Local lymph node involvement does not predict poor outcome in pediatric renal cell carcinoma

Abstract

BACKGROUND Local lymph node involvement in adults with renal cell carcinoma (RCC) is associated with poor outcome. The prognostic significance of local lymph node involvement in children with RCC has not been studied systematically. METHODS A retrospective review of patients treated at St Jude Children's Research Hospital (Memphis, TN) and an extensive review of the medical literature were undertaken to evaluate the prognostic significance of local lymph node involvement in pediatric RCC. RESULTS Thirteen patients with the diagnosis of RCC were treated at St. Jude since the hospital's inception in 1962. Four patients presented with lymph node‐positive, distant metastasis‐negative (N+M0) disease, and all 4 remain disease free after resection without adjuvant therapy (follow‐up duration, 2–9 years). A systematic review of the literature including 243 pediatric patients with RCC revealed stage‐specific survival rates of 92.5%, 84.6%, 72.7%, and 12.7% for Stage I–IV disease, respectively. Of 58 children with N+M0 RCC for whom outcome data were available, 42 (72.4%) were alive without disease at last follow‐up. Among patients whose therapy could be discerned, those who received no adjuvant therapy fared as well (15 of 16 alive) as those who received various adjuvant treatments (22 of 31 alive). CONCLUSIONS Children with lymph node–positive RCC in the absence of distant metastatic disease had a relatively favorable long‐term prognosis, with survival rate nearly triple those of adult historical controls. Until highly effective therapies for RCC are identified, these children should not be exposed to adjuvant treatment. Further investigation of the biologic differences between adult and pediatric RCC is warranted. Cancer 2004. © 2004 American Cancer Society.

Clinicohistological characteristics of renal cell carcinoma in children: A multicentre study

“…2 In our study, children and adults with RCC had similar CSS rates, although high-stage tumours were more frequent in the pediatric group. Additionally, there were no differences in recurrence-free survival outcomes.…”

“…1 RCC in children is rare and accounts for about 5.9% of pediatric malignant renal tumours, whereas Wilms' tumours account for 58% to 87% of cases. [2][3][4][5] Children with RCC have a similar overall prognosis as adults. 4 As observed in adult RCC, prognosis worsens with increasing stage.…”

Metastatic renal cell carcinoma kidney in children 10 years old – possibility of targeted therapy

“…С возрастом заболеваемость ПКР увеличивается. По данным Японского общества детских хирургов, на ПКР приходится 1,4 % всех опу-холей почек у пациентов в возрасте до 4 лет, 15,2 % -5-9 лет и 52,6 % -10-15 лет [3,4]. Метастатическая форма ПКР у детей встречается редко, в литературе описано всего 18 ее случаев: M. Uchiyama и соавт.…”

“…Наиболее рас-пространенные формы проявления ПКР у детей -макрогематурия и боль в боку, менее частые симпто-мы -синдром пальпируемой опухоли в брюшной полости, анемия и лихорадка [4,8]. Как правило, клинические проявления ПКР зависят от симптома-тики опухоли Вильмса у детей.…”

“…По данным мировой литературы, 85 % рецидивов, как правило, развиваются в течение первых 3 лет после установления диагноза [9], однако поздние рецидивы также не редки [2]. У детей это заболевание имеет ме-нее агрессивное течение, чем у взрослых [4,7]. …”