Age is not a prognostic factor in children with Wilms tumor beyond stage I in Africa.
BACKGROUND
Patients under age 4 with stage I favorable histology (FH) Wilms tumor have a reported survival advantage. Among children above 10 years, a poorer prognosis has been associated with a higher prevalence of diffuse anaplasia.


PURPOSE
To determine if, in our practice, patients with Wilms tumors >8 years of age (stage II-V) have a poorer prognosis than those aged <8 years or <4 years.


PROCEDURE
Case-control study of 19 patients >8 years with Wilms tumor stages II-V who were identified from a cohort of 192 new patients (2002-2012). For each patient two controls were chosen matched for stage and histology, one 0-3 years and one 4-7 years. Neo-adjuvant chemotherapy was offered to all, combined with intensive supportive care. Postoperative treatment was determined by local stage and histology. OS and EFS at 5 years for the different age groups were compared.


RESULTS
Each age group contained 19 patients, of whom 6 had stage II tumors, 3 stage III, 8 stage IV, and 2 stage V. Histology was intermediate risk (IR) in 17 and high risk (HR) in 2. OS at 5 years was 80.8% and EFS was 79.2% for the whole group. No significant difference in outcome could be shown between age groups. Loss to follow up was 6/57 (11%).


CONCLUSIONS
The survival advantage of young age (<4 years) associated with stage I FH could not be demonstrated in higher stages. Age had no significant impact on prognosis although a trend to better outcome was seen in children <4 years.
['Aronson|D C|DC|', 'Hadley|G P|GP|']
D000367:Age Factors D000971:Antineoplastic Combined Chemotherapy Protocols D016022:Case-Control Studies D002648:Child D002675:Child, Preschool D003131:Combined Modality Therapy D018572:Disease-Free Survival D005260:Female D006801:Humans D007223:Infant D053208:Kaplan-Meier Estimate D007680:Kidney Neoplasms D008297:Male D020360:Neoadjuvant Therapy D009367:Neoplasm Staging D009392:Nephrectomy D011379:Prognosis D012189:Retrospective Studies D013019:South Africa D016896:Treatment Outcome D009396:Wilms Tumor
age Wilms tumor survival nephroblastomatosis