Weight-for-Age Trajectories During SIOP-Based Treatment in Children With Unilateral Wilms Tumor: A 10-Year Real-World Cohort Study

Аннотация

Background

Nutritional and anthropometric changes during cancer treatment may reflect a complex interaction between disease burden, treatment toxicity, reduced intake, and changes in body composition. However, longitudinal weight trajectories during Wilms tumor treatment remain insufficiently characterized. This study evaluated changes in weight-for-age percentile during treatment and explored their relationships with clinical characteristics and survival outcomes in children with unilateral Wilms tumor.

Methods

This retrospective single-center cohort included 59 children with unilateral Wilms tumor treated according to SIOP-based principles between 2010 and 2020. Pre- and post-chemotherapy weight-for-age percentiles were compared using the Wilcoxon signed-rank test. Changes across percentile thresholds were assessed using exact McNemar tests. Clinical subgroup comparisons were performed using Mann–Whitney U or Kruskal–Wallis tests. Overall survival (OS) and disease-free survival (DFS) were estimated using Kaplan–Meier analysis, with exploratory univariable Cox regression.

Results

The median age at diagnosis was 3.24 years (IQR, 1.87–4.38). Median weight-for-age percentile decreased from 53.2 (IQR, 22.6–78.7) before chemotherapy to 25.9 (IQR, 9.9–46.2) after chemotherapy, corresponding to a median within-patient change of −16.0 percentile points (IQR, −32.7 to −3.5; p<0.001). Overall, 45/59 patients (76.3%) experienced a decline. The proportion below the 25th percentile increased from 28.8% to 47.5% (exact McNemar p=0.013). The magnitude of percentile decline did not differ significantly according to sex, age group, stage, risk group, radiotherapy exposure, treatment response, relapse, or vital status. Five-year OS was 93.5% among patients with a post-treatment percentile ≥25 and 82.1% among those <25 (log-rank p=0.193). Corresponding 5-year DFS rates were 87.1% and 75.0%, respectively (p=0.249).

Conclusions

Children with unilateral Wilms tumor demonstrated a substantial downward shift in recorded weight-for-age percentile during treatment. This change was observed across clinical subgroups and was not independently associated with survival in this cohort. Longitudinal anthropometric monitoring may provide useful supportive-care information, although prospective studies incorporating body composition and multidimensional nutritional assessment are required.