Efficacy Analysis of Multidisciplinary Treatment for Wilm’s Tumor in Single Center

Efficacy Analysis of Multidisciplinary Treatment for Wilm’s Tumor in Single Center | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Efficacy Analysis of Multidisciplinary Treatment for Wilm’s Tumor in Single Center Bing Yan, Fengming Ji, Chengchuang Wu, Ye Li, Haoyu Tang, Zhigang Yao, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1185550/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To analyze the efficacy of multidisciplinary treatment (MDT) for Wilm’s tumor (WT) in Kunming Children’s Hospital, and investigate the risk factors affecting the prognosis of WT. Method: The clinic-pathological data were collected and analyzed in patients with unilateral WT treated in Kunming Children's Hospital from January 2017 to July 2021. Research objects were selected according to inclusion criteria and exclusion criteria. The risk factors and independent risk factors that affect the prognosis of patients with WT were determined by Kaplan-Meier survival analysis and Cox proportional hazards model, respectively. Outcome: A total of 68 children were included in this study, and the 5-year overall survival (OS) rate was 92.65%. Kaplan-Meier survival analysis results showed that ethnicity (P=0.020), the tumor volume of resection (P=0.001), histological type (P<0.001), and postoperative recurrence (P<0.001) were the factors affecting the prognosis of children with WT. The results of the Cox proportional hazards model showed that only the histological type (P=0.028) was the independent risk factor for the prognosis of WT. Conclusion: The efficacy of MDT for WT was satisfying. The histological type has important predictive value for the prognosis of WT, and the patient with unfavorable histology has a poor prognosis. Wilms’ tumor Multidisciplinary treatment Histological type Prognosis， Follow-up Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Background Wilms’ tumor (WT) is the most common kidney tumor in childhood, accounting for 90% of childhood kidney tumors [1] . WT is a malignant tumor of embryonic origin whose histology and gene transcription are closely related to the early kidney [2] . Mutations in WT1 [3] , TP53 [4] , WTX [5] , and MYCN [6] genes are associated with the pathogenesis of WT. WT was named after Carl Max Wilhelm Wilms, who first reported pathological character on the disease in 1899 [7] . WT mainly occurs within 5 years after birth. The incidence of sex（female vs. male）and position （left vs. right） are similar，and the incidence of bilateral WT is about 5%-9% [8, 9] . Most children attend to hospital with an asymptomatic abdominal mass, and some children may present abdominal pain, hematuria, or high blood pressure [10] . Two major international collaborative organizations for renal tumors, Children’s Oncology Group (COG) and the International Society of Pediatric Oncology ( SIOP) have different strategies on WT treatment. The main controversy is whether preoperative chemotherapy is needed before nephrectomy: COG recommends surgery as a priority to accurately assess tumor stage, biology, and histology, followed by adjuvant theraphy. Conversely, SIOP insists that preoperative chemotherapy can reduce tumor volume, surgical difficulty, and the risk of tumor rupture [11-13] . Multidisciplinary treatment (MDT) is currently recognized as a good tumor treatment model [14] . In this study, clinico-pathological and prognostic data of single-center and relevant literature were analyzed respectively, aiming to summarize and share WT MDT experience for clinicians' reference. Research Data And Methods 1. Research data 1.1 Patients All clinico-pathological data of WT children who were diagnosed with postoperative pathology in Kunming Children's Hospital from January 2017 to July 2021 were collected. Study cases were screened according to inclusion and exclusion criteria, and the included cases were followed up. Inclusion criteria: (1)Preoperative chemotherapy, operation and, postoperative chemotherapy were all completed in Kunming Children's Hospital. (2) All patients underwent radical resection and were confirmed as WT by postoperative pathology. Exclusion criteria: (1) Bilateral WT in patients. (2)Relative data were incomplete. (3) Lost to follow-up. 1.2 Treatment and follow-up All patient protocols were decided by a multidisciplinary team. The team was consisted of experienced urologist、oncologist、radiologist、anesthetist、pathologist、 nephrologue and ICU doctors. The children were followed up by telephone and outpatient，and the follow-up deadline was September 1, 2021. 1.3 Research methods The optimal cut-off values of tumor volume of onset (TVO) and tumor volume of resection (TVR) were determined by receiver operating characteristic (ROC) curves. To determine the factors influencing the prognosis of WT, the variables, including gender, age, blood type, whether national, tumor location, WT - 1 mutation, the tumor volume of onset (TVO), the tumor volume of resection (TVR), preoperative chemotherapy, postoperative radiotherapy, histological type, lymph node metastasis and vascular metastasis, and recurrence, were analyzed. The Kaplan-Meier survival analysis and Cox proportional hazards model were carried for univariate and multivariate analysis to determine the risk factor and independent risk factor. There were significant differences when p-values are < 0.05, using two-tailed tests. Statistical analyses were performed using SPSS ver. 20.0. Results 3.1 The general information A total of 68 children were included in this study, including 33 males and 35 females. The median age of the patients was 36 months (6-264 months), and 22 of them were younger than 24 months. A total of 32 patients received preoperative chemotherapy, and all of them received radical nephrectomy with tumor volume ranging from 622.62 ml to 526.90 ml. Postoperative chemotherapy was performed in 1-9 courses according to tumor stage and histological type. Postoperative recurrence occurred in 9 children, with a recurrence rate of 13.24%. By September 1, 2021, a total of 6 children died, and the 5-year overall survival (OS) rate was 92.65% (Fig. 1 ). 