Standard of care for unilateral nephroblastoma includes total nephrectomy (TN) with nodal sampling. We sought to compare the outcomes of TN and partial nephrectomy (PN). We performed a retrospective cohort study of TN and PN for nephroblastoma using the National Cancer Data Base. The outcomes included nodal sampling frequency, margin status, and survival. Categorical and continuous data were evaluated with χ2 and t tests, respectively (P < 0.05). Generalized linear models evaluated nodal sampling and margin status. Cox regression compared survival. In total, 235 patients underwent PN and 3572 had TN. TN patients were 50 per cent more likely to undergo nodal sampling (RR: 1.47, 95% CI 1.30–1.66). There was no difference in margin status (RR: 0.91, 95% CI 0.65–1.28) or overall survival (HR 1.57; 95% CI 0.78–3.19). This study reports the largest review of patients with PN for unilateral nephroblastoma. PN patients had less nodal sampling but similar margin involvement and overall survival.
Get full access to this article
View all access options for this article.
References
1.
SiegelD.A., KingJ., TaiE.Cancer incidence rates and trends among children and adolescents in the United States, 2001–2009.Pediatrics2014; 134: e945–55.
2.
GurneyJ.G., SeversonR.K., DavisS.Incidence of cancer in children in the United States. Sex-, race-, and 1-year age-specific rates by histologic type.Cancer1995; 75: 2186–95.
3.
RouthJ.C., GrahamD.A., EstradaC.R.Contemporary use of nephron-sparing surgery for children with malignant renal tumors at freestanding children's hospitals.Urology2011; 78: 422–6.
BhatnagarS.Management of Wilms’ tumor: NWTS vs SIOP.J Indian Assoc Pediatr Surg2009; 14: 6–14.
6.
SmithM.A., SeibelN.L., AltekruseS.F.Outcomes for children and adolescents with cancer: challenges for the twenty-first century.J Clin Oncol2010; 28: 2625–34.
7.
GreenD.M.The evolution of treatment for Wilms tumor.J Pediatr Surg2013; 48: 14–9.
8.
HaeckerF-M, Schweinitz vonD., HarmsD.Partial nephrectomy for unilateral Wilms tumor: results of study SIOP 93-01/GPOH.J Urol2003; 170: 939–42;discussion 943–4.
9.
WildeJ.C.H., AronsonD.C., SznajderB.Nephron sparing surgery (NSS) for unilateral wilms tumor (UWT): the SIOP 2001 experience.Pediatr Blood Cancer2014; 61: 2175–9.
10.
Vanden BergR.N.W., BiermanE.N., NoordM.V.Nephron-sparing surgery for Wilms tumor: a systematic review.Urol Oncol2016; 34: 24–32.
11.
ManikandanR., SrinivasanV., RanéA.Which is the real gold standard for small-volume renal tumors? Radical nephrectomy versus nephron-sparing surgery.J Endourol2004; 18: 39–44.
12.
CostN.G., Sawicz-BirkowskaK., KajbafzadehA-MA comparison of renal function outcomes after nephron-sparing surgery and radical nephrectomy for nonsyndromic unilateral Wilms tumor.Urology2014; 83: 1388–93.
WinchesterD.P., StewartA.K., BuraC.The National Cancer Data Base: a clinical surveillance and quality improvement tool.J Surg Oncol2004; 85: 1–3.
15.
GrovasA., FremgenA., RauckA.The National Cancer Data Base Report on Patterns of Childhood Cancers in the United States, Vol 80. Cancer.New Jersey: John Wiley & Sons, Inc., 1997, pp 2321–32.
PUF Data Dictionary Items. National Cancer Data Base -Data Dictionary PUF 2013. ncdbpuf.facs.org. Available from: http://ncdbpuf.facs.org/node/259. Accessed December 3, 2015.
19.
McAteerJ.P., RichardsM.K., StergachisA.Influence of hospital and patient location on early postoperative outcomes after appendectomy and pyloromyotomy.J Pediatr Surg2015; 50: 1549–55.
20.
McKiernanJ., SimmonsR., KatzJ., RussoP.Natural history of chronic renal insufficiency after partial and radical nephrectomy.Urology2002; 59: 816–20.
21.
GowK.W., BarnhartD.C., HamiltonT.E.Primary nephrectomy and intraoperative tumor spill: report from the Children's Oncology Group (COG) renal tumors committee.J Pediatr Surg2013; 48: 34–8.
22.
FerrerF.A., RosenN., HerbstK.Image based feasibility of renal sparing surgery for very low risk unilateral Wilms tumors: a report from the Children's Oncology Group.J Urol2013; 190: 1846–51.
23.
GreenD.M., BreslowN.E., D'AngioG.J.Outcome of patients with Stage II/favorable histology Wilms tumor with and without local tumor spill: a report from the National Wilms Tumor Study Group.Pediatr Blood Cancer2014; 61: 134–9.
24.
KieranK., AndersonJ.R., DomeJ.S., EhrlichP.F., RitcheyM.L., ShambergerR.C.Lymph node involvement in Wilms tumor: results from National Wilms Tumor Studies 4 and 5.J Pediatr Surg2012; 47: 700–6.
EhrlichP.F., RitcheyM.L., HamiltonT.E.Quality assessment for Wilms’ tumor: a report from the National Wilms’ Tumor Study-5.J Pediatr Surg2005; 40: 208–12;discussion 212-3.
27.
TermuhlenA.M., TersakJ.M., LiuQ.Twenty-five year follow-up of childhood Wilms tumor: a report from the Childhood Cancer Survivor Study.Pediatr Blood Cancer2011 15; 57: 1210–6.
28.
WangH-H.S., AbernM.R., CostN.G.Use of nephron sparing surgery and impact on survival in children with Wilms tumor: a SEER analysis.J Urol2014; 192: 1196–202.
FernandezC.V., LiN., MullenE.A., GrundyP.E.Barriers to the enrollment of children in the Children's Oncology Group study of very low risk Wilms tumor: a report from the Children's Oncology Group.J Pediatr Hematol Oncol2011; 33: 521–3.
