Lauren N Parsons1, Elizabeth A Mullen2, James I Geller3, Yueh-Yun Chi4, Geetika Khanna5, Richard D Glick6, Jennifer H Aldrink7, Kelly L Vallance8, Yeonil Kim4, Conrad V Fernandez9,10, Jeffrey S Dome11, Elizabeth J Perlman12. 1. Department of Pathology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin. 2. Pediatric Hematology/Oncology, Dana Farber Cancer Institute/Boston Children's Hospital, Boston, Massachusetts. 3. Hematology/Oncology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio. 4. Department of Biostatistics, University of Florida, Gainesville, Florida. 5. Pediatric Radiology, Washington University School of Medicine, St. Louis, Missouri. 6. Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York. 7. Division of Pediatric Surgery, Department of Surgery, Ohio State University College of Medicine, Nationwide Children's Hospital, Columbus, Ohio. 8. Hematology/Oncology, Cook Children's Medical Center, Fort Worth, Texas. 9. Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada. 10. Department of Bioethics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada. 11. Division of Oncology, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, DC. 12. Department of Pathology and Laboratory Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Abstract
BACKGROUND: Stage I epithelial-predominant favorable-histology Wilms tumors (EFHWTs) have long been suspected to have an excellent outcome. This study investigates the clinical and pathologic features of patients with stage I EFHWTs to better evaluate the potential for a reduction of chemotherapy and its associated toxicity. METHODS: All patients registered in the Children's Oncology Group (COG) AREN03B2 study between 2006 and 2017 with stage I EFHWTs were identified. EFHWTs were defined as tumors with at least 66% epithelial differentiation, regardless of the degree of differentiation. Clinical information was abstracted from COG records. Event-free survival (EFS) and overall survival (OS) were calculated and compared between groups based on age and therapy. RESULTS: The 4-year EFS rate was 96.2% (95% confidence interval, 92%-100%), and the OS rate was 100%; EFS and OS did not statistically significantly differ with the age at diagnosis (<48 vs ≥48 months; P = .37) or treatment (EE4A vs observation only; P = .55). Six events were reported. Three patients developed contralateral tumors and did not otherwise relapse; none of these had nephrogenic rests or a recognized predisposition syndrome. Three patients developed metastatic recurrence; all 3 had received EE4A as their primary therapy after nephrectomy. CONCLUSIONS: These findings demonstrate an excellent outcome for stage I EFHWTs with >95% EFS and OS. These data support the utility of investigating the treatment of stage I EFHWTs with observation alone after nephrectomy.
BACKGROUND: Stage I epithelial-predominant favorable-histology Wilms tumors (EFHWTs) have long been suspected to have an excellent outcome. This study investigates the clinical and pathologic features of patients with stage I EFHWTs to better evaluate the potential for a reduction of chemotherapy and its associated toxicity. METHODS: All patients registered in the Children's Oncology Group (COG) AREN03B2 study between 2006 and 2017 with stage I EFHWTs were identified. EFHWTs were defined as tumors with at least 66% epithelial differentiation, regardless of the degree of differentiation. Clinical information was abstracted from COG records. Event-free survival (EFS) and overall survival (OS) were calculated and compared between groups based on age and therapy. RESULTS: The 4-year EFS rate was 96.2% (95% confidence interval, 92%-100%), and the OS rate was 100%; EFS and OS did not statistically significantly differ with the age at diagnosis (<48 vs ≥48 months; P = .37) or treatment (EE4A vs observation only; P = .55). Six events were reported. Three patients developed contralateral tumors and did not otherwise relapse; none of these had nephrogenic rests or a recognized predisposition syndrome. Three patients developed metastatic recurrence; all 3 had received EE4A as their primary therapy after nephrectomy. CONCLUSIONS: These findings demonstrate an excellent outcome for stage I EFHWTs with >95% EFS and OS. These data support the utility of investigating the treatment of stage I EFHWTs with observation alone after nephrectomy.
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