PTU - Polskie Towarzystwo Urologiczne
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Should a poorly differentiated epithelial feature of Wilms' tumor be considered an unfavourable prognostic factor?
Article published in Urologia Polska 2007/60/1.

authors

Jerzy Niedzielski 1, Rafał Becht 2, Katarzyna Taran 3
1 Department of Pediatric Surgery and Urology, University School of Medicine, Łódź, Poland
2 Department of Pediatric Surgery and Oncology, University School of Medicine, Łódź, Poland
Present appointment: Department of Haematology, Pomeranian Medical University in Szczecin, Poland
3 Department of Pathology, University School of Medicine, Łódź, Poland

keywords

nerka, guz Wilmsa, korelacja kliniczno-patologiczna, podtyp niskozróżnicowany nabłonkowy, rokowanie

summary

The aim of the study. The objective was to evaluate the course of disease and results of therapy in children with Wilms' tumor in relation to histological tumor features according to SIOP classification of 1993 and verified by means of classification SIOP-2001.
Material and method. The records of 44 children with Wilms' tumor, aged one month to 11 years treated in 1993-2001 were reviewed. All patients underwent multimodal therapy according to the SIOP protocols. 9 patients had favourable, 30 standard, 4 unfavourable, and one patient unclassified histological type of tumor (SIOP-93). 36 children were in clinical stage I and II (81.8%) and majority had standard tumor histology (68.1%). Most of the patients with standard histology had a blastemal subtype (60%), while within the unfavourable histology group an anaplastic subtype dominated (75%). Complications were observed in 10 children (22.7%); 4 of them died (9.1%). Event-free survival (EFS) was 86.4%, overall survival (OS) 90.9%. Follow up period ranged from 4 to 12 yrs. (mean 8.7).
Results. Simulated analysis acc. SIOP-01 revealed that 5 patients (11.4%) with favourable histology moved to the intermediate risk type, while 18 (40.9%) with standard histology moved to the high risk type. The blastemal subtype became the most common in high risk tumors (81.8%) and together with the anaplastic subtype was responsible for mortality in this group (3/22 - 13.6%). A poorly differentiated epithelial subtype became the most frequent (41.2%) and the only feature with decreased OS in intermediate risk tumors.
Conclusion. A poorly differentiated epithelial subtype should not, in authors' opinion, be considered an intermediate risk histological feature of Wilms' tumor.

references

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correspondence

Jerzy Niedzielski MD, PhD
Department of Pediatric Surgery and Urology
36/50 Sporna str.
91-738 Łódź, Poland
Phone: (4842) 617 77 11
Fax: (4842) 617 77 05
jniedzielski@usk4.umed.lodz.pl