Jonathan P Walker1, Jared S Johnson2, Megan M Eguchi3, Amanda F Saltzman4, Myles Cockburn5, Nicholas G Cost4. 1. Department of Surgery, Division of Urology, University of Colorado School of Medicine & Children's Hospital Colorado, 13123 E. 16th Ave, Aurora, CO, 80045, USA. Electronic address: jonathan.walker102310@gmail.com. 2. University of Colorado School of Medicine, 13001 East 17th Place, Aurora, CO, 80045, USA. 3. University of Colorado Cancer Center, 13001 E. 17th Place, Building 500, 6th Floor, Aurora, CO, 80045, USA. 4. Department of Surgery, Division of Urology, University of Colorado School of Medicine & Children's Hospital Colorado, 13123 E. 16th Ave, Aurora, CO, 80045, USA. 5. University of Colorado School of Public Health, Department of Epidemiology, 13001 E. 17th Place, Building 500, 6th Floor, Aurora, CO, 80045, USA.
Abstract
BACKGROUND: Lymph node (LN) involvement is an important prognostic indicator for patients with Wilms tumor (WT), and there have been previous reports of utilizing LN density (LND = positive LN/LNs examined) as an advanced metric to risk-stratify patients with WT. OBJECTIVE: The purpose of this study was to describe patient characteristics that affect LN yield and assess the effect of LND on the overall survival (OS) in patients with WT, with the expectation that patients with LNDs above a critical cut-point would demonstrate lower OS. STUDY DESIGN: The Surveillance, Epidemiology, and End Result (SEER) database was queried for all patients diagnosed with unilateral WT from 2004 to 2015. Patient and disease characteristics were collected, and Poisson regression was used to identify characteristics correlated with LN yield. LND was calculated for LN-positive patients, and multivariable survival analysis was performed, including patient demographics and LND as variables. RESULTS: 1489 patients with unilateral WT were identified for analysis, 231 (15.51%) of whom were LN-positive. Median patient age at diagnosis was three years (IQR 1-5). On Poisson regression, the year of diagnosis, patient age, tumor size and laterality, and stage were found to impact LN yield. For patients with positive LNs, five-year OS of patients with LNDs above 0.4 was worse than those below 0.4 (76.1% vs 89.6%, p = 0.041). On multivariable analysis, tumor size and LND remained significant predictors of OS. DISCUSSION: Administrative databases such as SEER provide an excellent resource for studying conditions where large patient numbers for analysis are difficult to obtain. Unfortunately, the SEER database is unable to account for every factor that could affect LN sampling patterns. Additionally, favorable vs unfavorable histology is not available in SEER, and SEER utilizes its own staging system, which makes comparison to Children's Oncology Group staging difficult. Despite these limitations, the findings of this study are similar to those previously published using administrative databases analyzing LN sampling patterns and the effect of LND on OS in WT. CONCLUSIONS: Analysis of the SEER database confirms that there are several patient- and disease-specific factors that affect the number of LNs sampled during nephrectomy for WT, and that LND may be a predictor of OS. These findings highlight the need for standardization of LN sampling patterns for pediatric renal tumors and support the investigation of LND in future studies to further risk-stratify WT patients to tailor therapy intensity.
BACKGROUND: Lymph node (LN) involvement is an important prognostic indicator for patients with Wilms tumor (WT), and there have been previous reports of utilizing LN density (LND = positive LN/LNs examined) as an advanced metric to risk-stratify patients with WT. OBJECTIVE: The purpose of this study was to describe patient characteristics that affect LN yield and assess the effect of LND on the overall survival (OS) in patients with WT, with the expectation that patients with LNDs above a critical cut-point would demonstrate lower OS. STUDY DESIGN: The Surveillance, Epidemiology, and End Result (SEER) database was queried for all patients diagnosed with unilateral WT from 2004 to 2015. Patient and disease characteristics were collected, and Poisson regression was used to identify characteristics correlated with LN yield. LND was calculated for LN-positive patients, and multivariable survival analysis was performed, including patient demographics and LND as variables. RESULTS: 1489 patients with unilateral WT were identified for analysis, 231 (15.51%) of whom were LN-positive. Median patient age at diagnosis was three years (IQR 1-5). On Poisson regression, the year of diagnosis, patient age, tumor size and laterality, and stage were found to impact LN yield. For patients with positive LNs, five-year OS of patients with LNDs above 0.4 was worse than those below 0.4 (76.1% vs 89.6%, p = 0.041). On multivariable analysis, tumor size and LND remained significant predictors of OS. DISCUSSION: Administrative databases such as SEER provide an excellent resource for studying conditions where large patient numbers for analysis are difficult to obtain. Unfortunately, the SEER database is unable to account for every factor that could affect LN sampling patterns. Additionally, favorable vs unfavorable histology is not available in SEER, and SEER utilizes its own staging system, which makes comparison to Children's Oncology Group staging difficult. Despite these limitations, the findings of this study are similar to those previously published using administrative databases analyzing LN sampling patterns and the effect of LND on OS in WT. CONCLUSIONS: Analysis of the SEER database confirms that there are several patient- and disease-specific factors that affect the number of LNs sampled during nephrectomy for WT, and that LND may be a predictor of OS. These findings highlight the need for standardization of LN sampling patterns for pediatric renal tumors and support the investigation of LND in future studies to further risk-stratify WTpatients to tailor therapy intensity.
Authors: A F Saltzman; A Carrasco; A Amini; J H Aldrink; R Dasgupta; K W Gow; R D Glick; P F Ehrlich; N G Cost Journal: J Pediatr Urol Date: 2017-10-31 Impact factor: 1.830
Authors: Derya Tilki; Thenappan Chandrasekar; Umberto Capitanio; Gaetano Ciancio; Siamak Daneshmand; Paolo Gontero; Javier Gonzalez; Axel Haferkamp; Markus Hohenfellner; William C Huang; Estefania Linares Espinós; Adam Lorentz; Juan I Martinez-Salamanca; Viraj A Master; James M McKiernan; Francesco Montorsi; Giacomo Novara; Sascha Pahernik; Juan Palou; Raj S Pruthi; Oscar Rodriguez-Faba; Paul Russo; Douglas S Scherr; Shahrokh F Shariat; Martin Spahn; Carlo Terrone; Cesar Vera-Donoso; Richard Zigeuner; John A Libertino; Christopher P Evans Journal: Urol Oncol Date: 2017-11-10 Impact factor: 3.498
Authors: R C Shamberger; K A Guthrie; M L Ritchey; G M Haase; J Takashima; J B Beckwith; G J D'Angio; D M Green; N E Breslow Journal: Ann Surg Date: 1999-02 Impact factor: 12.969
Authors: Peter F Ehrlich; James R Anderson; Michael L Ritchey; Jeffrey S Dome; Daniel M Green; Paul E Grundy; Elizabeth J Perlman; John A Kalapurakal; Norman E Breslow; Robert C Shamberger Journal: J Clin Oncol Date: 2013-02-04 Impact factor: 44.544
Authors: Cecilia A Cotton; Susan Peterson; Patricia A Norkool; Janice Takashima; Yevgeny Grigoriev; Daniel M Green; Norman E Breslow Journal: J Clin Oncol Date: 2009-01-12 Impact factor: 44.544
Authors: Johannes Betge; Lars Harbaum; Marion J Pollheimer; Richard A Lindtner; Peter Kornprat; Matthias P Ebert; Cord Langner Journal: Int J Colorectal Dis Date: 2017-02-16 Impact factor: 2.571