Postchemotherapy tumor volume as a prognostic indicator in Wilms tumor: A single‐center experience from South India

Abstract

Background: Optimal risk stratification is the key to minimizing relapse and toxicity in children with Wilms tumor (WT). The study evaluated poor tumor volume response to chemotherapy as a risk factor that predicts relapse. Procedure: Children with WT who were treated between 2005 and 2020 at the center were analyzed. Tumor volumes at the time of diagnosis and after preoperative chemotherapy were calculated from cross-sectional imaging. The International Society of Paediatric Oncology (SIOP)-WT-2001 protocol was used for treatment. The area under a receiver operating characteristic curve was estimated to ascertain the ability of tumor volume to predict relapse.Results: Ninety-five patients with a median age of 40 months were included. A postchemotherapy tumor volume cutoff of 270 ml was ascertained to have the best predictive value for relapse. Patients with a tumor volume of <270 ml following preoperative chemotherapy had a better 3-year event-free survival (EFS) than those with a tumor volume of ≥270 ml (89.8% ± 4.0% vs. 57.4% ± 12.5%, p = .001). The data demonstrated that a tumor volume of ≥270 ml after chemotherapy was associated with an increased risk of relapse (hazard ratio [HR]: 5.3, p = .006). The EFS in patients with an epithelial or stromal type of histopathology was not affected by the tumor volume response (p = .437). Conversely, patients with other types of intermediate-risk histopathology who had a poor tumor volume response had an inferior survival (3-year EFS 51.4% ± 18.7%, p = .001). Conclusion:A postchemotherapy tumor volume cutoff of ≥270 ml emerged as a strong predictor of relapse in a low-and middle-income country (LMIC) center study of WT treated with the SIOP protocol.

Prognostic impact of pre‐referral tumor resection in unilateral Wilms tumor: A single‐institute experience from a lower middle‐income country

“…12,14 Delayed presentation with advanced localized and/or metastatic disease, malnutrition, incomplete staging workup, suboptimal surgical and histopathological expertise, malnutrition, inadequate supportive care facilities, treatment abandonment, and scarcity of collaborative research has been identified as critical barriers to achieving better survival outcomes in LMICs. [15][16][17] This study illustrates the disparities in pre-referral management and its impact on survival outcomes, in comparison to the patients who were treated with F I G U R E 3 Continued pre-operative chemotherapy followed by nephrectomy performed at a large pediatric oncology unit in an LMIC.…”

Predictive value of cyst/tumor volume ratio of pituitary adenoma for tumor cell proliferation

“…Tumor volume is associated with the proliferation and malignancy of tumor cells and, in clinical practice, is an important factor affecting the survival of patients and prognosis [22][23][24][25]. However, the evaluation of PA cell proliferation based on PA volume cannot account for the effect of hemorrhage or necrosis on the growth of PAs.…”

Automated segmentation and volume prediction in pediatric Wilms’ tumor CT using nnu-net

“…By applying a specific network structure, accurate manual results can be achieved. However, extensive training can automate this process [ 11 ]. Many scholars have conducted research on deep learning, recognizing its potential for automatically segmenting lesions and saving time while minimizing subjective errors.…”