Survival Analysis of Pediatric Wilms Tumor Based on Risk Identification

Andy Andy, Yacobda Sigumonrong

Abstract


Background: Wilms Tumor (WT) or nephroblastoma is the most common primary malignant tumor of the kidney found in children (comprising about > 95% of all kidney tumors). The study of WT prognostic factors has not been elaborated enough in Indonesia. This study aimed to determine the prognostic factors of WT patients in Adam Malik Hospital, Medan.

 

Methods: This study was conducted with a retrospective design due to the rarity of WT cases. A total of 21 WT patients diagnosed from 2003 to 2019 were taken from medical records at Adam Malik Hospital, Medan. Univariate and multivariate Cox regression analyses were performed to determine the independent prognostic factors of WT. The primary endpoint of this study was patients’ overall survival (OS) obtained by the Kaplan-Meier analysis on significant variables.

 

Results: From the univariate Cox regression analysis, gender was found to be the sole significant factor (HR = 0.218, p = 0.005) where males have a lower hazard ratio. The multivariate Cox regression analysis yielded an age of diagnosis (HR = 13.860, p = 0.014) and complete tumor removals (HR = 0.056, p = 0.008). The Kaplan-Meier analysis was performed on three significant variables mentioned before. Only gender yielded a significant Mantel-Cox log-rank score (p = 0.002) with male patients found to have better survivability with a median survival of 476 days compared to that of females of 11 days. The three-year survival of males was 45.45% while all females did not survive until the cut-off.

 

Conclusions: Three prognostic factors, including children’s gender, age of diagnosis, and tumor removal status, were confirmed to be prognostic factors for the overall survival of children with WT. Further studies covering broader demographic areas were suggested to confirm significant results.


Keywords


mortality, prognostic factors, survival, Wilms tumor

References


Kliegman R, Stanton B, Schor N, St. Gemme III J, Behrman R. Nelson textbook of pediatrics. 20th ed. Philadelphia: Elsevier Saunders; 2016

Cunningham ME, Klug TD, Nuchtern JG, et al. Global Disparities in Wilms Tumor. J Surg Res. 2020;247:34–51.

Friedman AD. Wilms Tumor. Pediatr Rev. 2013;34(7):328.

Davidoff AM. Wilmsʼ tumor. Curr Opin Pediatr. 2009;21(3):357–64.

Dome JS, Perlman EJ, Graf N. Risk Stratification for Wilms Tumor: Current Approach and Future Directions. Am Soc Clin Oncol Educ B. 2014;(34):215–23.

Tang F, Zhang H, Lu Z, et al. Prognostic Factors and Nomograms to Predict Overall and Cancer-Specific Survival for Children with Wilms’ Tumor. Dis Markers. 2019;2019:1–11.

Dome JS, Graf N, Geller JI, et al. Advances in Wilms Tumor Treatment and Biology: Progress Through International Collaboration. J Clin Oncol. 2015;33(27):2999–3007.

Dome JS, Fernandez CV, Mullen EA, et al. Children’s Oncology Group’s 2013 blueprint for research: Renal tumors. Pediatr Blood Cancer. 2013;60(6):994–1000.

Pritchard-Jones K, Kelsey A, Vujanic G, et al. Older Age Is an Adverse Prognostic Factor in Stage I, Favorable Histology Wilms’ Tumor Treated with Vincristine Monochemotherapy: A Study by the United Kingdom Children’s Cancer Study Group, Wilm’s Tumor Working Group. J Clin Oncol. 2003;21(17):3269–75.

Hartono S. Hubungan faktor-faktor prognosis dan ketahanan hidup penderita Tumor Wilms di RS Dr. Sardjito tahun 2002-2006. Universitas Gadjah Mada; 2014

D’Angelo P, Di Cataldo A, Terenziani M, et al. Factors possibly affecting prognosis in children with Wilms’ tumor diagnosed before 24 months of age: A report from the Associazione Italiana Ematologia Oncologia Pediatrica (AIEOP) Wilms Tumor Working Group. Pediatr Blood Cancer. 2017;64(12):e26644.

Israels T, Pidini D, Borgstein E, et al. Survival of children with a Wilms tumor in Blantyre, Malawi. Pediatr Hematol Oncol. 2018;35(3):196–202.


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DOI: 10.33371/ijoc.v16i1.829

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