S Irtan1, M Jitlal2, J Bate1, M Powis3, G Vujanic4, A Kelsey5, J Walker6, C Mitchell7, D Machin8, K Pritchard-Jones9. 1. Cancer Section, Developmental Biology & Cancer Programme, Institute of Child Health, University College London, London, UK. 2. Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, 90 Tottenham Court Road, London W1T 4TJ, UK. 3. Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK. 4. Department of Pathology, School of Medicine, Cardiff University, Cardiff, UK. 5. Department of Pathology, Royal Manchester Children's Hospital, Manchester, UK. 6. Department of Paediatric Surgery, Sheffield Children's Hospital, Sheffield, UK. 7. Department of Paediatric Oncology, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK. 8. Children's Cancer and Leukaemia Group, University of Leicester, Leicester, UK. 9. Cancer Section, Developmental Biology & Cancer Programme, Institute of Child Health, University College London, London, UK. Electronic address: k.pritchard-jones@ucl.ac.uk.
Abstract
RATIONALE: The UKW3 trial compared biopsy/pre-operative chemotherapy versus immediate nephrectomy and afforded the opportunity to examine the influence of percutaneous retroperitoneal biopsy and other factors on local and distant relapse of Wilms tumour (WT). METHODS:Patients with unilateral WT (stages I-IV) excluding metachronous relapse or early progressive disease were eligible. Metastatic and 'inoperable' tumours were biopsied electively. 'Local' was defined as relapse within the abdomen, except for liver metastases considered as 'distant' relapse, together with other haematogenous routes. Uni- and multivariable analyses estimated the risk factors for relapse. RESULTS: Overall, 285/635 (44.9%) patients had a biopsy. With a median follow-up of 10.1 years, 35 (5.5%) patients experienced a 'local', 15 a combined (2.4%) and 60 (9.4%) a 'distant' relapse. On univariate analysis, biopsy, anaplasia and tumour size were associated with an increased risk of local relapse. On multivariable analysis, anaplasia and tumour size remained significant for local relapse whereas the elevated risk of biopsy (hazards ratio (HR) = 1.80: 95% confidence interval (CI) 0.97-3.32, p = 0.060) was marginal. Age, anaplasia, tumour size, lymph nodes metastases and stage, but not biopsy, were individually associated with increased risk of distant relapse but only age and anaplasia remained significant following multivariable analysis. CONCLUSIONS: The UKW3 trial provides some reassurance that biopsy should not automatically lead to 'upstaging' of WT. Further assessment of this controversial area is required. Comparison of local relapse rates in a multinational trial in which the United Kingdom (UK) continued the practice of routinely biopsying all patients in contrast to the standard European approach will afford this opportunity and is planned.
RCT Entities:
RATIONALE: The UKW3 trial compared biopsy/pre-operative chemotherapy versus immediate nephrectomy and afforded the opportunity to examine the influence of percutaneous retroperitoneal biopsy and other factors on local and distant relapse of Wilms tumour (WT). METHODS:Patients with unilateral WT (stages I-IV) excluding metachronous relapse or early progressive disease were eligible. Metastatic and 'inoperable' tumours were biopsied electively. 'Local' was defined as relapse within the abdomen, except for liver metastases considered as 'distant' relapse, together with other haematogenous routes. Uni- and multivariable analyses estimated the risk factors for relapse. RESULTS: Overall, 285/635 (44.9%) patients had a biopsy. With a median follow-up of 10.1 years, 35 (5.5%) patients experienced a 'local', 15 a combined (2.4%) and 60 (9.4%) a 'distant' relapse. On univariate analysis, biopsy, anaplasia and tumour size were associated with an increased risk of local relapse. On multivariable analysis, anaplasia and tumour size remained significant for local relapse whereas the elevated risk of biopsy (hazards ratio (HR) = 1.80: 95% confidence interval (CI) 0.97-3.32, p = 0.060) was marginal. Age, anaplasia, tumour size, lymph nodes metastases and stage, but not biopsy, were individually associated with increased risk of distant relapse but only age and anaplasia remained significant following multivariable analysis. CONCLUSIONS: The UKW3 trial provides some reassurance that biopsy should not automatically lead to 'upstaging' of WT. Further assessment of this controversial area is required. Comparison of local relapse rates in a multinational trial in which the United Kingdom (UK) continued the practice of routinely biopsying all patients in contrast to the standard European approach will afford this opportunity and is planned.
Authors: Thomas J Jackson; Richard D Williams; Jesper Brok; Tanzina Chowdhury; Milind Ronghe; Mark Powis; Kathy Pritchard-Jones; Gordan M Vujanić Journal: Pediatr Blood Cancer Date: 2019-02-13 Impact factor: 3.167
Authors: Conrad V Fernandez; Elizabeth A Mullen; Yueh-Yun Chi; Peter F Ehrlich; Elizabeth J Perlman; John A Kalapurakal; Geetika Khanna; Arnold C Paulino; Thomas E Hamilton; Kenneth W Gow; Zelig Tochner; Fredric A Hoffer; Janice S Withycombe; Robert C Shamberger; Yeonil Kim; James I Geller; James R Anderson; Paul E Grundy; Jeffrey S Dome Journal: J Clin Oncol Date: 2017-12-06 Impact factor: 44.544