title: Outcome of relapses of nephroblastoma in patients registered in the SIOP/GPOH trials and studies.
abstract: We registered 170 relapses in 1392 children with nephroblastoma in the SIOP/GPOH trials. The study aimed to evaluate prognostic factors for outcome in relapsed patients. Age, gender, initial stage, metastatic disease, local stage, histology, time to relapse and tumour volume were analysed for their prognostic relevance. Overall survival after relapse was 48% (median follow-up 5 years). Relapses were local in 28%, metastatic in 57% and combined in 15%. The median age of the cohort was 4.5 years whereas patients in complete continuous remission were significantly younger (3.1 years, p=0.001). Patients with initial stage I and II showed a significantly better prognosis than children with stage III (57 vs. 31%, p=0.008). Patients with high-risk tumours had a much poorer prognosis than those with intermediate and low-risk tumours (58 vs. 31%, p=0.003). Children with recurrence within 6 months after diagnosis had a poorer outcome than children relapsing later on (54 vs. 22%, p=0.0001). The tumour volume initially and after preoperative chemotherapy did not have any influence on outcome. Patients with isolated distant metastasis had a significantly better outcome than those with local and combined relapses (p=0.001). In conclusion, factors for poor prognosis after relapse are early relapse, local stage III, high-risk histology and combined relapse.
authors.affiliation: Asklepios Hospital, Pediatric Haematology and Oncology, D-53757 Sankt Augustin, Germany. h.reinhard@asklepios.com
authors.forename: Harald
authors.initials: H
authors.lastname: Reinhard
authors.forename: Andrea
authors.initials: A
authors.lastname: Schmidt
authors.forename: Rhoikos
authors.initials: R
authors.lastname: Furtwängler
authors.forename: Ivo
authors.initials: I
authors.lastname: Leuschner
authors.forename: Christian
authors.initials: C
authors.lastname: Rübe
authors.forename: Dietrich
authors.initials: D
authors.lastname: Von Schweinitz
authors.forename: Andreas
authors.initials: A
authors.lastname: Zoubek
authors.forename: Felix
authors.initials: F
authors.lastname: Niggli
authors.forename: Norbert
authors.initials: N
authors.lastname: Graf
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D009396:Wilms Tumor / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery