Twenty-five year follow-up of childhood Wilms tumor: A report from the Childhood Cancer Survivor Study

Amanda M. Termuhlen, Jean M. Tersak, Qi Liu, Yutaka Yasui, Marilyn Stovall, Rita Weathers, Melvin Deutsch, Charles A. Sklar, Kevin C. Oeffinger, Greg Armstrong, Leslie L. Robison, Daniel M. Green

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87 Scopus citations

Abstract

Background: Treatment cures over 90% of children with Wilms tumor (WT) who subsequently risk late morbidity and mortality. This study describes the 25-year outcomes of 5-year WT survivors in the Childhood Cancer Survivor Study (CCSS). Procedure: The CCSS, a multi-institutional retrospective cohort study, assessed WT survivors (N=1,256), diagnosed 1970-1986, for chronic health conditions, health status, health care utilization, socioeconomic status, subsequent malignant neoplasms (SMNs), and mortality compared to the US population and a sibling cohort (N=4,023). Results: The cumulative incidence of all and severe chronic health conditions was 65.4% and 24.2% at 25 years. Hazard ratios (HR) were 2.0, 95% confidence interval (CI) 1.8-2.3 for grades 1-4 and 4.7, 95%CI 3.6-6.1 for grades 3 and 4, compared to sibling group. WT survivors reported more adverse general health status than the sibling group (prevalence ratio [PR] 1.7; 95%CI 1.2-2.4), but mental health status, socioeconomic outcome, and health care utilization were similar. The cumulative incidence of SMN was 3.0% (95%CI 1.9-4.0%) and of mortality was 6.1% (95%CI 4.7-7.4%). Radiation exposure increased the likelihood of congestive heart failure (CHF) (no doxorubicin-HR 6.6; 95%CI 1.6-28.3; doxorubicin ≤250mg/m 2-HR 13.0; 95%CI 1.9-89.7; doxorubicin >250mg/m 2-HR 18.3; 95%CI 3.8-88.2), SMN (standardized incidence ratio [SIR] 9.0; 95%CI 3.9-17.7 with and 4.9; 95%CI 1.8-10.6 without doxorubicin) and death. Conclusion: Long-term survivors of WT treated from 1970 to 1986 are at increased risk of treatment related morbidity and mortality 25 years from diagnosis.

Original languageEnglish (US)
Pages (from-to)1210-1216
Number of pages7
JournalPediatric Blood and Cancer
Volume57
Issue number7
DOIs
StatePublished - Dec 15 2011

Keywords

  • Late effects
  • Survivorship
  • Wilms tumor

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