia; Becker, Jennifer; Shamberger, Robert C.

doi:10.1016/j.jpedsurg.2004.09.044

Cited by 108 publications

(69 citation statements)

References 17 publications

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“…[32][33][34][35][36] If lymph node samplings are not performed, it is likely that the number of patients with regional disease would be underestimated, whereas the localized patients would have a worse outcome. The SEER data suggest that adult Wilms' tumor patients, when treated in the community and off protocol, tend to be inadequately staged and are therefore undertreated compared with their pediatric counterparts.…”

Section: Discussionmentioning

confidence: 99%

A Surveillance, Epidemiology and End Results (SEER) program comparison of adult and pediatric Wilms' tumor

Ali¹,

Díaz²,

Shu³

et al. 2011

Cancer

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PURPOSE:To compare the characteristics and outcome of adults and children diagnosed with Wilms' tumor. METHODS: The Surveillance, Epidemiology and End Results (SEER) database was analyzed for patients diagnosed with Wilms' tumor between 1973 and 2007. Patients were stratified into pediatric (<16 years) or adult (!16 years) groups. Overall survival was the primary endpoint. RESULTS: A total of 2342 patients (2190 pediatric and 152 adult) with Wilms' tumor were identified. Adult patients were statistically more likely to be staged as localized than pediatric patients (62.5% vs 44.7%), to not receive any lymph node sampling (57.9% vs 16.2%), and to not receive any radiation treatment (74.3% vs 53.9%). Adults had a statistically worse overall survival (OS) than pediatric patients (5-year OS, 69% vs 88%, P<.001) despite the earlier tumor stage. When stratified by treatment era, the OS of all patients treated after 1981 was statistically higher than those treated before (5-year OS, 75% vs 89%, P<.001). Significant predictors of OS on univariate analysis for adults included treatment era, SEER stage, surgery, and radiation treatment. Significant predictors of OS on multivariate analysis of all patients included adult status (hazard ratio, 4.14; P<.001), treatment era, SEER stage, and surgery. CONCLUSION: Adults in the SEER database had statistically worse OS than pediatric patients despite previous studies showing comparable outcome when treated on protocol. The worse outcome of SEER adults likely stems from incorrect diagnosis, inadequate staging and undertreatment. We recommend lymph node samplings for all adult Wilms' tumor patients and collaboration with pediatric oncologists. Cancer 2012;118:2541-

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Section: Discussionmentioning

confidence: 99%

A Surveillance, Epidemiology and End Results (SEER) program comparison of adult and pediatric Wilms' tumor

Ali¹,

Díaz²,

Shu³

et al. 2011

Cancer

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“…The value of QA monitoring for surgical protocols in pediatric cancer studies has been previously demonstrated [7,8]. In the National Wilms' Tumor Study-5 protocol, deviations were identified that adversely impacted tumor staging and potentially increased the risk for local tumor recurrence or intensity and toxicity of therapy [7].…”

Section: Discussionmentioning

confidence: 99%

“…In the National Wilms' Tumor Study-5 protocol, deviations were identified that adversely impacted tumor staging and potentially increased the risk for local tumor recurrence or intensity and toxicity of therapy [7].…”

Section: Discussionmentioning

confidence: 99%

Monitoring diagnostic accuracy and complications. A report from the Children's Oncology Group Hodgkin lymphoma study

Ehrlich

Friedman

Schwartz

2007

Journal of Pediatric Surgery

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“…Tumor spillage is considered to be present if there has been preoperative tumor rupture, intraoperative tumor spill, or a tumor biopsy. Although intraoperative tumor spill and tumor biopsy are intervention-related events, preoperative tumor rupture can be spontaneous or occur after trauma (3,4).…”

Section: Methodsmentioning

confidence: 99%

Detection of Preoperative Wilms Tumor Rupture with CT: A Report from the Children’s Oncology Group

Khanna¹,

Naranjo²,

Hoffer³

et al. 2013

Radiology

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Purpose:To retrospectively determine the diagnostic performance of computed tomography (CT) in identifying the presence or absence of preoperative Wilms tumor rupture. Materials and Methods:The cohort was derived from the AREN03B2 study of the Children's Oncology Group. The study was approved by the institutional review board and was compliant with HIPAA. Written informed consent was obtained before enrollment. The diagnosis of Wilms tumor rupture was established by central review of notes from surgery and/or pathologic examination. Seventy Wilms tumor cases with rupture were matched to 70 Wilms tumor controls without rupture according to age and tumor weight (within 6 months and 50 g, respectively). CT scans were independently reviewed by two radiologists, and the following CT findings were assessed: poorly circumscribed mass, perinephric fat stranding, peritumoral fat planes obscured, retroperitoneal fluid (subcapsular vs extracapsular), ascites beyond the cul-de-sac, peritoneal implants, ipsilateral pleural effusion, and intratumoral hemorrhage. All fluids were classified as hemorrhagic or nonhemorrhagic by using a cutoff of 30 HU. The relationship between CT findings and rupture was assessed with logistic regression models. Results:The sensitivity and specificity for detecting Wilms tumor rupture were 54% (36 of 67 cases) and 88% (61 of 69 cases), respectively, for reviewer 1 and 70% (47 of 67 cases) and 88% (61 of 69 cases), respectively, for reviewer 2. Interobserver agreement was substantial (ĸ = 0.76). All imaging signs tested, except peritoneal implants, intratumoral hemorrhage, and subcapsular fluid, showed a significant association with rupture (P  .02). The attenuation of ascitic fluid did not have a significant correlation with rupture (P = .9990). Ascites beyond the cul-de-sac was the single best indicator of rupture for both reviewers, followed by perinephric fat stranding and retroperitoneal fluid for reviewers 1 and 2, respectively (P , .01). Conclusion:CT has moderate specificity but relatively low sensitivity in the detection of preoperative Wilms tumor rupture. Ascites beyond the cul-de-sac, irrespective of attenuation, is most predictive of rupture.q RSNA, 2012 Supplemental material: http://radiology.rsna.org/lookup /suppl

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Quality assessment for Wilms' tumor: a report from the National Wilms' Tumor Study-5

Cited by 108 publications

References 17 publications

A Surveillance, Epidemiology and End Results (SEER) program comparison of adult and pediatric Wilms' tumor

A Surveillance, Epidemiology and End Results (SEER) program comparison of adult and pediatric Wilms' tumor

Monitoring diagnostic accuracy and complications. A report from the Children's Oncology Group Hodgkin lymphoma study

Detection of Preoperative Wilms Tumor Rupture with CT: A Report from the Children’s Oncology Group

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