title: Clinicopathologic findings predictive of relapse in children with stage III favorable-histology Wilms tumor.
abstract: OBJECTIVE
  Stage III designation in NWTS-5 (National Wilms Tumor Study-5) was determined by four pathologic criteria: positive lymph nodes (LNs), peritoneal implants, residual disease, and tumor rupture. The objective of this study was to determine the prognostic significance of each of the stage III criteria.
  
  
  METHODS
  Children with stage III Wilms tumor (WT) treated in NWTS-5 were assessed for event-free (EFS) and overall survival (OS). Sites of relapse and molecular status of tumors are reported. EFS and OS are reported 8 years after diagnosis.
  
  
  RESULTS
  There were 569 patients with local stage III favorable-histology (FH) WT in this analysis, of whom 109 had overall stage IV disease. LN involvement alone was the most frequent criterion for stage III designation (38%), followed by microscopic residual disease alone (20%), microscopic residual disease and LN involvement (14%), and spill or soilage alone (9%). The 8-year EFS and OS estimates for all patients with local stage III FHWT were 82% and 91%, respectively. Multivariate analysis demonstrated that both LN involvement (relative risk, 1.89; P = .005) and microscopic residual disease (relative risk, 1.87; P = .007) were predictive of EFS, and OS results were similar. There was no apparent difference in pattern of relapse according to stage III subtype. The rate of loss of heterozygosity was higher (6%) for those with positive LNs than for those without (2%; P = .05).
  
  
  CONCLUSIONS
  LN involvement and microscopic residual are the stage III criteria highly predictive of EFS and OS for patients with stage III FHWT. It is possible that in future studies, patients with different stage III criteria may receive different therapies.
authors: University of Michigan, Ann Arbor, MI 48109, USA. pehrlich@med.umich.edu
authors: Peter F
authors: PF
authors: Ehrlich
authors: James R
authors: JR
authors: Anderson
authors: Michael L
authors: ML
authors: Ritchey
authors: Jeffrey S
authors: JS
authors: Dome
authors: Daniel M
authors: DM
authors: Green
authors: Paul E
authors: PE
authors: Grundy
authors: Elizabeth J
authors: EJ
authors: Perlman
authors: John A
authors: JA
authors: Kalapurakal
authors: Norman E
authors: NE
authors: Breslow
authors: Robert C
authors: RC
authors: Shamberger
mesh_terms: D002648:Child; D005544:Forecasting; D006801:Humans; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology*; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D009396:Wilms Tumor / Q000401:mortality / Q000473:pathology*
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