3.2 ROC results TVO was calculated according to abdominal enhanced CT measurement results before any treatment: TVO= length x width x height (ml). TVR was calculated based on the ruler measurement results after intraoperative tumor resection: TVR= length x width x height (mL). The results showed the area under the TVO-ROC curve was 0.039, so TVO has no predictive value for the prognosis in this study (Fig. 2 ). The area under the TVR-ROC curve was 0.890, P = 0.002,with a 95% CI of 0.760 ~ 1000 (Fig. 3 ). The maximal Youden Index (sensitivity+ specificity–1) showed the optimal cut-off value of TVR was 946.45ml, and the sensitivity and specificity were 83.30% and 87.10%, respectively. 3.3 Prognostic factors for WT In this study, 68 WT patients had a median survival time of 36.5 months and a 5-year OS rate of 92.65%. Kaplan-Meier survival analysis revealed that ethnicity (P=0.020) (Fig. 4 ), TVR (P=0.001) (Fig. 5 ), histological type (P༜0.001) (Fig. 6 ), and postoperative recurrence (P༜0.001) (Fig. 7 ) were risk factors for children with WT (Table 1 ). After multivariate analysis, the results indicated that only the histological type (P=0.028) was independent predictor for OS (Table 2 ). Table 1 Result of univariate analysis Variable No. 5-Year OS (%) P Variable No. 5-Year OS (%) P Sex Male 33 93.93 0.438 Tumor volume of resection ༜946.45 ml 56 96.43 0.001 Female 35 91.43 ≥ 946.45 ml 12 75.00 Age ༜2 years 22 90.90 0.467 Preoperative chemotherapy Yes 32 96.88 0.457 ≥ 2 years 46 93.48 No 36 88.89 Blood type A 29 93.10 0.134 Postoperative radiotherapy Yes 22 95.45 0.659 B 11 100.00 No 46 91.30 AB 6 100.00 Histological type FH 63 100.00 ༜0.001 O 22 86.36 UFH 5 0.00 Ethnicity Han 43 97.67 0.020 Vascular invasion Yes 7 100.00 0.462 Minority 25 84.00 No 68 92.65 Tumor location Left 37 97.30 0.056 Lymph node metastasis Yes 17 100 0.527 Right 31 87.10 No 51 90.20 WT-1 mutation Yes 56 91.07 0.161 Recurrence Yes 9 55.56 ༜0.001 No 12 100.00 No 59 98.31 Stage Ⅱ 12 83.33 0.278 Ⅲ 50 96.00 Ⅳ 6 83.33 Abbreviate: FH, Favorable histology; UFH, Unfavorable histology Table 2 Result of multivariate analysis Risk Factor P HR (95% CI) Race (Han vs. Minority) 0.224 0.258 (0.029ཞ2.296) Tumor volume of resection (༜946.45 ml vs. ≥ 946.45 ml) 0.212 0.203 (0.017ཞ2.479) Histological classification (FH vs. UFH) 0.028 0.035 (0.002ཞ0.698) Recurrence (Yes vs. No) 0.565 0.404 (0.018ཞ8.864) Discussion WT is one of the most common solid tumors in children. In recent years, with the development of tumor MDT models, such as surgery, chemotherapy, radiotherapy, and immunotherapy, the 5-year OS rate of WT has increased dramatically from 25–90% [ 15 , 16 ] . The difference between the SIOP and COG strategy for WT is whether preoperative chemotherapy is performed. At present, there is a basic consensus that is preoperative chemotherapy has no significant effect on the WT prognosis [ 17 ] , In the results of this study, whether preoperative chemotherapy was not a risk factor affecting the OS as well (P=0.457). However, preoperative chemotherapy can reduce tumor volume, staging, complications, and postoperative treatment intensity [ 18 , 19 ] . Moreover, preoperative chemotherapy can thicken tumor capsules and reduce the tumor’s blood supply, effectively reducing the risk of tumor rupture during operation. The results of previous studies of SIOP have shown that the incidence of tumor rupture in patients without preoperative chemotherapy are about 25%, and patients who have received preoperative chemotherapy are about 5% [ 20 ] . However, the 4 to 6-week preoperative chemotherapy time increases the risk of tumor invasion and metastasis, chemotherapy drugs also cause necrosis, suppuration, hemorrhage, or fibrosis of tumor tissues and lymph nodes. It affects the surgeon’s judgment of intraoperative lymph node tissue, and tumor staging in the postoperative pathological examination, which does not reflect the true tumor and lymph node involvement [ 21 ] . Therefore, whether to perform preoperative chemotherapy and the protocol should be determined by the MDT team after a comprehensive evaluation. According to COP recommendations, preoperative chemotherapy should be performed for WT of the isolated kidney, bilateral WT, tumor invading adjacent organs, inferior vena cava tumor thrombus above the level of the hepatic vein, or unresectable WT. Secondly, Rutigliano et al. [ 22 ] also pointed out that for children with ruptured WT, preoperative chemotherapy is conducive to the limitation of the ruptured tissue and avoids further local metastasis. It is also helpful to reduce the chance of intraoperative tumor rupture and the area of local radiotherapy after the operation. Yunnan is the province with the largest concentration of ethnic minorities in China and has 25 ethnic minorities with a population of more than 4,000. It provides a natural advantage for studying public health issues among various ethnic groups. The socioeconomic status, demographic and physiological characteristics, lifestyle, environmental factors, and genetic susceptibility of diseases of different races and ethnic groups are diverse in the incidence of many chronic diseases [ 23 – 25 ] . In this study, the difference in prognosis between Han and ethnic minorities is a risk factor affecting the OS of WT. This finding provides a new perspective for the research of WT. The histological type of WT is divided into favorable histology (FH) and unfavorable histology (UFH). FH includes blastemal、stromal、epithelial and mixed, and the classification based on the ratio of the three tissue types, blastemal, stromal and epithelial, on the broadest section of the tumor [ 26 ] . About 7%-10% of the histological type are UFH type, also called anaplasia, whose typical characteristics are large and deep stained nuclei, and have atypical mitotic features [ 27 ] . UFN is a vital risk risk factor for WT [ 28 , 29 ] . In our study, histological type was the only independent risk factor of OS and the histological types of all 5 patients were UFN. UFH can be divided into focal anaplasia (FA) and diffuse anaplasia (DA). FA and DA also have significant differences in the prognosis of WT, and the 4-year EFS was 74.9% (95% CI: 59.9-85.0%) and 54.9% (95% CI: 46.2-62.7%), respectively [ 30 ] . Anaplasia in WT is extremely rare before two years old, and the incidence gradually increases after the age of 4, and the anaplasia rate of tumor tissues above stage III are also significantly higher than the stages I and II [ 31 ] . There is no correlation between preoperative chemotherapy and anaplasia [ 32 ] . Research by Maschietto et al. [ 18 ] found that tissue anamorphosis is related to mutations in the TP53 gene, and the 5-year event-free survival (EFS) rate of wild-type TP53 patients is 80%, while the 4-year EFS rate of mutant TP53 patients is only 44% [ 33 ] . In summary, the long-term survival rate of patients with WT is significantly improved with an MDT model. Therefore, all departments should work closely together to develop individualized treatment protocols, screen and closely follow-up high-risk patients to improve overall survival. Meanwhile reducing long-term complications also needs to be further improved. Declarations Ethics approval: This study has obtained the ethical permission form the Medical Ethics Committee of Kunming Children’s Hospital. Competing interest: The authors declare that they have no conflict of interest. Funding: This study did received the support from: Yunnan Province Clinical Research Center for Children’s Health and Disease Author’s contribution: FMJ collected, analyzed data, and drafted the original manuscript; CHW and YL collected data and participated in to amend the manuscript; HYT collected and analyzed data; ZGY analyzed data; BY and ZY designed present study and amended the manuscript. Data sharing statement: Data were available to FMJ and BY. References Stokes CL, Stokes WA, Kalapurakal JA, et al. Timing of Radiation Therapy in Pediatric Wilms Tumor: A Report From the National Cancer Database. Int J Radiat Oncol Biol Phys. 2018. 101(2): 453–461. Coorens T, Treger TD, Al-Saadi R, et al. Embryonal precursors of Wilms tumor. Science. 2019. 366(6470): 1247–1251. Petiti J, Rosso V, Lo Iacono M, et al. Prognostic significance of The Wilms' Tumor-1 (WT1) rs16754 polymorphism in acute myeloid leukemia. Leuk Res. 2018. 67: 6–11. Rakheja D, Khokhar S, Mitui M, Cost NG. Immunohistochemical expression of GLUT1 and its correlation with unfavorable histology and TP53 codon 72 polymorphism in Wilms tumors. Pediatr Dev Pathol. 2012. 15(4): 286–92. Camp ND, James RG, Dawson DW, et al. Wilms tumor gene on X chromosome (WTX) inhibits degradation of NRF2 protein through competitive binding to KEAP1 protein. J Biol Chem. 2012. 287(9): 6539–50. 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Maschietto M, Williams RD, Chagtai T, et al. TP53 mutational status is a potential marker for risk stratification in Wilms tumour with diffuse anaplasia. PLoS One. 2014. 9(10): e109924. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1185550","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":76276792,"identity":"0aa4a73e-2fd9-4de1-8e43-09afdaded4d3","order_by":0,"name":"Bing 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4","display":"","copyAsset":false,"role":"figure","size":187187,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival analysis curve of ethnicity\u003c/p\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"Fig.4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1185550/v1/2e55051685b25423611bef8a.jpg"},{"id":17323711,"identity":"8fdcff64-c351-42c7-a382-0b6118165655","added_by":"auto","created_at":"2022-01-14 15:16:07","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":186091,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival analysis curve of TVR\u003c/p\u003e","description":"","filename":"Fig.5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1185550/v1/f3e577f9fc85b01f0bdc23fa.jpg"},{"id":17323705,"identity":"7b121c08-1057-47ba-860b-e70eca2f497f","added_by":"auto","created_at":"2022-01-14 15:16:07","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":157044,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival analysis curve of histological type\u003c/p\u003e","description":"","filename":"Fig.6.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1185550/v1/cf4f7c3139138840112b9fe5.jpg"},{"id":17323710,"identity":"daf2e43a-2de3-4f8e-9a49-ef37d10805a3","added_by":"auto","created_at":"2022-01-14 15:16:07","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":163108,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan-Meier survival analysis curve of postoperative recurrence\u003c/p\u003e","description":"","filename":"Fig.7.jpg","url":"https://assets-eu.researchsquare.com/files/rs-1185550/v1/cae9b093ea3754225e6ba8cf.jpg"},{"id":18083860,"identity":"3ba0bc7b-5c31-493b-92f1-cff2c3a8fcd2","added_by":"auto","created_at":"2022-02-10 04:59:16","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":586571,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1185550/v1/1ed50e15-46e0-424b-acce-dc589aff81fc.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Efficacy Analysis of Multidisciplinary Treatment for Wilm’s Tumor in Single Center","fulltext":[{"header":"Background","content":"\u003cp\u003eWilms\u0026rsquo; tumor (WT) is the most common kidney tumor in childhood, accounting for 90% of childhood kidney tumors\u003csup\u003e[1]\u003c/sup\u003e. WT is a malignant tumor of embryonic origin whose histology and gene transcription are closely related to the early kidney\u003csup\u003e[2]\u003c/sup\u003e. Mutations in WT1\u003csup\u003e[3]\u003c/sup\u003e, TP53\u003csup\u003e[4]\u003c/sup\u003e, WTX\u003csup\u003e[5]\u003c/sup\u003e, and MYCN\u003csup\u003e[6]\u003c/sup\u003e genes are associated with the pathogenesis of WT. WT was named after Carl Max Wilhelm Wilms, who first reported pathological character on the disease in 1899\u003csup\u003e[7]\u003c/sup\u003e. WT mainly occurs within 5 years after birth. The incidence of sex（female vs. male）and position\u0026nbsp;（left vs. right）\u0026nbsp;are similar，and the incidence of bilateral WT is about 5%-9%\u003csup\u003e[8, 9]\u003c/sup\u003e. Most children attend to hospital with an asymptomatic abdominal mass, and some children may present abdominal pain, hematuria, or high blood pressure\u003csup\u003e[10]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eTwo major international collaborative organizations for renal tumors, Children\u0026rsquo;s Oncology Group (COG) and the International Society of Pediatric Oncology ( SIOP) have different strategies on WT treatment. The main controversy is whether preoperative chemotherapy is needed before nephrectomy: COG recommends surgery as a priority to accurately assess tumor stage, biology, and histology, followed by adjuvant theraphy. Conversely, SIOP insists that preoperative chemotherapy can reduce tumor volume, surgical difficulty, and the risk of tumor rupture\u003csup\u003e[11-13]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMultidisciplinary treatment (MDT) is currently recognized as a good tumor treatment model\u003csup\u003e[14]\u003c/sup\u003e. In this study, clinico-pathological and prognostic data of single-center and relevant literature were analyzed respectively, aiming to summarize and share WT MDT experience for clinicians\u0026apos; reference.\u003c/p\u003e"},{"header":"Research Data And Methods","content":"\u003ch2\u003e1. Research data\u003c/h2\u003e\n\u003ch2\u003e1.1 Patients\u003c/h2\u003e\n\u003cp\u003eAll clinico-pathological data of WT children who were diagnosed with postoperative pathology in Kunming Children\u0026apos;s Hospital from January 2017 to July 2021 were collected. Study cases were screened according to inclusion and exclusion criteria, and the included cases were followed up. Inclusion criteria: (1)Preoperative chemotherapy, operation and, postoperative chemotherapy were all completed in Kunming Children\u0026apos;s Hospital. (2) All patients underwent radical resection and were confirmed as WT by postoperative pathology. Exclusion criteria: (1) Bilateral WT in patients. (2)Relative data were incomplete. (3) Lost to follow-up.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003e1.2 Treatment and follow-up\u003c/h2\u003e\n\u003cp\u003eAll patient protocols were decided by a multidisciplinary team. The team was consisted of experienced urologist、oncologist、radiologist、anesthetist、pathologist、\u003ca href=\"javascript%3A;\"\u003enephrologue\u003c/a\u003e and ICU doctors. The children were followed up by telephone and outpatient，and the follow-up deadline was September 1, 2021.\u003c/p\u003e\n\u003ch2\u003e1.3 Research methods\u003c/h2\u003e\n\u003cp\u003eThe optimal cut-off values of tumor volume of onset (TVO) and tumor volume of resection (TVR) were determined by receiver operating characteristic (ROC) curves. To determine the factors influencing the prognosis of WT, the variables, including gender, age, blood type, whether national, tumor location, WT - 1 mutation, the tumor volume of onset (TVO), the tumor volume of resection (TVR), preoperative chemotherapy, postoperative radiotherapy, histological type, lymph node metastasis and vascular metastasis, and recurrence, were analyzed. The Kaplan-Meier survival analysis and Cox proportional hazards model were carried for univariate and multivariate analysis to determine the risk factor and independent risk factor. There were significant differences when p-values are \u0026lt; 0.05, using two-tailed tests. Statistical analyses were performed using SPSS ver. 20.0.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv class=\"Section2\" id=\"Sec7\"\u003e\n \u003ch2\u003e3.1 The general information\u003c/h2\u003e\n \u003cp\u003eA total of 68 children were included in this study, including 33 males and 35 females. The median age of the patients was 36 months (6-264 months), and 22 of them were younger than 24 months. A total of 32 patients received preoperative chemotherapy, and all of them received radical nephrectomy with tumor volume ranging from 622.62 ml to 526.90 ml. Postoperative chemotherapy was performed in 1-9 courses according to tumor stage and histological type. Postoperative recurrence occurred in 9 children, with a recurrence rate of 13.24%. By September 1, 2021, a total of 6 children died, and the 5-year overall survival (OS) rate was 92.65% (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec8\"\u003e\n \u003ch2\u003e3.2 ROC results\u003c/h2\u003e\n \u003cp\u003eTVO was calculated according to abdominal enhanced CT measurement results before any treatment: TVO= length x width x height (ml). TVR was calculated based on the ruler measurement results after intraoperative tumor resection: TVR= length x width x height (mL). The results showed the area under the TVO-ROC curve was 0.039, so TVO has no predictive value for the prognosis in this study (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). The area under the TVR-ROC curve was 0.890, P = 0.002,with a 95% CI of 0.760 ~ 1000 (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). The maximal Youden Index (sensitivity+ specificity\u0026ndash;1) showed the optimal cut-off value of TVR was 946.45ml, and the sensitivity and specificity were 83.30% and 87.10%, respectively.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv class=\"Section2\" id=\"Sec9\"\u003e\n \u003ch2\u003e3.3 Prognostic factors for WT\u003c/h2\u003e\n \u003cp\u003eIn this study, 68 WT patients had a median survival time of 36.5 months and a 5-year OS rate of 92.65%. Kaplan-Meier survival analysis revealed that ethnicity (P=0.020) (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e), TVR (P=0.001) (Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e), histological type (P༜0.001) (Fig. \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e), and postoperative recurrence (P༜0.001) (Fig. \u003cspan class=\"InternalRef\"\u003e7\u003c/span\u003e) were risk factors for children with WT (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). After multivariate analysis, the results indicated that only the histological type (P=0.028) was independent predictor for OS (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable border=\"1\" id=\"Tab1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResult of univariate analysis\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e5-Year OS (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eNo.\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e5-Year OS (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e93.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.438\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTumor volume of resection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e༜946.45 ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge; 946.45 ml\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e༜2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e90.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.467\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePreoperative chemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.457\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge; 2 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e93.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88.89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBlood type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e93.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"4\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePostoperative radiotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.659\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91.30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistological type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e༜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e86.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUFH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.00\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEthnicity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eVascular invasion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.462\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMinority\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e84.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92.65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTumor location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLeft\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e97.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymph node metastasis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.527\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e87.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWT-1 mutation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e91.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRecurrence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"2\"\u003e\n \u003cp\u003e༜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e100.