Hepatic Metastasis At Diagnosis In Patients With Wilms Tumor Is Not An Independent Adverse Prognostic Factor. A Report From The Childrens Oncology Group- National Wilms Tumor Study(4/5)
*Peter F Ehrlich1, Robert C Shamberger2, *Fernado Ferrer3, *Michael Ritchey4, *James Anderson5, *Jeff Dome6, *Daniel Green7, *John Kalapurakal8
1University of Michigan, Ann Arbor, MI;2Boston Childrens Hospital, Boston, MA;3Connecticut Children's Medical Center, Hartford, CT;4Pediatric Urological Associates, Pheonix, AZ;5Nebraska Medical Center- university of Omaha, Omaha, NE;6Childrens National Medical Center, Washington, DC;7St Jude Research Hospital, Memphis, TN;8Northwestern University, Chicago, IL
To determine event free survival (EFS) of children with Wilms tumor(WT) and metastatic liver disease at diagnosis.
Reports have suggested that children with stage IV WT and liver disease have a worse prognosis than other Stage IV disease, thus requiring more intensive chemotherapy and surgical treatment.
Patients with stage IV Wilms tumor treated on National Wilms Tumor Study 4 and 5 (n = 742) were assessed for EFS (95% confidence interval [CI]) at 5 years after diagnosis. Subgroups for analysis by site of metastases and treatment
96/742 patients enrolled with stage IV disease due to liver metastases at diagnosis. In 22 patients a primary liver resection was performed and 71 patients did not require any liver surgery. Liver disease resolved in 14 patients with chemotherapy and in 57 with chemotherapy and radiation. EFS for all patients with Stage IV WT was 75% [71%, 78%] with no significant difference between categories (p=0.60). EFS with primary resection of the liver metastases was 86% [63%-95%] vs. 68% [56%-78%] with no resection of liver metastases (p=0.09). EFS for patientstreated with chemotherapy was 64% [34%, 83%] compared to those with chemotherapy and irradiation 77% [55%, 89] or those who had irradiation boost to the liver 72% [58%, 82%],(p=0.63).
Liver metastases at diagnosis is not an adverse prognostic factor for stage IV metastatic FH Wilms tumor.
|Stage IV Category||EFS||95%CI|
|Lung Only (513pts)||76%||72%-80%|
|Liver, not lung (34pts)||76%||58%-87%|
|Liver and lung (62 pts)||70%||57%- 80%|
|Other sites (25 pts)||64%||42%-79%|