Purpose: This study aims to compare the survival rates of pediatric patients with Wilms tumor (WT) presenting with intravascular thrombus (IVT) versus those without IVT.
Methods: Medical reports of patients with WT treated and followed up at our institution between June 2012 and June 2025 were retrospectively reviewed. Among these data, patients presented with IVT were identified. The initial levels of IVT were assessed and monitored throughout the treatment. All patients underwent a combination of surgical and oncological management, including neoadjuvant chemotherapy (AREN0534, NWTSG-5) where indicated. Survival analysis was performed utilizing the Kaplan-Meier method on SPSS software version 25.
Results: 51 patients with WT were treated during this period. The median age was 48 months (5-126 months). 43 patients had unilateral WT, 8 patients had bilateral WT. 7 patients (6 male, 1 female) with IVT were identified (13.7%). Tumor thrombus extension during initial evaluation were; level III (5), level IV (1), level V (1). Following neoadjuvant chemotherapy; thrombus level in patients with level III regressed to level II, while no regression was observed in 2 patients with cardiac thrombus. All patients with IVT underwent surgery after neoadjuvant chemotherapy. There were no significant difference in overall survival (OS) and event-free survival (EFS) for WT patients with and without IVT (5 year OS of 83.3% and 86.4%, respectively, p value: 0.823 and 5 year EFS of 83.3% and 82.3%, respectively, p value:0.811).
Conclusion: WT with IVT can achieve survival outcomes comparable to those without IVT, under multidisciplinary approach and experienced surgical teams.
Keywords: Wilms tumor, intravascular thrombus, survival
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