Risk factors for local recurrence in Wilms tumour and the potential influence of biopsy – The United Kingdom experience

• Published in: European journal of cancer (1990) 2015-01, Vol.51 (2), p.225-232
• Main Authors: Irtan, S, Jitlal, M, Bate, J, Powis, M, Vujanic, G, Kelsey, A, Walker, J, Mitchell, C, Machin, D, Pritchard-Jones, K
• Format: Article
• Language: English
• Subjects: Adolescent; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biopsy; Child; Child, Preschool; Combined Modality Therapy; Dactinomycin - administration & dosage; Doxorubicin - administration & dosage; Female; Hematology, Oncology and Palliative Medicine; Humans; Infant; Infant, Newborn; Kidney - drug effects; Kidney - pathology; Kidney - surgery; Kidney Neoplasms - drug therapy; Kidney Neoplasms - pathology; Kidney Neoplasms - surgery; Local relapse; Male; Multivariate Analysis; Neoplasm Recurrence, Local; Nephrectomy; Outcome Assessment (Health Care) - methods; Outcome Assessment (Health Care) - statistics & numerical data; Percutaneous biopsy; Proportional Hazards Models; Risk Factors; Survival Analysis; United Kingdom; Vincristine - administration & dosage; Wilms Tumor - drug therapy; Wilms Tumor - pathology; Wilms Tumor - surgery; Wilms tumour
• ISSN: 0959-8049; 1879-0852
• DOI: 10.1016/j.ejca.2014.10.026

Abstract Rationale The UKW3 trial compared biopsy/pre-operative chemotherapy versus immediate nephrectomy and afforded the opportunity to examine the influence of percutaneous retroperitoneal biopsy and other factors on local and distant relapse of Wilms tumour (WT). Methods Patients with unilateral WT (stages I–IV) excluding metachronous relapse or early progressive disease were eligible. Metastatic and ‘inoperable’ tumours were biopsied electively. ‘Local’ was defined as relapse within the abdomen, except for liver metastases considered as ‘distant’ relapse, together with other haematogenous routes. Uni- and multivariable analyses estimated the risk factors for relapse. Results Overall, 285/635 (44.9%) patients had a biopsy. With a median follow-up of 10.1 years, 35 (5.5%) patients experienced a ‘local’, 15 a combined (2.4%) and 60 (9.4%) a ‘distant’ relapse. On univariate analysis, biopsy, anaplasia and tumour size were associated with an increased risk of local relapse. On multivariable analysis, anaplasia and tumour size remained significant for local relapse whereas the elevated risk of biopsy (hazards ratio (HR) = 1.80: 95% confidence interval (CI) 0.97–3.32, p = 0.060) was marginal. Age, anaplasia, tumour size, lymph nodes metastases and stage, but not biopsy, were individually associated with increased risk of distant relapse but only age and anaplasia remained significant following multivariable analysis. Conclusions The UKW3 trial provides some reassurance that biopsy should not automatically lead to ‘upstaging’ of WT. Further assessment of this controversial area is required. Comparison of local relapse rates in a multinational trial in which the United Kingdom (UK) continued the practice of routinely biopsying all patients in contrast to the standard European approach will afford this opportunity and is planned.