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Bilateral Wilms tumors (BWTs) that increase in size during neoadjuvant chemotherapy, especially in younger patients, are most often stromal-predominant, according to a study published online March 27 in the Journal of the National Cancer Institute.
Colton Duncan, from the Dana-Farber Cancer Institute/Boston Children’s Hospital, and colleagues conducted a retrospective, single-institution study to examine whether initial chemotherapy response is associated with tumor histology among patients with BWT who underwent surgery from January 2000 to March 2022. A total of 68 patients were eligible for the study.
The researchers found that the odds ratio for being stromal-predominant versus any other histological subtype was 19.5 for tumors that increased in size. Compared with all other histologic subtypes, patients with stromal-predominant tumors had the youngest age at diagnosis (mean, 18.8 months). For confirming stromal-predominant histology, the predictive value of a tumor growing, combined with patient age younger than 18 months, was 85.7 percent.
“Wilms tumor with unfavorable outcomes actually do generally respond well, at least initially, to the chemotherapy,” coauthor Andrew Davidoff, M.D., from St. Jude Children’s Research Hospital in Memphis, Tennessee, said in a statement. “Whereas, at the other end of the spectrum, we have this extremely favorable type, this stromal-predominant tumor, that has typically good outcomes despite not responding very well to the chemotherapy.”
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