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98.31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅡ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" rowspan=\"3\"\u003e\n \u003cp\u003e0.278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅢ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e96.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eⅣ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e83.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"10\"\u003eAbbreviate: FH, Favorable histology; UFH, Unfavorable histology\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003c/p\u003e\n \u003ctable border=\"1\" id=\"Tab2\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResult of multivariate analysis\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRisk Factor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eHR (95% CI)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRace (Han vs. Minority)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.224\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.258 (0.029ཞ2.296)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTumor volume of resection (༜946.45 ml vs. \u0026ge; 946.45 ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.212\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.203 (0.017ཞ2.479)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistological classification (FH vs. UFH)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.035 (0.002ཞ0.698)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRecurrence (Yes vs. No)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.565\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.404 (0.018ཞ8.864)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eWT is one of the most common solid tumors in children. In recent years, with the development of tumor MDT models, such as surgery, chemotherapy, radiotherapy, and immunotherapy, the 5-year OS rate of WT has increased dramatically from 25\u0026ndash;90%\u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e. The difference between the SIOP and COG strategy for WT is whether preoperative chemotherapy is performed. At present, there is a basic consensus that is preoperative chemotherapy has no significant effect on the WT prognosis\u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/sup\u003e, In the results of this study, whether preoperative chemotherapy was not a risk factor affecting the OS as well (P=0.457). However, preoperative chemotherapy can reduce tumor volume, staging, complications, and postoperative treatment intensity\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/sup\u003e. Moreover, preoperative chemotherapy can thicken tumor capsules and reduce the tumor\u0026rsquo;s blood supply, effectively reducing the risk of tumor rupture during operation. The results of previous studies of SIOP have shown that the incidence of tumor rupture in patients without preoperative chemotherapy are about 25%, and patients who have received preoperative chemotherapy are about 5%\u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. However, the 4 to 6-week preoperative chemotherapy time increases the risk of tumor invasion and metastasis, chemotherapy drugs also cause necrosis, suppuration, hemorrhage, or fibrosis of tumor tissues and lymph nodes. It affects the surgeon\u0026rsquo;s judgment of intraoperative lymph node tissue, and tumor staging in the postoperative pathological examination, which does not reflect the true tumor and lymph node involvement\u003csup\u003e[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Therefore, whether to perform preoperative chemotherapy and the protocol should be determined by the MDT team after a comprehensive evaluation. According to COP recommendations, preoperative chemotherapy should be performed for WT of the isolated kidney, bilateral WT, tumor invading adjacent organs, inferior vena cava tumor thrombus above the level of the hepatic vein, or unresectable WT. Secondly, Rutigliano et al.\u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e also pointed out that for children with ruptured WT, preoperative chemotherapy is conducive to the limitation of the ruptured tissue and avoids further local metastasis. It is also helpful to reduce the chance of intraoperative tumor rupture and the area of local radiotherapy after the operation.\u003c/p\u003e \u003cp\u003eYunnan is the province with the largest concentration of ethnic minorities in China and has 25 ethnic minorities with a population of more than 4,000. It provides a natural advantage for studying public health issues among various ethnic groups. The socioeconomic status, demographic and physiological characteristics, lifestyle, environmental factors, and genetic susceptibility of diseases of different races and ethnic groups are diverse in the incidence of many chronic diseases\u003csup\u003e[\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/sup\u003e. In this study, the difference in prognosis between Han and ethnic minorities is a risk factor affecting the OS of WT. This finding provides a new perspective for the research of WT.