Factors affecting the treatment outcomes of stage II to IV nephroblastoma in children with neoadjuvant chemotherapy
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Abstract
Evidence on prognostic determinants among Vietnamese children with Wilms tumor presenting with imaging-defined risk features remains limited despite internationally standardized use of neoadjuvant chemotherapy therefore we conducted a study to identify factors associated with outcomes in unilateral Wilms tumor treated with neoadjuvant chemotherapy followed by delayed nephrectomy. This was a prospective cohort of 64 children managed at Children Hospital 2 (Ho Chi Minh City) from April 2013 to June 2016 with follow-up through June 2019. Patients, met preoperative imaging risk criteria and received neoadjuvant chemotherapy and delayed nephrectomy. Event-free survival with a mean follow-up of 46.9 months was 92.2%. Criteria that would affect the treatment results were postoperative high histopathologic risk associated with greater likelihood of relapse or death versus low/intermediate risk (hazard ratio 17.3; p = 0.046) and poor chemotherapy response (stable or progressive disease) associated with higher risk than complete or partial response (hazard ratio 12.7; p = 0.01). While neoadjuvant chemotherapy achieves excellent disease control, prognosis is driven primarily by postoperative histopathologic risk grouping and preoperative chemotherapy response, supporting their integration into postoperative therapeutic decision-making.
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Keywords
Nephroblastoma, neoadjuvant chemotherapy, preoperative chemotherapy
References
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