Can Lymph Node Involvement in Unilateral Wilms Tumor be Predicted by Preoperatively known Data in Combination with Intraoperative Findings?

Clemens-Magnus Meier; Rhoikos Furtwängler; Nils Welter; Marvin Mergen; Stefan Wagenpfeil; Dietrich von Schweinitz; Raimund Stein; Leo Kager; Jens-Peter Schenk; Christian Vokuhl; Sabine Kroiss-Benninger; Patrick Melchior; Steven W Warmann; Jörg Fuchs; Norbert Graf

doi:10.1097/SLA.0000000000006393

Can Lymph Node Involvement in Unilateral Wilms Tumor be Predicted by Preoperatively known Data in Combination with Intraoperative Findings?

Ann Surg. 2024 Jun 12. doi: 10.1097/SLA.0000000000006393. Online ahead of print.

Authors

Clemens-Magnus Meier¹, Rhoikos Furtwängler^{2

3}, Nils Welter³, Marvin Mergen³, Stefan Wagenpfeil⁴, Dietrich von Schweinitz⁵, Raimund Stein⁶, Leo Kager^{7

8}, Jens-Peter Schenk⁹, Christian Vokuhl¹⁰, Sabine Kroiss-Benninger¹¹, Patrick Melchior¹², Steven W Warmann^{13

14}, Jörg Fuchs¹⁴, Norbert Graf³

Affiliations

¹ Department of General Surgery, Visceral, Vascular and Paediatric Surgery, Saarland University, Homburg, Germany.
² Division of Pediatric Hematology and Oncology, Department of Pediatrics, Inselspital University Hospital, Bern, Switzerland.
³ Department of Paediatric Oncology and Haematology, Saarland University, Homburg, Germany.
⁴ Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, Germany.
⁵ Department of Pediatric Surgery, Dr. von Hauner Children's Hospital of the University of Munich, Munich, Germany.
⁶ Center for Pediatric, Adolescent and Reconstructive Urology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
⁷ St. Anna Children's Hospital, Department of Paediatrics, Medical University Vienna, Vienna, Austria.
⁸ St. Anna Children's Cancer Research Institute, Vienna, Austria.
⁹ Division of Paediatric Radiology, Department for Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany.
¹⁰ Section of Paediatric Pathology, Department of Pathology, University Hospital Bonn, Bonn, Germany.
¹¹ Department of Oncology, University Children's Hospital Zürich, Zurich, Switzerland.
¹² Department of Radiation Oncology, Saarland University, Homburg, Germany.
¹³ Pediatric Surgery, Charité University Hospital, Berlin, Germany.
¹⁴ Department of Paediatric Surgery and Urology, University Hospital Tübingen, Tübingen, Germany.

PMID: 38864214
DOI: 10.1097/SLA.0000000000006393

Abstract

Objective: This study aimed to identify parameters that allow the estimation of tumor-infiltrated lymph nodes (LN) after pretreatment for unilateral Wilms tumor (WT).

Summary background data: Complete tumor resection with removal of regional LN is always necessary. Positive LNs require local irradiation influencing benefits in case of NSS in long-term follow-up. Clinical and tumor-related data available at the time of surgery in combination with intraoperative findings (IAF) were used to estimate the LN status during surgery.

Methods: Altogether, 2115 patients with unilateral WT were prospectively enrolled in SIOP-93-01 / GPOH and SIOP-2001 / GPOH over a period of 30 years (1993-2023). LN infiltration by tumor was calculated for age, sex, metastases at diagnosis, tumor volume (TV), TV shrinkage, and intraoperative findings (IAF) using logistic regression models.

Results: Age ≥48 months (P<0.001, OR 2.17, CI 1.57 - 3.00), TV at diagnosis ≥300 (P<0.001, OR 3.72, CI 2.37 - 5.85), metastasis at diagnosis (P<0.001, OR 6.21, CI 4.47 - 8.62) and IAF (>1: P<0.001, OR 3.54, CI 2.13 - 5.88) correlated with positive LNs. TV shrinkage was not predictive of positive LN. Three flow charts were developed based on age, TV at diagnosis, metastasis, and IAF. These flowcharts defined risks between 0% and 41.5% for LN infiltration by tumor.

Conclusions: The combination of age, TV at diagnosis, and metastasis with IAF allows the estimation of the frequency of positive LNs, which may help surgeons deciding about NSS.