Skip to main content
PMC home page
Annals of Surgery logoLink to Annals of Surgery
. 1999 Feb;229(2):292–297. doi: 10.1097/00000658-199902000-00019

Surgery-related factors and local recurrence of Wilms tumor in National Wilms Tumor Study 4.

R C Shamberger 1, K A Guthrie 1, M L Ritchey 1, G M Haase 1, J Takashima 1, J B Beckwith 1, G J D'Angio 1, D M Green 1, N E Breslow 1
PMCID: PMC1191644  PMID: 10024113

Abstract

OBJECTIVE: To assess the prognostic factors for local recurrence in Wilms tumor. SUMMARY BACKGROUND DATA: Current therapy for Wilms tumor has evolved through four studies of the National Wilms Tumor Study Group. As adverse prognostic factors were identified, treatment of children with Wilms tumor has been tailored based on these factors. Two-year relapse-free survival of children in the fourth study (NWTS-4) exceeded 91%. Factors once of prognostic import for local recurrence may lose their significance as more effective therapeutic regimens are devised. METHODS: Children evaluated were drawn from the records of NWTS-4. A total of 2482 randomized or followed patients were identified. Local recurrence, defined as recurrence in the original tumor bed, retroperitoneum, or within the abdominal cavity or pelvis, occurred in 100 children. Using a nested case-control study design, 182 matched controls were selected. Factors were analyzed for their association with local failure. Relative risks and 95% confidence intervals were calculated, taking into account the matching. RESULTS: The largest relative risks for local recurrence were observed in patients with stage III disease, those with unfavorable histology (especially diffuse anaplasia), and those reported to have tumor spillage during surgery. Multiple regression analysis adjusting for the combined effects of histology, lymph node involvement, and age revealed that tumor spillage remained significant. The relative risk of local recurrence from spill was largest in children with stage II disease. The absence of lymph node biopsy was also associated with an increased relative risk of recurrence, which was largest in children with stage I disease. The survival of children after local recurrence is poor, with an average survival rate at 2 years after relapse of 43%. Survival was dependent on initial stage: those who received more therapy before relapse had a worse prognosis. CONCLUSIONS: This study has demonstrated that surgical rupture of the tumor must be prevented by the surgeon, because spills produce an increased risk of local relapse. Both local and diffuse spills produce this risk. Stage II children with local spill appear to require more aggressive therapy than that used in NWTS-4. The continued critical importance of lymph node sampling in conjunction with nephrectomy for Wilms tumor is also established. Absence of lymph node biopsy may result in understaging and inadequate treatment of the child and may produce an increased risk of local recurrence.

Full text

PDF
292

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Breslow N., Churchill G., Beckwith J. B., Fernbach D. J., Otherson H. B., Tefft M., D'Angio G. J. Prognosis for Wilms' tumor patients with nonmetastatic disease at diagnosis--results of the second National Wilms' Tumor Study. J Clin Oncol. 1985 Apr;3(4):521–531. doi: 10.1200/JCO.1985.3.4.521. [DOI] [PubMed] [Google Scholar]
  2. Breslow N., Sharples K., Beckwith J. B., Takashima J., Kelalis P. P., Green D. M., D'Angio G. J. Prognostic factors in nonmetastatic, favorable histology Wilms' tumor. Results of the Third National Wilms' Tumor Study. Cancer. 1991 Dec 1;68(11):2345–2353. doi: 10.1002/1097-0142(19911201)68:11<2345::aid-cncr2820681103>3.0.co;2-t. [DOI] [PubMed] [Google Scholar]
  3. D'Angio G. J., Breslow N., Beckwith J. B., Evans A., Baum H., deLorimier A., Fernbach D., Hrabovsky E., Jones B., Kelalis P. Treatment of Wilms' tumor. Results of the Third National Wilms' Tumor Study. Cancer. 1989 Jul 15;64(2):349–360. doi: 10.1002/1097-0142(19890715)64:2<349::aid-cncr2820640202>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  4. D'Angio G. J., Evans A. E., Breslow N., Beckwith B., Bishop H., Feigl P., Goodwin W., Leape L. L., Sinks L. F., Sutow W. The treatment of Wilms' tumor: Results of the national Wilms' tumor study. Cancer. 1976 Aug;38(2):633–646. doi: 10.1002/1097-0142(197608)38:2<633::aid-cncr2820380203>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  5. D'Angio G. J., Evans A., Breslow N., Beckwith B., Bishop H., Farewell V., Goodwin W., Leape L., Palmer N., Sinks L. The treatment of Wilms' tumor: results of the Second National Wilms' Tumor Study. Cancer. 1981 May 1;47(9):2302–2311. doi: 10.1002/1097-0142(19810501)47:9<2302::aid-cncr2820470933>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
  6. Green D. M., Breslow N. E., Beckwith J. B., Finklestein J. Z., Grundy P. E., Thomas P. R., Kim T., Shochat S. J., Haase G. M., Ritchey M. L. Comparison between single-dose and divided-dose administration of dactinomycin and doxorubicin for patients with Wilms' tumor: a report from the National Wilms' Tumor Study Group. J Clin Oncol. 1998 Jan;16(1):237–245. doi: 10.1200/JCO.1998.16.1.237. [DOI] [PubMed] [Google Scholar]
  7. Grundy P., Breslow N., Green D. M., Sharples K., Evans A., D'Angio G. J. Prognostic factors for children with recurrent Wilms' tumor: results from the Second and Third National Wilms' Tumor Study. J Clin Oncol. 1989 May;7(5):638–647. doi: 10.1200/JCO.1989.7.5.638. [DOI] [PubMed] [Google Scholar]
  8. Jereb B., Tournade M. F., Lemerle J., Voûte P. A., Delemarre J. F., Ahstrom L., Flamant R., Gérard-Marchant R., Sandstedt B. Lymph node invasion and prognosis in nephroblastoma. Cancer. 1980 Apr 1;45(7):1632–1636. doi: 10.1002/1097-0142(19800401)45:7<1632::aid-cncr2820450719>3.0.co;2-f. [DOI] [PubMed] [Google Scholar]
  9. Leape L. L., Breslow N. E., Bishop H. C. The surgical treatment of Wilms' tumor: results of the National Wilms' Tumor Study. Ann Surg. 1978 Apr;187(4):351–356. doi: 10.1097/00000658-197804000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Martin L. W., Reyes P. M., Jr An evaluation of 10 years' experience with retroperitoneal lymph node dissection for Wilms' tumor. J Pediatr Surg. 1969 Dec;4(6):683–687. doi: 10.1016/0022-3468(69)90497-7. [DOI] [PubMed] [Google Scholar]
  11. Othersen H. B., Jr, DeLorimer A., Hrabovsky E., Kelalis P., Breslow N., D'Angio G. J. Surgical evaluation of lymph node metastases in Wilms' tumor. J Pediatr Surg. 1990 Mar;25(3):330–331. doi: 10.1016/0022-3468(90)90079-o. [DOI] [PubMed] [Google Scholar]
  12. Sutow W. W., Breslow N. E., Palmer N. F., D'Angio G. J., Takashima J. Prognosis in children with Wilms' tumor metastases prior to or following primary treatment: results from the first National Wilms' Tumor Study (NWTS-1). Am J Clin Oncol. 1982 Aug;5(4):339–347. doi: 10.1097/00000421-198208000-00001. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES