Factors Influencing Overall Survival of Children, Adolescents, and Young Adults With High-risk Renal Tumors - 19/09/18

Doi : 10.1016/j.urology.2018.07.032

Majdee Islam ^a, Amanda F. Saltzman ^a, Arya Amini ^b, Alonso Carrasco ^a, Nicholas G. Cost ^a,^⁎
^a University of Colorado, Department of Surgery, Division of Urology; Children's Hospital Colorado, Aurora, CO
^b University of Colorado, Department of Radiation Oncology, Aurora, CO

^⁎Address correspondence to: Nicholas G. Cost, M.D., University of Colorado School of Medicine, Department of Surgery, Division of Urology, 13123 E 16th Ave, Box 463, Aurora, CO 80045.University of Colorado School of MedicineDepartment of SurgeryDivision of Urology13123 E 16th Ave, Box 463AuroraCO80045

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 19 September 2018

Abstract

Objective

To identify factors impacting overall survival (OS) in children, adolescents, and young adults with high-risk renal tumors (HRRTs).

Methods

The National Cancer Database was queried for patients ≤30 years old diagnosed with anaplastic Wilms tumors (AWT), clear cell sarcoma of the kidney (CCSK), or rhabdoid tumor of the kidney (RTK) between 2004 and 2013. Demographic, clinical, and OS data were abstracted. OS between groups was compared with a Kaplan-Meier curve. Univariate and multivariate survival analyses were performed.

Results

A total of 349 patients were identified meeting criteria; 133 (38.1%) AWT, 120 (34.4%) CCSK, and 96 (27.5%) RTK. Patients with RTK were less likely to undergo surgery than those with AWT or CCSK (77.1% vs 94% vs 99%, P < .001) and less likely to receive chemotherapy (84.4% vs 96.2% vs 95%, P = .013) or radiation (52.1% vs 81.2% vs 86.7%, P < .001). Estimated 5-year OS was 76.1% (95% confidence interval [CI] 67.9-84.4) for AWT, 92.7% (95% CI 87.4-97.9) for CCSK, and 33.5% (95% CI 23.1-43.9) for RTK (P < .001). On multivariate analysis, AWT (HR 3.372, P = .032) and RTK histology (HR 12.595, P < .001) were significantly associated with worse OS, while receiving radiation (HR 0.43, P = .006) was associated with improved OS. LN positivity, margin status, and undergoing surgery were not. Analyzing the HRRTs individually, for AWT, undergoing surgery was associated with OS (HR 0.308, P = .031). For RTK, factors associated with OS included undergoing surgery (HR 0.209, P = .007) and radiation (HR 0.411, P = .008).

Conclusion

Within the HRRTs, RTK is associated with worse outcomes than either AWT or CCSK. Receiving radiation is significantly associated with improved outcomes, and surgery is important for those with AWT and RTK.

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Plan

	Financial Disclosure: The authors declare that they have no relevant financial interests.
	Funding Support: The Etkin Family Fund of the Aspen Community Foundation.
	Ethical Approval: IRB exemption was obtained.