Association of Systemic Inflammatory Markers and Clinical Outcomes Among Children With Wilms Tumor
Corresponding Author
Shannon N. Acker
Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
The Surgical Oncology Program at Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Division of Urology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorIoannis A. Ziogas
Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorNicholas Cost
The Surgical Oncology Program at Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Division of Urology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Research Outcomes in Children's Surgery, Center for Children's Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
Search for more papers by this authorEmily Cooper
Research Outcomes in Children's Surgery, Center for Children's Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
Search for more papers by this authorZishaan Farooqui
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
Search for more papers by this authorCaitlin R. Eason
Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorAlyssa E. Vaughn
Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorCatherine Dawson-Gore
Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorKatherine M. Somers
Division of Oncology, Cancer & Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
Search for more papers by this authorSandra Luna Fineman
Section of Pediatric Oncology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorSarah Vangi
Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorMichela M. Carter
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
Search for more papers by this authorStephen J. Hartman
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
Search for more papers by this authorMeera Kotagal
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
Search for more papers by this authorCorresponding Author
Shannon N. Acker
Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
The Surgical Oncology Program at Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Division of Urology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorIoannis A. Ziogas
Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorNicholas Cost
The Surgical Oncology Program at Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Division of Urology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Research Outcomes in Children's Surgery, Center for Children's Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
Search for more papers by this authorEmily Cooper
Research Outcomes in Children's Surgery, Center for Children's Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
Search for more papers by this authorZishaan Farooqui
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
Search for more papers by this authorCaitlin R. Eason
Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorAlyssa E. Vaughn
Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorCatherine Dawson-Gore
Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorKatherine M. Somers
Division of Oncology, Cancer & Blood Disease Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
Search for more papers by this authorSandra Luna Fineman
Section of Pediatric Oncology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorSarah Vangi
Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
Search for more papers by this authorMichela M. Carter
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
Search for more papers by this authorStephen J. Hartman
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
Search for more papers by this authorMeera Kotagal
Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
Search for more papers by this authorABSTRACT
Background
Elevated pre-treatment inflammatory markers predict disease progression and overall survival among adults with renal tumors, including elevated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR). We hypothesized that elevated inflammatory markers at diagnosis predict higher disease stages and adverse outcomes for children with Wilms tumor.
Procedure
We performed a retrospective review of children with Wilms tumor who underwent surgical resection at two centers from 2002 to 2022. Differences in patient demographics and laboratory parameters were compared between the overall disease stages. Differences in tumor characteristics and patient outcomes were compared by elevated LMR, NLR, and PLR at diagnosis using Wilcoxon tests and chi-squared or Fisher's exact tests. For LMR, NLR, and PLR, optimal cut points for predicting disease ≥ stage 3 were determined using the Youden index for optimization.
Results
Data were collected from 235 children with Wilms tumor. The median age was 39.8 months and 50.2% of patients were female; 40 had stage 1 disease, 50 had stage 2 disease, 61 had stage 3 disease, 54 had stage 4 disease, and 26 had stage 5 disease. Preoperative inflammatory markers varied with the overall stage. LMR, NLR, and PLR increased as the stage increased. After controlling for age, final histology, and any abnormal genetic marker, elevated NLR, PLR, and LMR at presentation were each associated with significantly higher odds of stage 3 or 4 disease.
Conclusion
Elevation in serum inflammatory markers at diagnosis among children with Wilms tumors is associated with higher disease stage, cancer recurrence, and unfavorable histology.
Conflicts of Interest
The authors declare no conflicts of interest.
Supporting Information
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