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. 2009 Mar 10;27(8):1304-9.
doi: 10.1200/JCO.2008.18.6981. Epub 2009 Jan 12.

Early and late mortality after diagnosis of wilms tumor

Cecilia A Cotton  1 , Susan Peterson, Patricia A Norkool, Janice Takashima, Yevgeny Grigoriev, Daniel M Green, Norman E Breslow
Affiliations

Early and late mortality after diagnosis of wilms tumor

Cecilia A Cotton et al. J Clin Oncol. .

Erratum in

  • J Clin Oncol. 2009 Oct 1;27(28):4819. Green, Daniel M [added]

Abstract

Purpose: To assess rates and causes of mortality in patients with Wilms tumor (WT).

Methods: Through 2002, 6,185 patients enrolled onto the National Wilms Tumor Study between 1969 and 1995 were actively observed. Deaths were classified on the basis of medical records as the result of original disease, late effects (including second malignant neoplasms [SMNs], cardiac causes, pulmonary disease, and renal failure), or other causes. Standardized mortality ratios (SMRs) and Cox regression were used to assess the effects of sex, age, and calendar period of diagnosis on mortality.

Results: Within 5 years of WT diagnosis, 819 deaths occurred, and 159 deaths occurred among 4,972 known 5-year survivors. The SMR was 24.3 (95% CI, 22.6 to 26.0) for the first 5 years, was 12.6 (95% CI, 10.0 to 15.7) for the next 5 years, and remained greater than 3.0 thereafter. For deaths in the first 5 years, the mortality risk decreased by 5-year calendar period of diagnosis (rate ratio [RR] = 0.78 per period). No such trend occurred for later deaths. Among 5-year survivors, 62 deaths were attributed to late effects of treatment or disease, including 27 to SMNs. A trend of decreased risk with calendar period of diagnosis was observed for late-effects mortality (RR = 0.86; 95% CI, 0.67 to 1.10) and for SMN mortality (RR = 0.82; 95% CI, 0.55 to 1.21).

Conclusion: Although the survival outlook for WT patients has improved greatly over time, survivors remain at elevated risk for death many years after their original diagnosis.

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Conflict of interest statement

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Figures

Fig 1.
Fig 1.
Standardized mortality ratios (SMRs) for all-cause mortality by time since diagnosis. The points represent yearly SMR estimates, and the lines are best-fit polynomial curves for all patients, males, and females.
See this image and copyright information in PMC

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