Summary
Introduction
The clinical value of lymph node sampling in Wilms tumor (WT) lies in its ability
to accurately determine lymph node (LN) involvement. LN yield (LNY) is used as a valuable
tool to measure LN retrieval, and a minimum of 6 LNs is one of the current recommendations.
In patients who are managed with the SIOP strategy, preoperative chemotherapy decreases
the retrieval of LN during surgery resulting in lower LNY values.
Purpose
To determine the mean LNY and to analyze survival outcomes in patients with WT who
underwent preoperative chemotherapy at a single center.
Methods
We performed a retrospective chart review of all patients between 6 months and 12
years of age with unilateral WT who underwent preoperative chemotherapy between 2010
and 2018. Patients with bilateral WT or without preoperative chemotherapy were excluded.
Collected data included: demographics, tumor volume, tumor histopathology, number
of LNs collected (LNY), presence or absence of tumor in the retrieved LNs, and disease
stage according to these results. Kaplan Meier curves were calculated to estimate
5-year event-free survival (EFS) and overall survival (OS).
Results
95 patients with a median follow-up of 25 months were included in the study. A total
of 19 patients underwent laparoscopic surgery. Mean LNY for the entire cohort was
3.26 (95% CI, 2.4–3.6; SD, 3.62). Six patients (6.3%) had at least one positive LN.
The estimated 5-year OS was 89.3% (95% CI, 82.1%–96.5%). EFS was 79.8 (95% CI, 74.8%–84.8%).
Recurrence rate was 20% (n: 19). Four patients (4.2%) developed local recurrence and
15 patients (15.7%) developed pulmonary recurrence. The initial mean LNY in patients
that relapsed was 4.16 (95% CI, 2.2–5.8; SD: 4.18), which was higher than in patients
who did not relapse (LNY: 3; 95% CI, 2.33–3.67; SD, 3.39). No recurrences or deaths
occurred in the laparoscopic group.
Discussion
The identification of a minimum LNY (i.e. threshold) to minimize the risk of harboring
occult metastatic disease has been proposed to standardize the surgical procedure.
Preliminary results in this study suggest that a limited LNY with acceptable survival
outcomes is a possible scenario in patients treated according to the SIOP protocol.
Systematic LN sampling to reduce the rate of false negatives is still strongly recommended.
Conclusion
Our cohort presented with a relatively low LNY compared to standard recommendations.
Our EFS, however, remained acceptable. Multivariate analysis would be necessary to
determine the actual role of LN sampling as an isolated prognostic factor in unilateral
WT.
Keywords
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Article info
Publication history
Published online: November 23, 2020
Accepted:
November 18,
2020
Received in revised form:
October 27,
2020
Received:
May 19,
2020
Identification
Copyright
© 2020 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.
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- Outcomes of event-free survival in patients with Wilms tumor undergoing preoperative chemotherapy. Analysis of lymph-node yield in a single-center cohortJournal of Pediatric UrologyVol. 17Issue 2