Tumor size and prognosis in patients with Wilms tumor

OBJECTIVE: Investigate the relationship of the tumor volume after preoperative chemotherapy (TVAPQ) and before preoperative chemotherapy (TVBPQ) with overall survival at two and at five years, and lifetime. METHODS: Our sample consisted of consecutive patients evaluated in the period from 1989 to 2009 in an Onco-Hematology Service. Clinical, histological and volumetric data were collected from the medical records. For analysis, chi-square, Kaplan-Meier, log-rank and Cox regression tests were used. RESULTS: The sample consisted of 32 patients, 53.1% were male with a median age at diagnosis of 43 months. There was a significant association between TVAPQ>500mL and the difference between the TVBPQ and TVAPQ (p=0.015) and histologic types of risk (p=0.008). It was also verified an association between the difference between the TVBPQ and TVAPQ and the predominant stromal tumor (p=0.037). When assessing the TVAPQ of all patients, without a cutoff, there was an association of the variable with lifetime (p=0.013), i.e., for each increase of 10mL in TVAPQ there was an average increase of 2% in the risk of death. CONCLUSIONS: Although our results indicate that the TVAPQ could be considered alone as a predictor of poor prognosis regardless of the cutoff suggested in the literature, more studies are needed to replace the histology and staging by tumor size as best prognostic variable. . OBJETIVO: Investigar a relacao entre o volume do tumor apos a quimioterapia pre-operatoria (VTPOS) e antes da quimioterapia pre-operatoria (VTPRE) com sobrevida geral aos dois e cinco anos e tempo de vida. METODOS: A amostra foi composta por pacientes consecutivos avaliados de 1989 a 2009, em um servico de onco-hematologia. Os dados clinicos, histologicos e volumetricos foram coletados a partir dos registros medicos. Para analise, usaram-se os testes qui-quadrado, Kaplan-Meier, log-rank e regressao de Cox. RESULTADOS: A amostra foi composta de 32 pacientes, 53,1% do sexo masculino, com mediana de idade ao diagnostico de 43 meses. Houve associacao significativa entre VTPOS >500 mL e a diferenca entre o VTPRE e VTPOS (p=0,015) e os tipos histologicos de risco (p=0,008). Verificou-se tambem uma associacao entre a diferenca entre o VTPRE e VTPOS e o tumor de predominio estromal (p=0,037). Quando se avaliou o VTPOS de todos os pacientes, sem um ponto de corte definido, observou-se associacao dessa variavel com o tempo de vida (p=0,013), isto e, para cada aumento de 10 mL no VTPOS houve um aumento medio de 2% no risco de morte. CONCLUSOES: Embora os resultados indiquem que o VTPOS poderia ser considerado um preditor isolado de mau prognostico, independentemente do ponto de corte sugerido na literatura, mais estudos sao necessarios para substituir a histologia e estadiamento pelo tamanho do tumor como melhor variavel prognostica. .