Center for Cancer and Blood Disorders, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado.
Department of Radiation Oncology, University of Colorado School of Medicine, Aurora, Colorado.
Int J Radiat Oncol Biol Phys. 2018 Jun 1;101(2):453-461. doi: 10.1016/j.ijrobp.2018.01.110. Epub 2018 Feb 6.
To determine, using the National Cancer Database (NCDB), the impact of the surgery to radiation therapy interval (SRI) on survival in contemporary patients with Wilms tumor (WT).
The NCDB was queried for patients aged ≤25 years diagnosed from 2004 to 2013 with unilateral WT who underwent definitive surgery and radiation therapy. The SRI was calculated for each patient. A stratified analysis was performed based on presence of metastasis using logistic regression to calculate risk factors for prolonged SRI, with a focus on the recommended SRI according to recent Children's Oncology Group trials (by day 14) and National Wilms Tumor Study-5 (by day 9). Cox regression was performed to assess the association of SRI with overall survival.
A total of 1488 patients were included; 32.1% had metastasis at diagnosis. Among both metastatic and nonmetastatic groups, older patients were more likely to have prolonged SRI. For those without metastasis, SRI > 14 days was associated with increased risk of mortality (hazard ratio 2.13, P = .013). Analyzing SRI as a continuous variable also demonstrated an increased risk of death with longer SRI (hazard ratio 1.04 per day, P = .006) in this group. In contrast, among patients with metastasis, no significant association between SRI and mortality was found.
Early initiation of radiation therapy remains a critical component of multimodal treatment for patients with nonmetastatic WT. For nonmetastatic patients, SRI ≤ 14 days correlates with improved overall survival. However, no such association was noted for patients with metastases. These results may inform the development of future WT trials.
利用国家癌症数据库（NCDB）确定手术与放疗间隔（SRI）对当代 Wilms 瘤（WT）患者生存的影响。
从 2004 年至 2013 年，NCDB 对年龄≤25 岁、诊断为单侧 WT、接受确定性手术和放疗的患者进行了查询。计算了每位患者的 SRI。采用逻辑回归对存在转移的患者进行分层分析，以计算 SRI 延长的危险因素，重点关注根据最近的儿童肿瘤学组试验（第 14 天）和国家 Wilms 瘤研究-5（第 9 天）推荐的 SRI。采用 Cox 回归评估 SRI 与总生存的关系。
共纳入 1488 例患者，32.1%患者在诊断时存在转移。在转移性和非转移性组中，年龄较大的患者更有可能出现 SRI 延长。对于无转移的患者，SRI>14 天与死亡风险增加相关（风险比 2.13，P=0.013）。对 SRI 作为连续变量进行分析，也显示在该组中，SRI 延长与死亡风险增加相关（每天增加 1.04 倍，P=0.006）。相比之下，在转移性患者中，SRI 与死亡率之间无显著相关性。
对于非转移性 WT 患者，早期开始放疗仍然是多模式治疗的关键组成部分。对于非转移性患者，SRI≤14 天与总生存改善相关。然而，对于转移性患者则没有观察到这种相关性。这些结果可能为未来 WT 试验的开展提供信息。
