Outcome of Patients With Stage II/Favorable Histology Wilms Tumor With and Without Local Tumor Spill: A Report From the National Wilms Tumor Study Group

Daniel M. Green, Norman E. Breslow, Giulio J. D'Angio, Marcio Malogolowkin, Michael L. Ritchey, Audrey E. Evans, J. Bruce Beckwith, Elizabeth J. Perlman, Robert C. Shamberger, Susan Peterson, Paul E. Grundy, Jeffrey S. Dome, Patrick R.M. Thomas, John A. Kalapurakal

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background. Intra-operative tumor spill increases the risk of local recurrence of Wilms tumor, and adversely impacts relapse-free (RFS) and overall survival (OS) rates. Methods. Surgical checklists, operative notes, institutional pathology reports, central pathology review and flow sheets of 602 patients registered between August 1986 and September 1994 on National Wilms Tumor Study-4 as randomized, followed or switched and coded as Final Stage II, favorable histology (FH) were reviewed. RFS and OS were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were estimated using the Cox model and tested for statistical significance by the log-rank test. Results. Four hundred ninety-nine patients were found after review to have Stage II, FH Wilms tumor. The 8-year RFS percentages were 85.0% (95% confidence interval (CI): 81.1%, 88.1%) for those with no spill compared to 75.7% (65.8%, 83.2%) for those with spill. The 8-year OS percentages were 95.6% (93.1%, 97.3%) for those with no spill compared to 90.3% (82.2%, 94.9%) for those with spill. The HR for relapse among those with spill was 1.55 ((95%CI: 0.97,2.51), P=0.067) and the HR for death was 1.94 ((0.92,4.09), P=0.077). Conclusions. RFS and OS were lower for patients who had intra-operative tumor spill. The majority of NWTS Stage II, FH patients with intra-operative tumor spill have an overall excellent outcome when treated with two drug chemotherapy (vincristine and actinomycin D) and no abdominal irradiation. Pediatr Blood Cancer 2014;:134-139.

Original languageEnglish (US)
Pages (from-to)134-139
Number of pages6
JournalPediatric Blood and Cancer
Volume61
Issue number1
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Wilms Tumor
Histology
Recurrence
Survival
Neoplasms
Confidence Intervals
Pathology
Dactinomycin
Vincristine
Checklist
Proportional Hazards Models
Survival Rate
Drug Therapy
Pharmaceutical Preparations

Keywords

  • Actinomycin D
  • Doxorubicin
  • Oncology
  • Radiation therapy
  • Vincristine
  • Wilms tumor

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Outcome of Patients With Stage II/Favorable Histology Wilms Tumor With and Without Local Tumor Spill : A Report From the National Wilms Tumor Study Group. / Green, Daniel M.; Breslow, Norman E.; D'Angio, Giulio J.; Malogolowkin, Marcio; Ritchey, Michael L.; Evans, Audrey E.; Beckwith, J. Bruce; Perlman, Elizabeth J.; Shamberger, Robert C.; Peterson, Susan; Grundy, Paul E.; Dome, Jeffrey S.; Thomas, Patrick R.M.; Kalapurakal, John A.

In: Pediatric Blood and Cancer, Vol. 61, No. 1, 01.01.2014, p. 134-139.

Research output: Contribution to journalArticle

Green, DM, Breslow, NE, D'Angio, GJ, Malogolowkin, M, Ritchey, ML, Evans, AE, Beckwith, JB, Perlman, EJ, Shamberger, RC, Peterson, S, Grundy, PE, Dome, JS, Thomas, PRM & Kalapurakal, JA 2014, 'Outcome of Patients With Stage II/Favorable Histology Wilms Tumor With and Without Local Tumor Spill: A Report From the National Wilms Tumor Study Group', Pediatric Blood and Cancer, vol. 61, no. 1, pp. 134-139. https://doi.org/10.1002/pbc.24658
Green, Daniel M. ; Breslow, Norman E. ; D'Angio, Giulio J. ; Malogolowkin, Marcio ; Ritchey, Michael L. ; Evans, Audrey E. ; Beckwith, J. Bruce ; Perlman, Elizabeth J. ; Shamberger, Robert C. ; Peterson, Susan ; Grundy, Paul E. ; Dome, Jeffrey S. ; Thomas, Patrick R.M. ; Kalapurakal, John A. / Outcome of Patients With Stage II/Favorable Histology Wilms Tumor With and Without Local Tumor Spill : A Report From the National Wilms Tumor Study Group. In: Pediatric Blood and Cancer. 2014 ; Vol. 61, No. 1. pp. 134-139.
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abstract = "Background. Intra-operative tumor spill increases the risk of local recurrence of Wilms tumor, and adversely impacts relapse-free (RFS) and overall survival (OS) rates. Methods. Surgical checklists, operative notes, institutional pathology reports, central pathology review and flow sheets of 602 patients registered between August 1986 and September 1994 on National Wilms Tumor Study-4 as randomized, followed or switched and coded as Final Stage II, favorable histology (FH) were reviewed. RFS and OS were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were estimated using the Cox model and tested for statistical significance by the log-rank test. Results. Four hundred ninety-nine patients were found after review to have Stage II, FH Wilms tumor. The 8-year RFS percentages were 85.0{\%} (95{\%} confidence interval (CI): 81.1{\%}, 88.1{\%}) for those with no spill compared to 75.7{\%} (65.8{\%}, 83.2{\%}) for those with spill. The 8-year OS percentages were 95.6{\%} (93.1{\%}, 97.3{\%}) for those with no spill compared to 90.3{\%} (82.2{\%}, 94.9{\%}) for those with spill. The HR for relapse among those with spill was 1.55 ((95{\%}CI: 0.97,2.51), P=0.067) and the HR for death was 1.94 ((0.92,4.09), P=0.077). Conclusions. RFS and OS were lower for patients who had intra-operative tumor spill. The majority of NWTS Stage II, FH patients with intra-operative tumor spill have an overall excellent outcome when treated with two drug chemotherapy (vincristine and actinomycin D) and no abdominal irradiation. Pediatr Blood Cancer 2014;:134-139.",
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T2 - A Report From the National Wilms Tumor Study Group

