The prognosis of prechemotherapy blastemal predominant histology subtype in Wilms tumor: A retrospective study in China

Abstract

This study aimed to retrospectively analyze survival outcomes for Chinese patients with prechemotherapy blastemal predominant histology type Wilms tumors (WTs). Methods: We collected and analyzed clinical data concerning patients aged <15 years with favorable histology (FH) WTs treated at the Sun Yat-Sen University Cancer Center from December 2005 to May 2016, based on the Children's Oncology Group protocol. Pathological specimens were collected through biopsy or surgical resection before initiation of chemotherapy. We analyzed survival outcomes involving different prechemotherapy histology subtypes. Results: We enrolled 97 patients with FH WTs (median follow-up, 71.5 months; range, 22.2-170.7). The total recurrence rate was 17.5%, and the subtype recurrence rates were as follows: blastemal predominant (45.5%), mixed (7.5%), epithelial (14.3%), and mesenchymal (9.5%) (P = .010). Five-year event-free survival (EFS) and overall survival (OS) rates were 84.9% and 81.4%, respectively. Respective 5-year EFS and OS rates for subtypes were as follows: blastemal predominant (54.5% and 68.2%), mixed (90.0% and 88.9%), epithelial (85.7% and 85.1%), and mesenchymal (90.5% and 94.7%). Multivariate survival analyses showed that the blastemal predominant subtype was an independent prognostic factor of EFS (P = .001) and OS (P = .017). Conclusions: Our findings showed that prechemotherapy blastemal predominant WTs had higher recurrence and lower EFS and OS rates. Our findings suggested that, albeit with some deficiencies, blastemal predominant histology WT-diagnosed prechemotherapy may have prognostic relevance. Further research into other

Characteristics of patients with blastemal-type Wilms’ tumour

“…In contrast, in another Japanese study that used the same JWiTS protocol in the treatment, there were no significant difference in 10-year relapse-free survival (RFS) and OS (78.8% vs. 84.5%, p = 0.201) between blastemal-type and non-blastemal Wilms' tumour [9]. Two of the presented studies from countries outside Europe suggest the necessity of blastemal-type extraction from the favourable histology group and modification of treatment in this group [7,8].…”

“…Blastemal-type tumour consists of over 66% of blastemal cells in a tumour with more than 33% of cells viable [4]. Blastemal cells respond poorly to treatment, which is associated with greater risk of recurrence and lower EFS and OS rates [6][7][8]. In this article we presented 3 cases of patients diagnosed with blastemal-type Wilms' tumours.…”

“…In a Chinese retrospective study including patients treated according to the COG protocol the recurrence rate was 45.5% in blastemal-type Wilms' tumour, while EFS and OS were 54.5% and 68.2%, respectively [7]. In the COG protocol there are only 2 histological types: with favourable histology and with unfavourable histology indicating presence of anaplasia [7]. Blastemal-type is classified as favourable histology and is not considered as a high-risk factor, in contrast to the SIOP protocol [7].…”

“…In the COG protocol there are only 2 histological types: with favourable histology and with unfavourable histology indicating presence of anaplasia [7]. Blastemal-type is classified as favourable histology and is not considered as a high-risk factor, in contrast to the SIOP protocol [7]. In a Japanese study the 5-year overall survival (OS) in blastemal-type was 65.4%, in mixed type it was 90.1%, in epithelial type it was 100%, and in mesenchymal type it was 93.3% [8].…”

Downregulated TICAM1 is a prognostic biomarker and associated with immune tolerance of Wilms tumor patients

“…Although the diagnosis and prognosis of WT have been dramatically improved by standardized surgical treatments such as early diagnosis and preoperative chemotherapy, chemotherapeutic drug resistance and immune tolerance still pose a major challenge. [ 12 ] Therefore, further exploration of the mechanism of WT is warranted. The pan-cancer analysis results show that TICAM1 is either highly or lowly expressed in other cancers, but in the WT TARGET cohort and external validation cohort GSE66405, it is confirmed that TICAM1 expression in WT tissue is significantly lower than that in normal tissue ( p < 0.05).…”