Prognostic significance of age in 5631 patients with Wilms tumour prospectively registered in International Society of Paediatric Oncology (SIOP) 93-01 and 2001

• Published in: PloS one Vol. 14; no. 8; p. e0221373
• Main Authors: Hol, J A, Lopez-Yurda, M I, Van Tinteren, H, Van Grotel, M, Godzinski, J, Vujanic, G, Oldenburger, F, De Camargo, B, Ramírez-Villar, G L, Bergeron, C, Pritchard-Jones, K, Graf, N, Van den Heuvel-Eibrink, M M
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.08.2019; Public Library of Science (PLoS)
• Subjects: Adolescent; Age; Age Factors; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Associations; Biology and Life Sciences; Biometrics; Biopsy; Cancer; Cancer therapies; Cancer treatment; Care and treatment; Chemotherapy; Chemotherapy, Adjuvant - methods; Child; Child, Preschool; Disease-Free Survival; Female; Hematology; Histology; Humans; Infant; Kidney - pathology; Kidney - surgery; Kidney Neoplasms - mortality; Kidney Neoplasms - pathology; Kidney Neoplasms - therapy; Leukemia; Male; Martingales; Medical prognosis; Medicine and Health Sciences; Neoplasm Staging; Nephrectomy; Nephroblastoma; Oncology; Pathology; Patient Selection; Patients; Pediatric research; Pediatrics; Prognosis; Prospective Studies; Risk Assessment; Risk Factors; Statistics; Studies; Surgery; Survival; Tumor Burden; Tumors; Urology; Vincristine; Wilms Tumor - mortality; Wilms Tumor - pathology; Wilms Tumor - therapy; United Kingdom; Ireland; England; Poland; Netherlands; United Kingdom > UK
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0221373

To enhance risk stratification for Wilms tumour (WT) in a pre-operative chemotherapy setting, we explored the prognostic significance and optimal age cutoffs in patients treated according to International Society of Paediatric Oncology Renal Tumour Study Group (SIOP-RTSG) protocols. Patients(6 months-18 years) with unilateral WT were selected from prospective SIOP 93-01 and 2001 studies(1993-2016). Martingale residual analysis was used to explore optimal age cutoffs. Outcome according to age was analyzed by uni- and multivariable analysis, adjusted for sex, biopsy(yes/no), stage, histology and tumour volume at surgery. 5631 patients were included; median age was 3.4 years(IQR: 2-5.1). Estimated 5-year event-free survival (EFS) and overall survival (OS) were 85%(95%CI 83.5-85.5) and 93%(95%CI 92.0-93.4). Martingale residual plots detected no optimal age cutoffs. Multivariable analysis showed lower EFS with increasing age(linear trend P<0.001). Using previously described age categories, EFS was lower for patients aged 2-4(HR 1.34, P = 0.02), 4-10(HR 1.83, P<0.0001) and 10-18 years(HR 1.74, P = 0.01) as compared to patients aged 6 months-2 years. OS was lower for patients 4-10 years(HR 1.67, P = 0.01) and 10-18 years(HR 1.87, P = 0.04), but not for 2-4 years(HR 1.29, P = 0.23). Higher stage, histological risk group and tumour volume were independent adverse prognostic factors. Although optimal age cutoffs could not be identified, we demonstrated the prognostic significance of age as well as previously described cutoffs for EFS (2 and 4 years) and OS (4 years) in children with WT treated with pre-operative chemotherapy. These findings encourage the consideration of age in the design of future SIOP-RTSG protocols.