Patterns of Care and Survival Comparison of Adult and Pediatric Wilms Tumor in the United States: A Study of the National Cancer Database

Abstract

Objective: To describe and compare the management of WT and oncologic outcomes by patient age using a large national database.

Methods: The National Cancer Database was queried for patients with WT diagnosis from 2004 to 2013. Patients were grouped by age and compared: pediatric (<16 years), young adults (16-35 years) and adult (>35 years). Overall survival (OS) was the primary endpoint. Factors associated with OS were determined using multivariate analysis.

Results: The majority of patients were pediatric (n = 2686), followed by young adult (n = 91), and adult (n = 35). Five-year OS was significantly better for children vs young adults or adults (93.1% vs 79.1% vs 78.9%, respectively; P <.001), as was 10-year OS (91.5% vs 52.4% vs 70%; P <.001). On multivariate analysis, OS was significantly better for children vs young adult (HR 3.62; 95% CI 2.25-5.8; P <.001), and adult (HR 3.38; 95% CI, 1.49-7.7; P <.004). Other variables associated with worse OS included bilateral disease (HR 2.06; P = .003), stage II disease (HR 2.92; P = .036), stage IV disease (HR 4.1; P = .004), and positive lymph nodes (HR 1.97-4.90; P = .018). Patients >15 years were less likely to undergo lymph node sampling (OR 0.19; P <.001), radiation therapy (OR 0.62; P = .03), or chemotherapy (OR 0.38; P <.001).

Conclusion: Adults with WT experience worse 5- and 10-year OS when compared to children with WT. Survival decrements in adults are likely multifactorial including modifiable factors such as inadequate staging due to low rates of lymph node sampling, and underutilization of adjuvant therapies.