Prognostic Significance of Metastatic Site at Diagnosis in Wilms?? Tumor

Abstract

The purpose of this study was to identify the prognostic significance of pulmonary and liver involvements present at diagnosis in children with Wilms' tumor. From 1971 to 2002, 57 patients with stage IV Wilms' tumor were diagnosed, treated, and followed in the authors' institution. Metastases were detected by chest radiography, abdominal ultrasonography, and/or thoracoabdominal computed tomography. Nephrectomy with tumor resection was performed and appropriate chemotherapy was given to all the patients. The Kaplan-Meier survival method was used to calculate survival. The log-rank test was used to compare the groups with respect to survival. The age range was 1.25 to 15 years (median 4 years). Thirty-seven patients had only lung metastases, 12 had only liver metastases, 6 had both lung and liver metastases, 1 had adrenal gland metastases, and 1 had other site metastases. The overall survival rate in the whole group was 37.1%. The overall survival rates for lung and liver metastases were 50.2% and 16.6%, respectively. The overall survival rates were significantly different between the two groups (P = 0.005). Only one patient survived in the group with liver involvement. Liver involvement at diagnosis indicates a worse prognosis than lung involvement. Wilms' tumor patients with liver metastases should be treated with more intensive regimens than those with lung metastases.

Hepatic Metastasis at Diagnosis in Patients With Wilms Tumor is not an Independent Adverse Prognostic Factor for Stage IV Wilms Tumor

“…Varan et al reported poor outcomes of patients with liver metastases. 6 This single institutional report included 542 patients treated over thirty years, 57 of whom had stage IV disease, including 18 with liver metastases. The overall survival rate was 50.2% for those with lung metastases compared to 16.6% for those with liver metastases.…”

“…2–5 Recent reports, however, suggested that liver involvement at diagnosis in infants and children with Wilms tumor indicated a worse prognosis than lung or other sites of Stage IV disease. 6–8 The International Society of Pediatric Oncology (SIOP) and the German Pediatric Oncology Group (GPOH) studied 29 patients with liver metastases at diagnosis, including some adult patients with Wilms tumor. 7 The overall survival was less than 60%, but all patients who had complete resection of the hepatic lesions survived.…”

“…Another report from Varan et al of 18 patients with liver metastases also noted a poorer outcome than for patients with pulmonary disease (50.2% vs. 16.6%). 6 These authors suggested, based on the poor outcomes of patients with liver metastases, that more intensive chemotherapy and more aggressive surgical treatment was warranted. This would be a significant change in approach that potentially could increase morbidity and mortality for these patients.…”

Wilms’ Tumor in Children: An Overview

“…Because the presence or absence of lung nodules does not affect the treatment plan in the early stages, a lung CT is not necessary [39]. The survival of the patients with metastasis from the right kidney is worse than the survival of those with metastasis from the left kidney [40]. …”

“…The most common sites of recurrence are the lungs, pleura, tumor bed, and the liver. Among all patients with Wilms’ tumor, those with liver involvement have a poorer prognosis than those with lung metastasis [40, 71]. …”