Childhood renal tumors: surgical treatment and results

Abstract

Aim: Renal tumors in children are rare. Wilms’ tumor (WT) is the most common renal tumor in childhood. The aim of this study is to investigate the data on the demographic factors, treatment, and follow-up results of pediatric patients who were operated on for renal tumors and determine the factors affecting mortality. Material and Method: Patients who were operated for renal tumor in our clinic in 2005-2020 were evaluated retrospectively. Age at diagnosis, gender, complaint, localization of the involved kidney, additional anomalies, tumor size, tru-cut biopsy performed, tumor stage, distant metastasis, applied treatments, pathology, treatment complications, and follow-up period were examined. Results: Of the 47 patients, 25 were female and 22 were male. The mean age was 45.46 (2–204) months. The tumor was located in the right in 21 cases, left in 23 cases and bilateral in three cases. The mean length of the tumor was 11.73 cm. At the time of diagnosis, there was metastasis in 15 cases (31.9%). While metastasis were the most common seen in lung (24.3%), bone-cell metastases were seen in clear cell carcinoma (33.3%) and brain metastases were seen in rhabdoid tumor (50%). Tru-cut biopsy was performed in 15 (31.9%) cases and biopsy was diagnostic in ten cases. Histopathologically, 41 cases had WT (87.23%), three cases were clear cell carcinoma (6.3%), two cases had anaplasia rhabdoid tumor (4.2%), and one case had metanephric adenoma. Relaps occured in nine cases (19.14%) during the follow-up period. Histopathologically, one case was a clear cell carcinoma, one case was a rhabdoid tumor, and seven cases were unilateral WT. The survival rate of our series was 89,4%. Conclusion: The most common renal tumor in childhood was WT. Surgery have no effect on survival; the most important survival factors were detecting the existence of rhabdoid tumors and anaplasia histopathologically. Therefore, during the follow-up and treatment of renal tumors in childhood, pathological examination should be of primary importance and followed up with the pediatric oncologists.

Keywords

• Renal tumors
• children
• surgery
• Wilms tumor
• Rhabdoid tumor
• Clear cell carcinoma

References

1. Malkan AD, Loh A, Bahrami A, et al. An approach to renal masses in pediatrics. Pediatrics 2015; 135: 142-58.
2. Kieran K, Ehrlich PF. Current surgical standards of care in Wilms tumor. In Urologic Oncology: Seminars and Original Investigations 2016; 34: 13-23.
3. Saula PW, Hadley GP. Pediatric non-Wilms’ renal tumors: a third world experience. World J Surg 2012; 36: 565-72.
4. Ünal E, Yilmaz E, Özcan A, et al. Twenty children with non-Wilms renal tumors from a reference center in Central Anatolia, Turkey. Turk J Med Sci 2020; 50: 18-24.
5. Pritchard-Jones K, Dome JS (eds.). Renal Tumors of Childhood: Biology and Therapy, Pediatric Oncology. SpringerVerlag Berlin Heidelberg; 2014. doi:10.1007/978-3-662-44003-2_3.
6. Tan XH, Zhang DY, Liu X, et al. Retrospective analysis to determine outcomes of patients with bilateral Wilms tumor undergoing nephron sparing surgery: 15-year tertiary single-institution experience. Pediatr Surg Int 2018; 34: 427-33.
7. Pan C, Cai JY, Xu M, et al. Renal tumor in developing countries: 142 cases from a single institution at Shanghai, China. World J Pediatr 2015; 11: 326-30.
8. Genç B, Özkan MA. Çocukluk çağı böbrek tümörleri. Kanser Gündemi Dergisi 2016; 4: 1-2.

9. Bozlu G, Çıtak EÇ. Evaluation of renal tumors in children. Turk J Urol 2018; 44: 268-73.
10. Miniati D, Gay AN, Parks KV, et al. Imaging accuracy and incidence of Wilms’ and non-Wilms’ renal tumors in children. J Pediatr Surg 2008; 43: 1301-7.
11. Ward E, DeSantis C, Robbins A, Kohler B, Jemal A. Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin 2014; 64: 83-103.
12. Dumoucel S, Gauthier-Villars M, Stoppa-Lyonnet D, et al. Malformations, genetic abnormalities, and Wilms tumor. Pediatr Blood Cancer 2014; 61: 140-4.
13. Emir S, Kan R, Demir HA, Cakar N, Güler M. Occurrence of Wilms tumor in a child with urofacial (OCHOA) syndrome. Pediatr Hematol Oncol 2011; 28: 616-8.
14. Metzger ML, Dome JS. Current therapy for Wilms’ tumor. Oncologist 2005; 10: 815-26.
15. Kembhavi SA, Qureshi S, Vora T, et al. Understanding the principles in management of Wilms’ tumour: can imaging assist in patient selection? Clin Radiol 2013; 68: 646-53.
16. Venkatramani R, Malogolowkin M, Davidson TB, May W, Sposto R, Mascarenhas L. A phase I study of vincristine, irinotecan, temozolomide and bevacizumab (vitb) in pediatric patients with relapsed solid tumors. PLoS One 2013; 8: e68416.
17. Ritchey ML, Shamberger RC, Haase G, Horwitz J, Bergemann T, Breslow NE. Surgical complications after primary nephrectomy for Wilms’ tumor: report from the National Wilms’ Tumor Study Group. J Am Coll Surg 2001; 192: 63-8.
18. Mavinkurve-Groothuis AM, van den Heuvel-Eibrink MM, Tytgat GA, et al. Treatment of relapsed Wilms tumour (WT) patients: experience with topotecan. A report from the SIOP Renal Tumour Study Group (RTSG). Pediatr Blood Cancer 2015; 62: 598-602.
19. Spreafico F, Bellani FF. Wilms’ tumor: past, present and (possibly) future. Expert Rev Anticancer Ther 2006; 6: 249-58.
20. Cunningham ME, Klug TD, Nuchtern JG, et al. Global Disparities in Wilms Tumor. J Surg Res 2020; 247: 34-51.
21. Lovvorn HN 3rd, Pierce J, Libes J, et al. Kenyan Wilms Tumor Consortium. Genetic and chromosomal alterations in Kenyan Wilms Tumor. Genes Chromosomes Cancer 2015; 54: 702-15.
22. Davidoff AM. Wilms’ tumor. Curr Opin Pediatr 2009; 21: 357-64.
23. Berger M, Fernandez-Pineda I, Cabello R, et al. The relationship between the site of metastases and outcome in children with stage IV Wilms tumor: data from 3 European pediatric cancer institutions. J Pediatr Hematol Oncol 2013; 35: 518e24.
24. Verschuur A, Van Tinteren H, Graf N, Bergeron C, Sandstedt B, Kraker J. Treatment of pulmonary metastases in children with stage IV nephroblastoma with risk-based use of pulmonary radiotherapy. J Clin Oncol 2012; 30: 3533-59.
25. Iaboni DSM, Chi YY, Kim Y, Dome JS, Fernandez CV. Outcome of Wilms tumor patients with bone metastasis enrolled on national Wilms tumor studies 1-5: a report from the children’s Oncology group. Pediatr Blood Canc 2019; 66: e27430.