To identify factors impacting overall survival (OS) in children, adolescents, and young adults with HRRTs.
The National Cancer Database was queried for patients ≤30 years-old diagnosed with AWT, CCSK, or RTK between 2004-2013. Demographic, clinical, and overall survival (OS) data were abstracted. OS between groups was compared with a Kaplan-Meier curve. Univariate and multivariate survival analyses were performed.
A total of 349 patients were identified meeting criteria; 133 (38.1%) AWT, 120 (34.4%) CCSK and 96 (27.5%) RTK. Patients with RTK were less likely to undergo surgery than those with AWT or CCSK (77.1% vs. 94% vs. 99%, p<0.001) and less likely to receive chemotherapy (84.4% vs. 96.2% vs. 95%, p=0.013) or radiation (52.1% vs. 81.2% vs. 86.7%, p<0.001). Estimated 5yr OS was 76.1% (95% CI 67.9-84.4) for AWT, 92.7% (95% CI 87.4-97.9) for CCSK and 33.5% (95% CI 23.1-43.9) for RTK (p<0.001). On multivariate analysis, AWT (HR 3.372, p=0.032) and RTK histology (HR 12.595, p<0.001) were significantly associated with worse OS, while receiving radiation (HR 0.43, p=0.006) was associated with improved OS. LN positivity, margin status, and undergoing surgery were not. Analyzing the HRRTs individually, for AWT, undergoing surgery was associated with OS (HR 0.308, p=0.031). For RTK, factors associated with OS included undergoing surgery (HR 0.209, p=0.007) and radiation (HR 0.411, p=0.008).
Within the HRRTs, RTK is associated with worse outcomes than either AWT or CCSK. Receiving radiation is significantly associated with improved outcomes and surgery is important for those with AWT and RTK.
Urology. 2018 Aug 01 [Epub ahead of print]
Majdee Islam, Amanda F Saltzman, Arya Amini, Alonso Carrasco, Nicholas G Cost
University of Colorado, Department of Surgery, Division of Urology; Children's Hospital Colorado, Aurora, CO., University of Colorado, Department of Radiation Oncology, Aurora, CO., University of Colorado, Department of Surgery, Division of Urology; Children's Hospital Colorado, Aurora, CO. Electronic address: .