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Use of nephron sparing surgery and impact on survival in children with Wilms tumor: a SEER analysis.

Publication ,  Journal Article
Wang, H-HS; Abern, MR; Cost, NG; Chu, DI; Ross, SS; Wiener, JS; Routh, JC
Published in: J Urol
October 2014

PURPOSE: Nephron sparing surgery is the standard of care for many adults with renal tumors and has been described in some children with Wilms tumor. However, beyond case series the data concerning nephron sparing surgery application and outcomes in patients with Wilms tumor are scarce. We examined nephron sparing surgery outcomes and factors associated with its application in children with Wilms tumor. MATERIALS AND METHODS: We retrospectively reviewed the 1998 to 2010 SEER database. We identified patients 18 years old or younger with Wilms tumor. Clinical, demographic and socioeconomic data were abstracted, and statistical analysis was performed using multivariate logistic regression (predicting use of nephron sparing surgery limited to unilateral tumors smaller than 15 cm) and Cox regression (predicting overall survival) models. RESULTS: We identified 876 boys and 956 girls with Wilms tumor (mean ± SD age 3.3 ± 2.9 years). Of these patients 114 (6.2%) underwent nephron sparing surgery (unilateral Wilms tumor in 74 and bilateral in 37). Median followup was 7.1 years. Regarding procedure choice, nephron sparing surgery was associated with unknown lymph node status (Nx vs N0, p <0.001) and smaller tumor size (p <0.001). Regarding survival, only age (HR 1.09, p = 0.002), race (HR 2.48, p = 0.002), stage (HR 2.99, p <0.001) and lymph node status (HR 2.17, p = 0.001) predicted decreased overall survival. Survival was not significantly different between children undergoing nephron sparing surgery and radical nephrectomy (HR 0.79, p = 0.58). CONCLUSIONS: In children with Wilms tumor included in the SEER database nephron sparing surgery has been infrequently performed. Nephron sparing surgery application is associated with smaller, bilateral tumors and with omission of lymphadenectomy. However, there are no evident differences in application of nephron sparing surgery based on demographic or socioeconomic factors. Despite lymph node under staging, overall survival is similar between patients undergoing nephron sparing surgery and radical nephrectomy.

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Published In

J Urol

DOI

EISSN

1527-3792

Publication Date

October 2014

Volume

192

Issue

4

Start / End Page

1196 / 1202

Location

United States

Related Subject Headings

  • Wilms Tumor
  • Urology & Nephrology
  • Treatment Outcome
  • Survival Rate
  • SEER Program
  • Retrospective Studies
  • Postoperative Complications
  • Nephrons
  • Nephrectomy
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Wang, H.-H., Abern, M. R., Cost, N. G., Chu, D. I., Ross, S. S., Wiener, J. S., & Routh, J. C. (2014). Use of nephron sparing surgery and impact on survival in children with Wilms tumor: a SEER analysis. J Urol, 192(4), 1196–1202. https://doi.org/10.1016/j.juro.2014.04.003
Wang, Hsin-Hsiao S., Michael R. Abern, Nicholas G. Cost, David I. Chu, Sherry S. Ross, John S. Wiener, and Jonathan C. Routh. “Use of nephron sparing surgery and impact on survival in children with Wilms tumor: a SEER analysis.J Urol 192, no. 4 (October 2014): 1196–1202. https://doi.org/10.1016/j.juro.2014.04.003.
Wang H-HS, Abern MR, Cost NG, Chu DI, Ross SS, Wiener JS, et al. Use of nephron sparing surgery and impact on survival in children with Wilms tumor: a SEER analysis. J Urol. 2014 Oct;192(4):1196–202.
Wang, Hsin-Hsiao S., et al. “Use of nephron sparing surgery and impact on survival in children with Wilms tumor: a SEER analysis.J Urol, vol. 192, no. 4, Oct. 2014, pp. 1196–202. Pubmed, doi:10.1016/j.juro.2014.04.003.
Wang H-HS, Abern MR, Cost NG, Chu DI, Ross SS, Wiener JS, Routh JC. Use of nephron sparing surgery and impact on survival in children with Wilms tumor: a SEER analysis. J Urol. 2014 Oct;192(4):1196–1202.
Journal cover image

Published In

J Urol

DOI

EISSN

1527-3792

Publication Date

October 2014

Volume

192

Issue

4

Start / End Page

1196 / 1202

Location

United States

Related Subject Headings

  • Wilms Tumor
  • Urology & Nephrology
  • Treatment Outcome
  • Survival Rate
  • SEER Program
  • Retrospective Studies
  • Postoperative Complications
  • Nephrons
  • Nephrectomy
  • Male