\u003c/p\u003e \u003cp\u003eThe histological type of WT is divided into favorable histology (FH) and unfavorable histology (UFH). FH includes blastemal、stromal、epithelial and mixed, and the classification based on the ratio of the three tissue types, blastemal, stromal and epithelial, on the broadest section of the tumor\u003csup\u003e[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e. About 7%-10% of the histological type are UFH type, also called anaplasia, whose typical characteristics are large and deep stained nuclei, and have atypical mitotic features\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]\u003c/sup\u003e. UFN is a vital risk risk factor for WT\u003csup\u003e[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e. In our study, histological type was the only independent risk factor of OS and the histological types of all 5 patients were UFN.\u003c/p\u003e \u003cp\u003eUFH can be divided into focal anaplasia (FA) and diffuse anaplasia (DA). FA and DA also have significant differences in the prognosis of WT, and the 4-year EFS was 74.9% (95% CI: 59.9-85.0%) and 54.9% (95% CI: 46.2-62.7%), respectively\u003csup\u003e[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]\u003c/sup\u003e. Anaplasia in WT is extremely rare before two years old, and the incidence gradually increases after the age of 4, and the anaplasia rate of tumor tissues above stage III are also significantly higher than the stages I and II\u003csup\u003e[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]\u003c/sup\u003e. There is no correlation between preoperative chemotherapy and anaplasia\u003csup\u003e[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]\u003c/sup\u003e. Research by Maschietto et al.\u003csup\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e found that tissue anamorphosis is related to mutations in the TP53 gene, and the 5-year event-free survival (EFS) rate of wild-type TP53 patients is 80%, while the 4-year EFS rate of mutant TP53 patients is only 44%\u003csup\u003e[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn summary, the long-term survival rate of patients with WT is significantly improved with an MDT model. Therefore, all departments should work closely together to develop individualized treatment protocols, screen and closely follow-up high-risk patients to improve overall survival. Meanwhile reducing long-term complications also needs to be further improved.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThis study has obtained the ethical permission form the Medical Ethics Committee of Kunming Children\u0026rsquo;s Hospital.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eCompeting interest:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003ch2 skip=\"true\"\u003eFunding:\u0026nbsp;\u003c/h2\u003e\n\u003cp skip=\"true\"\u003eThis study did received the support from: Yunnan Province Clinical Research Center for Children\u0026rsquo;s Health and Disease\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAuthor\u0026rsquo;s contribution:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eFMJ collected, analyzed data, and drafted the original manuscript; CHW and YL collected data and participated in to amend the manuscript; HYT collected and analyzed data; ZGY analyzed data; BY and ZY designed present study and amended the manuscript. \u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eData sharing statement:\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eData were available to FMJ and BY.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eStokes CL, Stokes WA, Kalapurakal JA, et al. Timing of Radiation Therapy in Pediatric Wilms Tumor: A Report From the National Cancer Database. Int J Radiat Oncol Biol Phys. 2018. 101(2): 453\u0026ndash;461.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCoorens T, Treger TD, Al-Saadi R, et al. Embryonal precursors of Wilms tumor. Science. 2019. 366(6470): 1247\u0026ndash;1251.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePetiti J, Rosso V, Lo Iacono M, et al. Prognostic significance of The Wilms' Tumor-1 (WT1) rs16754 polymorphism in acute myeloid leukemia. Leuk Res. 2018. 67: 6\u0026ndash;11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRakheja D, Khokhar S, Mitui M, Cost NG. Immunohistochemical expression of GLUT1 and its correlation with unfavorable histology and TP53 codon 72 polymorphism in Wilms tumors. Pediatr Dev Pathol. 2012. 15(4): 286\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCamp ND, James RG, Dawson DW, et al. 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Int J Cancer. 2020. 147(12): 3313\u0026ndash;3327.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBreslow N, Olshan A, Beckwith JB, Green DM. Epidemiology of Wilms tumor. Med Pediatr Oncol. 1993. 21(3): 172\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBahoush G, Saeedi E. Outcome of Children with Wilms' Tumor in Developing Countries. J Med Life. 2020. 13(4): 484\u0026ndash;489.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLopes RI, Lorenzo A. Recent advances in the management of Wilms' tumor. F1000Res. 2017. 6: 670.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNakamura L, Ritchey M. Current management of wilms' tumor. Curr Urol Rep. 2010. 11(1): 58\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVujanić GM, D'Hooghe E, Graf N, et al. Prognostic significance of histopathological response to preoperative chemotherapy in unilateral Wilms' tumor: An analysis of 899 patients treated on the SIOP WT 2001 protocol in the UK-CCLG and GPOH studies. Int J Cancer. 2021. 149(6): 1332\u0026ndash;1340.