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Is the absolute blastema volume after preoperative chemotherapy in nephroblastoma relevant for prognosis? [Abstract]

Graf, Norbert, van Tinteren, Harm, Pritchard-Jones, Kathy, Bergeron, Christophe, Sandstedt, Bengt, Leuschner, Ivo, Vujanic, Gordan, Boccon-Gibod, Liliane, van den Heuvel-Eibrink, Marry, de Camargo, Beatriz, Spreafico, Filippo, Oldenburger, Foppe, Godzinski, Jan and de Kraker, Jan 2011. Is the absolute blastema volume after preoperative chemotherapy in nephroblastoma relevant for prognosis? [Abstract]. Pediatric Blood and Cancer 57 (5) , pp. 741-742. 10.1002/pbc.23299

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Purpose: It was hypothesized that the volume of blastema rather than the overall volume of the tumour or the crude percentage of blastema left after pre-operative chemotherapy could have prognostic value with respect to event-free and overall survival.Method: In SIOP WT 2001 trial (to December 2010) data on tumour volume after preoperative chemotherapy (pre-CT) and the percentage of necrosis and blastema in the tumour specimen is available in 1363 (50.4%) of 2702 registered children with unilateral nephroblastoma. The absolute volume of remaining blastema (V[b]) was retrospectively calculated using the formula: V[b]= V[tumor after pre-CT] x (1 = fraction necrosis) x fraction blastema. V[b] in relation to event-free-survival (EFS) was investigated by means of martingale residual plots. Results: In 980 patients with localized/intermediate risk tumours, V[b] could be calculated. The risk of relapse increases continuously beyond a V[b] of 20 ml. This holds true for stage and various types of intermediate risk groups. In 168 patients with localized/high risk tumours such a threshold could be calculated at a V[b] of 100 ml and in 189 metastatic patients at 10 ml. A Cox proportional Hazard analysis in localized tumours including age (6– 24 months, 24–48 months, 48–96 months and older than 96 months)), stage (I, II, III), risk groups (low, intermediate versus high risk) and the continuous variable V[b] showed age and V[b] as the most important factors. None of the other factors were significantly associated with EFS in the model. Conclusion: The results suggest, for the first time in solid tumours, that an absolute volume of non-responding tumour (blastema after primary chemotherapy) might have prognostic value as is already existing in acute lymphoblastic Leukemias. The results need to be confirmed by prospective trials to define an optimal threshold of V[b] for a better risk stratification in combination with age.

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)
Additional Information: 43rd Congress of the International Society of Paediatric Oncology (SIOP) 2011 Auckland, New Zealand, 28th-30th October, 2011, SIOP Abstracts
Publisher: Wiley-Blackwell
ISSN: 1545-5009
Last Modified: 04 Jun 2017 03:29

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