Comparative Analysis Of The Efficacy And Toxicity Between WT-2016 And NWTS-5chemotherapy In The Treatment Of Children With Wilms Tumor

Objective: To analyze the efficacy and toxicity of WT-2016 regimen by comparing the clinical effects between WT-2016 and NWTS-5chemotherapy regimens in the treatment of children with Wlims tumor.Methods: The clinical data of children with wilms tumor who were initially treated in Children’s Hospital of Chongqing Medical University from January 2014 to February 2019 was reviewed.the staging and classification was according to the NWTS standards;The chemotherapy regimen is choose from WT-2016 or NWTS-5 program;EFS and OS curves were estimated using the Kaplan-Meier method and compared using the log-rank test.The relapse rate,myelosuppression rate,sepsis rate,and the incidence of pulmonary infection or abnormal liver function were compared using chi-square test.Results: Of 116 children,40 patients were treated with chemotherapy regimen WT-2016,76 patients were treated with chemotherapy regimen NWTS-5.The follow-up duration were 10.8months(range,5.8 to 26.6mouth)and 39.2 month(range,4.5 to 66.5 month),respectively.Two-year overall survival estimate was 86.6% and 88.1%(P =0.64),respectively;two-year event-free survival estimate was 80.0% and 74.9%(P =0.90),respectively.Overall relapse rate was 7.5% and 25.0%(P=0.02),respectively;the grade IV myelosuppression rate was 42.5% and 19.7%(P=0.01),respectively.Moreover,the relapse rate in children with low-stage tumors was 7.7% and 16.2%(P =0.77),respectively,that with high-stage tumors was 7.4% and 33.3%(P =0.03),respectively;the relapse rate in children with non-anaplastic tumors was 9.1% and 22.6%(P =0.18),respectively,that with anaplastic tumors was 0% and 35.7%(P =0.12),respectively.The grade IV myelosuppression rate in children with low-stage tumors was 23.1% and 0%(P =0.01),respectively,that with high-stage tumors was 51.9% and 38.5%(P =0.28),respectively;the grade IV myelosuppression rate in children with non-anaplastic tumors was30.3% and 19.4%(P =0.35),respectively,that with anaplastic tumors was100% and 21.4%(P <0.01),respectively.In addition,there was no significant difference in incidence of sepsis,pulmonary infection and abnormal liver function.Conclusion: WT-2016 chemotherapy regimen is associated with significantly decreased relapse rate and increased incidence of myelosuppression in children with Wlims tumor.It is noteworthy that,when comparing by different stages and pathological types,only therelapse rate in children with high-stage tumors and the incidence of myelosuppression in children with low-stage or anaplastic tumors remained significant differences.There is no significant difference in 2-year survival rates,further clinical follow-up is needed todetermine whether WT-2016 chemotherapy regimen will improve the long term survival rates compared with NWTS-5 regimen.