Older age tied to poor survival among children with Wilms tumour

Children who have been diagnosed with Wilms tumour (WT) at an older age appear to have worse overall survival (OS), reveals a study.

“International trials have reported conflicting findings on whether the association between age and worse OS among children with WT is due to age as an independent prognostic factor or the observation of more advanced disease at older ages,” said the authors, who then sought to explore this relationship using a population-based registry analysis.

The Surveillance, Epidemiology, and End Results database was explored to identify all patients diagnosed with WT under 20 years of age. Multivariable Cox proportional hazards regression was used to examine the association between age and OS.

A total of 3,464 patients (54 percent female) had a diagnosis of WT between 1975 and 2016. Worse OS correlated with more advanced stage, larger primary tumour size, lymph node involvement, disease requiring radiotherapy, and omission of surgery (p<0.05).

Notably, more advanced stage, larger primary tumour size, and disease requiring radiotherapy also correlated with older age, while bilateral disease correlated with younger age (p<0.001). On average, each year of age resulted in a rise in hazard ratio (HR) of 1.07 (95 percent confidence interval [CI], 1.01‒1.12; p=0.018) independent of relevant covariates.

The increase in adjusted OS HR was most noticeable following the transitions in diagnosis age from 2 to 3 years (HR_{age 3–15 vs. 0–2}, 1.77, 95 percent CI, 1.11‒2.82; p=0.016) and from 15 to 16 years (HR_{age 16–19 vs. 3–15}, 2.58, 95 percent CI, 1.06 to 6.25; p=0.036).

“Although additional prospective studies are warranted to examine tumour biology and other potential correlates, more aggressive treatment of older children based on age, especially as they approach early adulthood, may be considered in the multidisciplinary management of WT,” the authors said.