AU - Green, Daniel M.

AU - Breslow, Norman E.

AU - D'Angio, Giulio J.

AU - Malogolowkin, Marcio

AU - Ritchey, Michael L.

AU - Evans, Audrey E.

AU - Beckwith, J. Bruce

AU - Perlman, Elizabeth J.

AU - Shamberger, Robert C.

AU - Peterson, Susan

AU - Grundy, Paul E.

AU - Dome, Jeffrey S.

AU - Thomas, Patrick R.M.

AU - Kalapurakal, John A.

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N2 - Background. Intra-operative tumor spill increases the risk of local recurrence of Wilms tumor, and adversely impacts relapse-free (RFS) and overall survival (OS) rates. Methods. Surgical checklists, operative notes, institutional pathology reports, central pathology review and flow sheets of 602 patients registered between August 1986 and September 1994 on National Wilms Tumor Study-4 as randomized, followed or switched and coded as Final Stage II, favorable histology (FH) were reviewed. RFS and OS were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were estimated using the Cox model and tested for statistical significance by the log-rank test. Results. Four hundred ninety-nine patients were found after review to have Stage II, FH Wilms tumor. The 8-year RFS percentages were 85.0% (95% confidence interval (CI): 81.1%, 88.1%) for those with no spill compared to 75.7% (65.8%, 83.2%) for those with spill. The 8-year OS percentages were 95.6% (93.1%, 97.3%) for those with no spill compared to 90.3% (82.2%, 94.9%) for those with spill. The HR for relapse among those with spill was 1.55 ((95%CI: 0.97,2.51), P=0.067) and the HR for death was 1.94 ((0.92,4.09), P=0.077). Conclusions. RFS and OS were lower for patients who had intra-operative tumor spill. The majority of NWTS Stage II, FH patients with intra-operative tumor spill have an overall excellent outcome when treated with two drug chemotherapy (vincristine and actinomycin D) and no abdominal irradiation. Pediatr Blood Cancer 2014;:134-139.

AB - Background. Intra-operative tumor spill increases the risk of local recurrence of Wilms tumor, and adversely impacts relapse-free (RFS) and overall survival (OS) rates. Methods. Surgical checklists, operative notes, institutional pathology reports, central pathology review and flow sheets of 602 patients registered between August 1986 and September 1994 on National Wilms Tumor Study-4 as randomized, followed or switched and coded as Final Stage II, favorable histology (FH) were reviewed. RFS and OS were estimated using the Kaplan-Meier method. Hazard ratios (HRs) were estimated using the Cox model and tested for statistical significance by the log-rank test. Results. Four hundred ninety-nine patients were found after review to have Stage II, FH Wilms tumor. The 8-year RFS percentages were 85.0% (95% confidence interval (CI): 81.1%, 88.1%) for those with no spill compared to 75.7% (65.8%, 83.2%) for those with spill. The 8-year OS percentages were 95.6% (93.1%, 97.3%) for those with no spill compared to 90.3% (82.2%, 94.9%) for those with spill. The HR for relapse among those with spill was 1.55 ((95%CI: 0.97,2.51), P=0.067) and the HR for death was 1.94 ((0.92,4.09), P=0.077). Conclusions. RFS and OS were lower for patients who had intra-operative tumor spill. The majority of NWTS Stage II, FH patients with intra-operative tumor spill have an overall excellent outcome when treated with two drug chemotherapy (vincristine and actinomycin D) and no abdominal irradiation. Pediatr Blood Cancer 2014;:134-139.

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KW - Doxorubicin

KW - Oncology

KW - Radiation therapy

KW - Vincristine

KW - Wilms tumor

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