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, D. M.; Breslow, N. E.; D'Angio, G. J.; Malogolowkin, M. H.; Ritchey, M. L.; Evans, A. E.; Beckwith, J. B.; Perlman, E. J.; Shamberger, R. C.; Peterson, S.; Grundy, P. E.; Dome, J. S.; Thomas, P. R.; Kalapurakal, J. A.

Pediatr Blood Cancer. 2013 Sep 17; 61(1):134-9

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;61:134-139. (c) 2013 Wiley Periodicals, Inc.

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