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. 2022 Nov 1;150(5):e2022056918.
doi: 10.1542/peds.2022-056918.

Clinical Assessment of Late Health Outcomes in Survivors of Wilms Tumor

Kayla L Foster  1 , Sedigheh Mirzaei Salehabadi  2 , Daniel M Green  3   4 , Mengqi Xing  2 , Kirsten K Ness  4 , Kevin R Krull  4   5 , Tara M Brinkman  4   5 , Matthew J Ehrhardt  3   4 , Wassim Chemaitilly  6 , Stephanie B Dixon  3   4 , Nickhill Bhakta  3   4   7 , Rachel C Brennan  3 , Matthew J Krasin  8 , Andrew M Davidoff  9 , Leslie L Robison  4 , Melissa M Hudson  3   4   5 , Daniel A Mulrooney  3   4
Affiliations

Clinical Assessment of Late Health Outcomes in Survivors of Wilms Tumor

Kayla L Foster et al. Pediatrics. .

Abstract

Objectives: We aimed to clinically characterize the health, neurocognitive, and physical function outcomes of curative treatment of Wilms tumor.

Methods: Survivors of Wilms tumor (n = 280) participating in the St. Jude Lifetime Cohort, a retrospective study with prospective follow-up of individuals treated for childhood cancer at St. Jude Children's Research Hospital, were clinically evaluated and compared to age and sex-matched controls (n = 625). Health conditions were graded per a modified version of the National Cancer Institute's Common Terminology Criteria for Adverse Events. Standardized neurocognitive testing was graded by using age-adjusted z-scores. Impaired physical function was defined by age- and sex-matched z-scores >1.5 SD below controls. Modified Poisson regression was used to compare the prevalence of conditions and multivariable logistic regression to examine treatment associations.

Results: Median age at evaluation was similar between survivors and controls (30.5 years [9.0-58.0] and 31.0 [12.0-70.0]). Therapies included nephrectomy (100%), vincristine (99.3%), dactinomycin (97.9%), doxorubicin (66.8%), and abdominal (59.3%) and/or chest radiation (25.0%). By age 40 years, survivors averaged 12.7 (95% confidence interval [CI] 11.7-13.8) grade 1-4 and 7.5 (CI: 6.7-8.2) grade 2 to 4 health conditions, compared to 4.2 (CI: 3.9-4.6) and 2.3 (CI: 2.1-2.5), respectively, among controls. Grade 2 to 4 endocrine (53.9%), cardiovascular (26.4%), pulmonary (18.2%), neurologic (8.6%), neoplastic (7.9%), and kidney (7.2%) conditions were most prevalent. Survivors exhibited neurocognitive and physical performance impairments.

Conclusions: Wilms tumor survivors experience a threefold higher burden of chronic health conditions compared to controls and late neurocognitive and physical function deficits. Individualized clinical management, counseling, and surveillance may improve long-term health maintenance.

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Conflict of interest statement

Conflict of Interest Disclosures (includes financial disclosures): The authors have no conflicts of interest relevant to this article to disclose.

Figures

Figure 1.
Figure 1.
Cumulative burden and 95% confidence intervals of grade 1–4 and grade 2–4 chronic health conditions in survivors of Wilms tumor and community controls.
Figure 2.
Figure 2.
Prevalence and grade of neurocognitive impairment among survivors of Wilms tumor and controls by neurocognitive domain.
Figure 3.
Figure 3.
Prevalence of physical performance impairment in survivors of Wilms tumor. ┼ Percent with scores >1.5 SD below age and sex-matched z-score for controls. * p <0.05 Λ Percentage of the general population performing >1.5 standard deviations below age- and sex-matched z-scores
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