Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Oct;250(4):642-8.
doi: 10.1097/SLA.0b013e3181b76f20.

Hepatic metastasis at diagnosis in patients with Wilms tumor is not an independent adverse prognostic factor for stage IV Wilms tumor: a report from the Children's Oncology Group/National Wilms Tumor Study Group

Peter F Ehrlich  1 , Fernando A Ferrer, Michael L Ritchey, James R Anderson, Daniel M Green, Paul E Grundy, Jeffrey S Dome, John A Kalapurakal, Elizabeth J Perlman, Robert C Shamberger
Affiliations

Hepatic metastasis at diagnosis in patients with Wilms tumor is not an independent adverse prognostic factor for stage IV Wilms tumor: a report from the Children's Oncology Group/National Wilms Tumor Study Group

Peter F Ehrlich et al. Ann Surg. 2009 Oct.

Abstract

Objective: To determine event free survival (EFS) of children with Wilms tumor (WT) and metastatic liver disease at diagnosis.

Summary and background data: We reviewed patients with stage IV Wilms tumor treated on National Wilms Tumor Study 4 and 5 to ascertain if they have a worse prognosis than other Stage IV disease.

Methods: A total of 742 patients (pts) with stage IV disease were assessed for EFS (95% confidence interval [CI]) at 5 years after diagnosis. Cohorts included those who underwent resection of the liver lesions compared with those who received only chemotherapy and radiotherapy.

Results: A total of 742 patients with stage IV Wilms tumor were enrolled on NWTS-4 and 5, 111 of who had liver metastases. Of these, 96 had favorable histology disease and are the focus of this analysis. Twenty-two patients had a primary liver resection (wedge resection, 18 and lobectomy, 4). After chemotherapy and/or radiation, 13 patients underwent liver resection (wedge resection, 7; lobectomy, 5; and trisegmentectomy, 1). Seventy-one patients (67%) did not undergo surgery for their liver disease. In 14 patients, the liver disease disappeared with chemotherapy only. Eighty-two patients received abdominal radiation. EFS for the patients with metastatic FH Wilms tumor was 75% (95% confidence interval [CI]: (71%, 78%), EFS by Stage IV category was: lung only 76% (95% CI: 72%, 80%) (513 patients); liver, not lung 76% (95% CI: 58%, 87%) (34 patients), liver and lung 70% (95% CI: 57%, 80%) (62 patients), and other sites 64% (95% CI: 42%, 79%) (25 patients). There were no significant differences among stage IV groups (P = 0.60). EFS (95% CI) for the patients with primary resection of the liver metastases (22 patients) was 86% (63%, 95%) compared with 68% (56%, 78%) (P = 0.09) for the 74 with no primary resection of liver metastases. There was no significant difference in EFS for patients with FH Wilms tumor treated with chemotherapy compared with that of patients treated with chemotherapy and radiation (P = 0.63). The EFS (95% CI) for each of the subsets was; no abdominal radiation: 64% (34%, 83%); abdominal radiation, no boost: 77% (55%, 89%); abdominal radiation, boost: 72% (58%, 82%) (P = 0.05).

Conclusion: Liver metastasis at diagnosis is not an adverse prognostic factor for stage IV metastatic FH WT.

PubMed Disclaimer

Figures

1
1
Estimated 5-year event-free survival (EFS) of patients with Stage IV disease by site of metastasis. The x axis is time and the y axis is proportion.
2
2
Event-free survival (EFS) for FH patients with liver metastases, by whether primary resection of metastases.
3
3
Estimated event-free survival (EFS) correlated with radiation treatment.
See this image and copyright information in PMC

References

    1. Dome JS, Perlman EJ, Ritchey ML, et al. Renal Tumors. In: Pizzo PA, Poplack DG, editors. Principles and Practice of Pediatric Oncology. Lippincott Williams and Wilkins; Philadelphia: 2006. pp. 905–932.
    1. Green DM, Breslow N, Evans I, et al. Treatment of children with stage IV favorable histology Wilms tumor: a report from the National Wilms Tumor Study Group. Med Pediatr Oncol. 1996;26:147–152. - PubMed
    1. Green DM, Thomas PRM, Schocat S. The treatment of Wilms tumor. Results of the National Wilms Tumor Studies. Hematol Oncol Clin North Am. 1995;9:1267–1274. - PubMed
    1. Malogolowkin M, Cotton CA, Green DM, et al. Treatment of Wilms tumor relapsing after initial treatment with vincristine, actinomycin D, and doxorubicin. A report from the National Wilms Tumor Study Group. Pediatr Blood Cancer. 2008;50:236–241. - PubMed
    1. Thomas PRM, Schocat S, Norkool P. Prognostic implications of hepatic adhesion, invasion, and metastases at diagnosis of Wilms' tumor. The National Wilms' Tumor Study Group. Cancer. 1991;68:2486–2488. - PubMed

MeSH terms