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Should biopsy influence tumour staging in Wilms tumour? The UK experience [Abstract]

Pritchard-Jones, Kathy, Jitlal, Mark, Powis, Mark, Vujanic, Gordan, Kelsey, Anna and Mitchell, Chris 2010. Should biopsy influence tumour staging in Wilms tumour? The UK experience [Abstract]. Pediatric Blood and Cancer 55 (5) , p. 813. 10.1002/pbc.22779

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Abstract

Purpose: On behalf of the Renal Tumours Committee, Children’s Cancer and Leukaemia Group,CCLG. The influence of percutaneous biopsy on local recurrence rates ofWilms tumour (WT) in the setting of pre-operative chemotherapy followed by delayed nephrectomy has not been systematically reported. The UKW3 trial compared biopsy/pre-operative chemotherapy and immediate nephrectomy and affords the opportunity to examine this question.Method: Data on treatment and outcome for 647 patients with unilateral WT (stage I-IV) registered in the UKW3 trial (1991–2001) were analysed. Metastatic and ‘inoperable’ tumours were electively biopsied, 39% of localised tumours were randomised; overall, 299 had biopsy and 348 immediate nephrectomy. Patients with metachronous relapse or early progressive disease were excluded. Hazard ratios (HR) for risk of abdominal recurrence (excluding liver metastases) were calculated by Cox regression analysis. Adjustments included tumour histology (605FH, 42UH), stage, age, largest tumour size in one dimension and lymph node metastasis. Results: 50/647 (7.7%) patients experienced a relapse involving the abdomen (þ/-distant) and 63 distant relapse only. Anaplastic histology, positive lymph nodes, stage IV disease and increasing tumour size were all significantly associated with increased risk of any recurrence. Only anaplastic histology and increasing tumour size were significantly associated with abdominal recurrence. The adjusted HRs for association of biopsy with abdominal recurrence (HR:1.75 (95%CI:0.91–3.38, p¼0.10) or any relapse/death (HR:1.42 (95%CI:0.94–2.15, p¼0.10) did not reach statistical significance. Conclusion: The UKW3 trial provides reassurance that biopsy should not automatically lead to ‘upstaging’ of WT but that treatment intensity can be based on tumour stage at delayed nephrectomy. Note that biopsy was helpful in revealing non- WT in 12% of cases in this trial (Vujanic et al, MPO 2003). International comparison of local recurrence rates in the ongoing SIOP WT 2001 trial, where the UK continues to use biopsy without influencing tumour stage, will provide a further assessment of this ongoing controversial area.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
Additional Information: International Society of Paediatric Oncology SIOP XXXXII Congress Boston, United States October 21-24, 2010 SIOP Abstracts
Publisher: Wiley-Blackwell
ISSN: 1545-5009
Last Modified: 04 Jun 2017 03:15
URI: http://orca.cf.ac.uk/id/eprint/18996

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