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePillay B, Wootten AC, Crowe H, et al. The impact of multidisciplinary team meetings on patient assessment, management and outcomes in oncology settings: A systematic review of the literature. Cancer Treat Rev. 2016. 42: 56\u0026ndash;72.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCox S, B\u0026uuml;y\u0026uuml;k\u0026uuml;nal C, Millar A. Surgery for the complex Wilms tumour. Pediatr Surg Int. 2020. 36(2): 113\u0026ndash;127.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang Y, Song HC, Yang YF, Sun N, Zhang WP, Huang CR. Preoperative Wilms tumor rupture in children. Int Urol Nephrol. 2021. 53(4): 619\u0026ndash;625.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJunjun J, Xuelian Z, Dhruba K, Haiyang X, Lin Z, Shusen Z. Efficacy of Preoperative Chemotherapy in Treatment of Children With Wilms' Tumor: A Meta-Analysis. Iran J Pediatr. 2015. 25(2): e366.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGroenendijk A, Spreafico F, de Krijger RR, et al. Prognostic Factors for Wilms Tumor Recurrence: A Review of the Literature. Cancers (Basel). 2021. 13(13).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePowis M, Messahel B, Hobson R, Gornall P, Walker J, Pritchard-Jones K. Surgical complications after immediate nephrectomy versus preoperative chemotherapy in non-metastatic Wilms' tumour: findings from the 1991-2001 United Kingdom Children's Cancer Study Group UKW3 Trial. 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Treatment of children with stages II to IV anaplastic Wilms' tumor: a report from the National Wilms' Tumor Study Group. J Clin Oncol. 1994. 12(10): 2126\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDome JS, Perlman EJ, Graf N. Risk stratification for wilms tumor: current approach and future directions. Am Soc Clin Oncol Educ Book. 2014: 215\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVujanić GM, Gessler M, Ooms A, et al. The UMBRELLA SIOP-RTSG 2016 Wilms tumour pathology and molecular biology protocol. Nat Rev Urol. 2018. 15(11): 693\u0026ndash;701.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDome JS, Cotton CA, Perlman EJ, et al. Treatment of anaplastic histology Wilms' tumor: results from the fifth National Wilms' Tumor Study. J Clin Oncol. 2006. 24(15): 2352\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVujanić GM, Harms D, Sandstedt B, Weirich A, de Kraker J, Delemarre JF. New definitions of focal and diffuse anaplasia in Wilms tumor: the International Society of Paediatric Oncology (SIOP) experience. Med Pediatr Oncol. 1999. 32(5): 317\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpreafico F, Fernandez CV, Brok J, et al. Wilms tumour. Nat Rev Dis Primers. 2021. 7(1): 75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaschietto M, Williams RD, Chagtai T, et al. TP53 mutational status is a potential marker for risk stratification in Wilms tumour with diffuse anaplasia. PLoS One. 2014. 9(10): e109924.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Wilms’ tumor, Multidisciplinary treatment, Histological type, Prognosis， Follow-up","lastPublishedDoi":"10.21203/rs.3.rs-1185550/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1185550/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eTo analyze the efficacy of multidisciplinary treatment (MDT) for Wilm’s tumor (WT) in Kunming Children’s Hospital, and investigate the risk factors affecting the prognosis of WT.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethod: \u003c/strong\u003eThe clinic-pathological data were collected and analyzed in patients with unilateral WT treated in Kunming Children's Hospital from January 2017 to July 2021. Research objects were selected according to inclusion criteria and exclusion criteria. The risk factors and independent risk factors that affect the prognosis of patients with WT were determined by Kaplan-Meier survival analysis and Cox proportional hazards model, respectively. \u003c/p\u003e\u003cp\u003e\u003cstrong\u003eOutcome:\u003c/strong\u003e A total of 68 children were included in this study, and the 5-year overall survival (OS) rate was 92.65%. Kaplan-Meier survival analysis results showed that ethnicity (P=0.020), the tumor volume of resection (P=0.001), histological type (P\u0026lt;0.001), and postoperative recurrence (P\u0026lt;0.001) were the factors affecting the prognosis of children with WT. The results of the Cox proportional hazards model showed that only the histological type (P=0.028) was the independent risk factor for the prognosis of WT.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The efficacy of MDT for WT was satisfying. The histological type has important predictive value for the prognosis of WT, and the patient with unfavorable histology has a poor prognosis.\u003c/p\u003e","manuscriptTitle":"Efficacy Analysis of Multidisciplinary Treatment for Wilm’s Tumor in Single Center","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-01-14 15:16:05","doi":"10.21203/rs.3.rs-1185550/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"71e28c71-f884-4879-b9b8-1f10bac34a91","owner":[],"postedDate":"January 14th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-02-10T04:59:12+00:00","versionOfRecord":[],"versionCreatedAt":"2022-01-14 15:16:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1185550","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1185550","identity":"rs-1185550","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}